Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda

on behalf of the Lablite Project Team; George Abongomera; Levison Chiwaula; Paul Revill; Travor Mabugu; Edward Tumwesige; Misheck Nkhata; Fabian Cataldo; J van Oosterhout; Robert Colebunders; Adrienne K Chan; Cissy Kityo; Charles Gilks; James Hakim; Janet Seeley; Diana M Gibb; Deborah Ford

doi:10.1093/inthealth/ihx061

Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda

on behalf of the Lablite Project Team
, George Abongomera
, Levison Chiwaula
, Paul Revill
, Travor Mabugu
, Edward Tumwesige
, Misheck Nkhata
, Fabian Cataldo
, J van Oosterhout
, Robert Colebunders
, Adrienne K Chan
, Cissy Kityo
, Charles Gilks
, James Hakim
, Janet Seeley
, Diana M Gibb
, Deborah Ford

Research output: Contribution to journal › Article › peer-review

46 Downloads (Pure)

Abstract

Background
The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities (‘hubs’) and lower-level health facilities (‘spokes’) in Phalombe district, Malawi and in Kalungu district, Uganda.

Methods
We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46).

Results
In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1–Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1–Q2; p<0.001). In Uganda, 7% of patients mapped to Q1–Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1–Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30–120) in Malawi and 30 min (IQR 20–60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs.

Conclusions
Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.

Original language	English
Pages (from-to)	8-19
Number of pages	12
Journal	International Health
Volume	10
Issue number	1
DOIs	https://doi.org/10.1093/inthealth/ihx061 https://doi.org/10.1093/inthealth/ihx061
Publication status	Published - 10 Jan 2018
Externally published	Yes

Bibliographical note

Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press Royal Society of Tropical Medicine and Hygiene.

Access to Document

10.1093/inthealth/ihx061Licence: CC BY
10.1093/inthealth/ihx061

Full textFinal published version, 388 KBLicence: CC BY

Cite this

on behalf of the Lablite Project Team, Abongomera, G., Chiwaula, L., Revill, P., Mabugu, T., Tumwesige, E., Nkhata, M., Cataldo, F., Oosterhout, J. V., Colebunders, R., Chan, A. K., Kityo, C., Gilks, C., Hakim, J., Seeley, J., Gibb, D. M., & Ford, D. (2018). Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda. International Health, 10(1), 8-19. https://doi.org/10.1093/inthealth/ihx061, https://doi.org/10.1093/inthealth/ihx061

@article{f5a9436f04d44a09b373c747fd1884c2,

title = "Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda",

abstract = "Background The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ({\textquoteleft}hubs{\textquoteright}) and lower-level health facilities ({\textquoteleft}spokes{\textquoteright}) in Phalombe district, Malawi and in Kalungu district, Uganda. Methods We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). Results In Malawi, 47\% of patients mapped to the two lowest wealth quintiles (Q1–Q2); patients at spokes were poorer than at a hub (57\% vs 23\% in Q1–Q2; p<0.001). In Uganda, 7\% of patients mapped to Q1–Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15\% vs 4\% in Q1–Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30–120) in Malawi and 30 min (IQR 20–60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Conclusions Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.",

author = "\{on behalf of the Lablite Project Team\} and George Abongomera and Levison Chiwaula and Paul Revill and Travor Mabugu and Edward Tumwesige and Misheck Nkhata and Fabian Cataldo and Oosterhout, \{J van\} and Robert Colebunders and Chan, \{Adrienne K\} and Cissy Kityo and Charles Gilks and James Hakim and Janet Seeley and Gibb, \{Diana M\} and Deborah Ford",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2018. Published by Oxford University Press Royal Society of Tropical Medicine and Hygiene.",

year = "2018",

month = jan,

day = "10",

doi = "10.1093/inthealth/ihx061",

language = "English",

volume = "10",

pages = "8--19",

journal = "International Health",

issn = "1876-3413",

publisher = "Oxford University Press",

number = "1",

}

on behalf of the Lablite Project Team, Abongomera, G, Chiwaula, L, Revill, P, Mabugu, T, Tumwesige, E, Nkhata, M, Cataldo, F, Oosterhout, JV, Colebunders, R, Chan, AK, Kityo, C, Gilks, C, Hakim, J, Seeley, J, Gibb, DM & Ford, D 2018, 'Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda', International Health, vol. 10, no. 1, pp. 8-19. https://doi.org/10.1093/inthealth/ihx061, https://doi.org/10.1093/inthealth/ihx061

TY - JOUR

T1 - Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda

AU - on behalf of the Lablite Project Team

AU - Abongomera, George

AU - Chiwaula, Levison

AU - Revill, Paul

AU - Mabugu, Travor

AU - Tumwesige, Edward

AU - Nkhata, Misheck

AU - Cataldo, Fabian

AU - Oosterhout, J van

AU - Colebunders, Robert

AU - Chan, Adrienne K

AU - Kityo, Cissy

AU - Gilks, Charles

AU - Hakim, James

AU - Seeley, Janet

AU - Gibb, Diana M

AU - Ford, Deborah

PY - 2018/1/10

Y1 - 2018/1/10

N2 - Background The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities (‘hubs’) and lower-level health facilities (‘spokes’) in Phalombe district, Malawi and in Kalungu district, Uganda. Methods We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). Results In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1–Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1–Q2; p<0.001). In Uganda, 7% of patients mapped to Q1–Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1–Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30–120) in Malawi and 30 min (IQR 20–60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Conclusions Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.

AB - Background The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities (‘hubs’) and lower-level health facilities (‘spokes’) in Phalombe district, Malawi and in Kalungu district, Uganda. Methods We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). Results In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1–Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1–Q2; p<0.001). In Uganda, 7% of patients mapped to Q1–Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1–Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30–120) in Malawi and 30 min (IQR 20–60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Conclusions Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.

UR - https://www.scopus.com/pages/publications/85042605213

U2 - 10.1093/inthealth/ihx061

DO - 10.1093/inthealth/ihx061

M3 - Article

C2 - 29329396

SN - 1876-3413

VL - 10

SP - 8

EP - 19

JO - International Health

JF - International Health

IS - 1

ER -

Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this