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Baleeta K, Muhwezi A, Tumwesigye N, Kintu BN, Riese S, Byonanebye D, Mbonye M, Mwehire D, Iriso R, Ayebazibwe B, Bailey L, Lopez D, McGough L, Etukoit M, Nantamu D, Nakitende L, Tibengana B, Wasswa J. Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in east Central Uganda: a cross-sectional study. BMC Health Serv Res 2023; 23:127. [PMID: 36750840 PMCID: PMC9906920 DOI: 10.1186/s12913-023-09114-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) and the Uganda Ministry of Health recommend differentiated service delivery models (DSDMs) as patient-centered antiretroviral therapy (ART) mechanisms for people living with HIV/AIDS (PLHIV) with undetectable viral loads. We studied patient satisfaction with ART services, and its associated factors amongst PLHIV enrolled in DSDMs in Uganda. METHODS This cross-sectional study involved a random sample of PLHIV accessing DSDM-related ART at nine facilities in East Central Uganda. Eligible patients were adult PLHIV (≥18 years), on ART, and enrolled for at least 12 months in one of three DSDMs: Community Client-Led ART Delivery (CCLAD), Community Drug Distribution Points (CDDP), or Fast-Track Drug Refill (FTDR). We collected data from June to July 2019. A validated tool measured satisfaction. General Estimating Equations with modified Poisson regression and exchangeable correlation structures accounted for clustering at health facilities and identified DSDM-related satisfaction factors. RESULTS Of 842 participants enrolled, 530 (63.5%) accessed HIV care through CDDP, 166 (20.1%) through CCLAD, and 146 (16.3%) through FTDR; 541 (64.2%) were satisfied with DSDM services: 78.7% in CDDP, 42.8% in CCLAD, and 36.3% in FTDR. The delivery and treatment factors positively associated with satisfaction included: being enrolled on CDDP [adjusted prevalence ratio (aPR) = 1.51, 95% CI:1.47-1.56] or FTDR [aPR = 1.47, 95% CI:1.26-1.71] relative to CCLAD and being enrolled in a DSDM for more than 3 years [aPR = 1.28, 95% CI:1.11-1.48]. Poor ART adherence [aPR = 0.33, 95% CI:0.19-0.56] and having a baseline WHO HIV stage of 3 or 4 [aPR = 0.36, 95% CI:0.20-0.64] relative to stages 1 and 2 were negatively associated. Among socioeconomic factors, having lower transport costs (< $1.35) per clinic visit [aPR = 1.34, 95% CI:1.17-1.53], being employed [aPR = 1.61, 95% CI:1.38-1.87], and being single [aPR = 1.10, 95% CI:1.08-1.13] were positively associated with satisfaction; drinking alcohol at least once a week [aPR = 0.77, 95% CI:0.63-0.93] was negatively associated with patient satisfaction. CONCLUSIONS Results showed that 64.2% of patients were satisfied with DSDM services. HIV service delivery and treatment factors (DSDM type, time in DSDM, WHO stage, ART adherence), plus social factors (employment and marital status, transport costs, alcohol consumption), were associated with patient satisfaction. DSDM implementers should tailor services to address these factors to improve patient satisfaction.
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Affiliation(s)
| | | | | | | | - Sara Riese
- University Research Co., LLC, Jinja, Uganda
| | - Dathan Byonanebye
- grid.11194.3c0000 0004 0620 0548College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | | | - Lauren Bailey
- grid.420285.90000 0001 1955 0561United States Agency for International Development, Washington, DC USA
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Luwangula AK, McGough L, Tetui M, Wamani H, Ssennono M, Agabiirwe CN, Michaud-Létourneau I, Tumwesigye N, Baleeta K, Rwegyema T, Muhwezi A. Improving Iron and Folic Acid Supplementation Among Pregnant Women: An Implementation Science Approach in East-Central Uganda. Glob Health Sci Pract 2022; 10:GHSP-D-21-00426. [PMID: 36951283 PMCID: PMC9771459 DOI: 10.9745/ghsp-d-21-00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/08/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION To address maternal iron-deficiency anemia and low uptake of iron and folic acid supplementation (IFAS) among antenatal care (ANC) clinic attendees in East-Central Uganda, the Anemia Implementation Science Initiative embedded enhanced quality improvement (QI) activities into an integrated health project utilizing QI methodologies. METHODS To address 2 bottlenecks of stock-outs and inadequate health education for pregnant women during ANC, an enhanced QI intervention was implemented from July 2019 to September 2020 in 2 districts. We conducted a mixed-methods effectiveness quasi-experimental study to assess whether the intervention increased the availability of IFAS in the intervention districts. We used longitudinal facility-level data from 2 treatment districts and 1 comparison district for the quantitative results. Difference-in-difference estimation was used to measure the impact of the intervention on IFAS health education and IFA availability at the health facility. We used logistic regression modeling to control for factors associated with IFAS uptake and potential differences in baseline values. Researchers conducted exit interviews with ANC clients and in-depth interviews with providers and district managers for greater insights into the implementation process. RESULTS The intervention increased the probability, at a statistically significant level, of pregnant women both receiving IFAS and receiving health education on IFAS during ANC. According to inter-viewees, the intervention approach improved stakeholder engagement and buy-in, which brought about change at all levels of the health system. DISCUSSION The intervention successfully addressed the 2 main bottlenecks to availability of IFAS for pregnant women attending ANC-inadequate provision of IFAS education and a weak drug quantification process. Even without additional funds to purchase commodities, this approach improved district capacity to advocate for and manage IFAS commodities. It could also be used to strengthen overall ANC quality.
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Affiliation(s)
| | | | - Moses Tetui
- School of Pharmacy, University of Waterloo, Kitchener, Canada; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Makerere University, Kampala, Uganda
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Besada D, Goga A, Daviaud E, Rohde S, Chinkonde JR, Villeneuve S, Clarysse G, Raphaely N, Okokwu S, Tumwesigye N, Daries N, Doherty T. Roles played by community cadres to support retention in PMTCT Option B+ in four African countries: a qualitative rapid appraisal. BMJ Open 2018; 8:e020754. [PMID: 29567853 PMCID: PMC5875612 DOI: 10.1136/bmjopen-2017-020754] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To explore the roles of community cadres in improving access to and retention in care for PMTCT (prevent mother-to-child transmission of HIV) services in the context of PMTCT Option B+ treatment scale-up in high burden low-income and lower-middle income countries. DESIGN/METHODS Qualitative rapid appraisal study design using semistructured in-depth interviews and focus group discussions (FGDs) between 8 June and 31 July 2015. SETTING AND PARTICIPANTS Interviews were conducted in the offices of Ministry of Health Staff, Implementing partners, district offices and health facility sites across four low-income and lower-middle income countries: Cote D'Ivoire, Democratic Republic of Congo (DRC), Malawi and Uganda. A range of individual interviews and FGDs with key stakeholders including Ministry of Health employees, Implementation partners, district management teams, facility-based health workers and community cadres. A total number of 18, 28, 31 and 83 individual interviews were conducted in Malawi, Cote d'Ivoire, DRC and Uganda, respectively. A total number of 15, 9, 10 and 16 mixed gender FGDs were undertaken in Malawi, Cote d'Ivoire, DRC and Uganda, respectively. RESULTS Community cadres either operated solely in the community, worked from health centres or in combination and their mandates were PMTCT-specific or included general HIV support and other health issues. Community cadres included volunteers, those supported by implementing partners or employed directly by the Ministry of Health. Their complimentary roles along the continuum of HIV care and treatment include demand creation, household mapping of pregnant and lactating women, linkage to care, infant follow-up and adherence and retention support. CONCLUSIONS Community cadres provide an integral link between communities and health facilities, supporting overstretched health workers in HIV client support and follow-up. However, their role in health systems is neither standardised nor systematic and there is an urgent need to invest in the standardisation of and support to community cadres to maximise potential health impacts.
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Affiliation(s)
- Donela Besada
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ameena Goga
- Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Emmanuelle Daviaud
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sarah Rohde
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Susie Villeneuve
- Regional Health, UNICEF West and Central African Office, Dakar, Senegal
| | - Guy Clarysse
- Regional Health, UNICEF West and Central African Office, Dakar, Senegal
| | - Nika Raphaely
- Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Steve Okokwu
- Child Survival and Development, UNICEF, Kampala, Uganda
| | - Nathan Tumwesigye
- Child Survival and Development, UNICEF, Kampala, Uganda
- USAID's Regional Health Integration to Enhance Services in East Central Uganda (USAID RHITES-EC) Project, University Research Co., LLC, Kampala, Uganda
| | - Nathalie Daries
- HIV /AIDS and Adolescent Section, UNICEF, Abidjan, Côte d'Ivoire
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Nabukeera-Barungi N, Elyanu P, Asire B, Katureebe C, Lukabwe I, Namusoke E, Musinguzi J, Atuyambe L, Tumwesigye N. Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect Dis 2015; 15:520. [PMID: 26573923 PMCID: PMC4647509 DOI: 10.1186/s12879-015-1265-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/05/2015] [Indexed: 11/25/2022] Open
Abstract
Background Adolescents have gained increased attention because they are the only age group where HIV related mortality is going up. We set out to describe the level and factors associated with adherence to antiretroviral therapy (ART) as well as the 1 year retention in care among adolescents in 10 representative districts in Uganda. In addition, we explored the barriers and facilitators of adherence to ART among adolescents. Methods The study involved 30 health facilities from 10 representative districts in Uganda. We employed both qualitative and quantitative data collection methods in convergent design. The former involved Focus group discussions with adolescents living with HIV, Key informant interviews with various stakeholders and in depth interviews with adolescents. The quantitative involved using retrospective records review to extract the last recorded adherence level from all adolescents who were active in HIV care. Factors associated with adherence were extracted from the ART cards. For the 1 year retention in care, we searched the hospital records of all adolescents in the 30 facilities who had started ART 1 year before the study to find out how many were still in care. Results Out of 1824 adolescents who were active on ART, 90.4 % (N = 1588) had ≥95 % adherence recorded on their ART cards at their last clinic visit. Only location in rural health facilities was independently associated with poor adherence to ART (P = 0.008, OR 2.64 [1.28 5.43]). Of the 156 adolescents who started ART, 90 % (N = 141) were still active in care 1 year later. Stigma, discrimination and disclosure issues were the most outstanding of all barriers to adherence. Other barriers included poverty, fatigue, side effects, pill burden, depression among others. Facilitators of adherence mainly included peer support groups, counseling, supportive health care workers, short waiting time and provision of food and transport. Conclusion Adherence to ART was good among adolescents. Being in rural areas was associated with poor adherence to ART and 1 year retention in care was very good among adolescents who were newly started on ART. Stigma and disclosure issues continue to be the main barriers to adherence among adolescents.
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Affiliation(s)
- Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, P O Box 7062, Kampala, Uganda.
| | - Peter Elyanu
- AIDS Control Program, Ministry of Health, Kampala, Uganda.
| | - Barbara Asire
- AIDS Control Program, Ministry of Health, Kampala, Uganda.
| | | | - Ivan Lukabwe
- AIDS Control Program, Ministry of Health, Kampala, Uganda.
| | | | | | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Nathan Tumwesigye
- USAID SUSTAIN Project, University Research Co., LLC, Kampala, Uganda.
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Arrivé E, Kyabayinze DJ, Marquis B, Tumwesigye N, Kieffer MP, Azondekon A, Wemin L, Fassinou P, Newell ML, Leroy V, Abrams EJ, Cotton M, Boulle A, Mbori-Ngacha D, Dabis F. Cohort profile: the paediatric antiretroviral treatment programmes in lower-income countries (KIDS-ART-LINC) collaboration. Int J Epidemiol 2007; 37:474-80. [PMID: 17998240 DOI: 10.1093/ije/dym216] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elise Arrivé
- Unité INSERM 593, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen, Bordeaux, France
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Rukundo H, Tumwesigye N, Wakwe VC. Screening for HIV I through the regional blood transfusion service in southwest Uganda: the Mbarara experience. Health Transit Rev 1996; 7 Suppl:101-4. [PMID: 10169638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Antibody screening for HIV has reduced transmission of AIDS by blood transfusion. Of the 12,768 units of blood donated to the Mbarara Regional Blood Bank between January 1992 and December 1994, 577 were found to be HIVI-positive using the ELISA technique. Percentage of positivity decreased from 5.4 in 1992 to 3.9 in 1994. Replacement donors had a higher positivity rate than volunteer donors. The females had more positives than the males. Distribution of the blood groups O and AB was similar between the Ugandan and English samples. There were differences in the blood groups A and B. The AB blood group which was only 4 per cent of the total had a higher percentage of HIV I positives. This preliminary finding should be confirmed by a more organized study.
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Affiliation(s)
- H Rukundo
- Department of Pathology, Mbarara University of Science and Technology, Uganda
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