Identification of gaps for implementation science in the HIV prevention, care and treatment cascade; a qualitative study in 19 districts in Uganda

Abstract

BackgroundOver the last 20 years, countries in sub Saharan Africa have made significant strides in the implementation of programs for HIV prevention, care and treatment. Despite, the significant progress made, many targets set by the United Nations have not been met. There remains a large gap between the ideal and what has been achieved. There are several operational issues that may be responsible for this gap, and these need to be addressed in order to achieve the targets. Therefore, the aim of this study was to identify gaps in the HIV prevention, care and treatment cascade, in a large district based HIV implementation program. We aimed to identify gaps that are amenable for evaluation using implementation science, in order to improve the delivery of HIV programs in rural Uganda.MethodsWe conducted key informant (KI) interviews with 60 district health officers and managers of HIV/AIDS clinics and organizations and 32 focus group discussions with exit clients seeking care and treatment for HIV in the 19 districts. The data analysis process was guided using a framework approach. The recordings were transcribed verbatim. Transcripts were read back and forth and codes generated based on the framework.ResultsNine emerging themes that comprise the gaps were identified and these were referral mechanisms indicating several loop holes, low levels of integration of HIV/TB services, low uptake of services for PMTCT services by pregnant women, low coverage of services for most at risk populations (MARPs), poor HIV coordination structures in the districts, poor continuity in the delivery of pediatric HIV/AIDS services, limited community support for orphans and vulnerable (OVC’s), inadequate home based care services and HIV services and support for discordant couples. The themes indicate there are plenty of gaps that need to be covered and have been ignored by current programs.ConclusionsOur study has identified several gaps and suggested several interventions that should be tested before large scale implementation. The implementation of these programs should be adequately evaluated in order to provide field evidence of effectiveness and replicability in similar areas.

Mbarara University Research Training Initiative: a spin-off of the Medical Education Partnership Initiative in Uganda

“…The selected scientific areas were used as a training base to provide realistic training to address the existing gaps in the health priority areas. 15 …”

“… 9 – 14 In Uganda, gaps still exist in addressing research in these diseases of public health concern. 15 …”

Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers

“…Furthermore, community-based strategies, such as mobile testing, reach men, who are less likely than women to receive HIV testing at a health facility (42% men versus 58% women) [ 7 ]. Key informant interviews conducted recently among Ugandan public health stakeholders identified expansion of home-based HIV care services as a key measure to improve the delivery of HIV services [ 9 ]. As community-based strategies form part of Uganda’s national AIDS policy [ 2 ], their implementation must be carefully evaluated and described in the literature to inform future efforts.…”

Abandoned Children Admitted to the Nursery of Lome (Togo): Place of HIV/AIDS Infection

“…This could be explained by the systematic implementation of the Prevention of Mother-to-Child Transmission (PMTCT) program of HIV infection in the country since 2002. PMTCT is one of the priority interventions in the fight against pandemic [13][14][15][16], and would also justify the gradual reduction of the seroprevalence observed. Indeed, HIV prevalence among pregnant women (12- Overall, from 2001 to 2012, the number of new infections among children was declined by 52% worldwide [17].…”