Retrospective review of task-shifting community-based programs supporting ARV treatment and retention in Uganda

Kalibala, Sam; Okal, Jerry; Zieman, Brady; Jani, Nrupa; Vu, Lung; Birungi, Josephine; Okoboi, Stephen; Wangisi, Jonathan; Nabiryo, Christine; Okullu, Joanne Lyavala; Etukoit, Michael; Buzaalirwa, Lydia; Lubanga, Augustine; Kiyingi, Paul; Ikapule, Jonathan; Nakyeyune, Syson; Nakibinge, Stephen; Lutung, Penninah; Waliggo, Samuel; Nsamba, Joseph; Wamanga, Yashien; Kamya, Joseph; Sentongo, Robina; Yiga, Robert

doi:10.31899/hiv7.1001

Cited by 5 publications

(9 citation statements)

References 22 publications

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“…Additionally, a Ugandan mobile clinic found patients paid on average US$0.88 per month for ART refills, an average monthly net savings of US$10.70 per patient (Sethi et al, 2010). However, other cost analyses of mobile clinics in Uganda found a higher annual cost of providing services of US$404 per patient than facility-based models (US$257-332) (Kalibala et al, 2016).…”

Section: Community Art Distribution Points or Home-based Carementioning

confidence: 87%

“…Similarly, another community distribution model in the Democratic Republic of Congo had 89% retention in care (MSF, 2013). Mobile clinics in Uganda had lower retention in care (79.0% at 24 months), but still low loss to follow-up (6.2%) and transfer of care (7.4%) (Kalibala et al, 2016).…”

Section: Community Art Distribution Points or Home-based Carementioning

confidence: 93%

“…Nurses were less likely to identify virologic failure, and only slightly more than half of patients with virologic failure were referred for more specialized care (Uzodike, Ross & Harbor, 2015). A review of different task-shifting models of care in Uganda found similar percentages of patients were retained in care, lost to follow-up, or died after 24 months in care; but more patients reported good adherence at the minimally task shifted sites compared with maximally task shifted sites (70.7% versus 54.5%) (Kalibala et al, 2016).…”

Section: Decentralization or Task-shiftingmentioning

confidence: 99%

“…Mobile clinic ART refills in rural Uganda also resulted in decreased patient waiting time and increased patient and provider satisfaction (Sethi et al, 2010). However, a similar mobile clinic in Uganda resulted in a slightly lower satisfaction than in facility-based care, and there was still a considerable waiting time of 205 minutes before seeing a provider (Kalibala et al, 2016).…”

Section: Community Art Distribution Points or Home-based Carementioning

confidence: 99%

“…Task-shifting models in Uganda decreased costs per patient and national costs for HIV care with nurse-based care or pharmacist-based care, largely due to the decrease in full time equivalents (FTEs) of physician time (Kalibala et al, 2016;Babigumira et al, 2009). The opposite trend was true in South Africanurse-based care was more expensive than doctorbased care with an incremental cost effectiveness ratio of US$12,539 per patient with an undetectable viral load annually.…”

Section: Decentralization or Task-shiftingmentioning

confidence: 99%

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Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya

Hagey

Barr‐Walker

et al. 2018

AIDS Care

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Many gaps in care exist for provision of antiretroviral therapy (ART) in sub-Saharan Africa. Differentiated HIV care tailors provision of ART for patients based on their level of acuity, providing alternatives for where, by whom, and how often care occurs. We conducted a scoping review to assess novel differentiated care models for ART provision for stable HIV-infected adults in sub-Saharan Africa, and how these models can be used to guide differentiated care implementation in Kenya. A systematic search was conducted using PubMed, Embase, Web of Science, Popline, Cochrane Library, and African Index Medicus between January 2006 and January 2017. Grey literature searches and handsearching were also used. We included articles that quantitatively assessed the health, acceptability, and cost-effectiveness of differentiated HIV care. Two reviewers independently performed article screening, data extraction and determination of inclusion for analysis. We included 40 publications involving over 240,000 participants spanning nine countries in sub-Saharan Africa - 54.4% evaluated clinical outcomes, 23.5% evaluated acceptability outcomes, and 22.1% evaluated cost outcomes. Differentiated care models included: facility fast-track drug refills and appointment spacing, facility or community-based ART groups, community ART distribution points or home-based care, and task-shifting or decentralization of care. Studies suggest that these approaches had similar outcomes in viral load suppression and retention in care and were acceptable alternatives to standard HIV care. No clear results could be inferred for studies investigating task shifting and those reporting cost-effectiveness outcomes. Kenya has started to scale up differentiated care models, but further evaluation, quality improvement and research studies should be performed as different models are rolled out.

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Section: Community Art Distribution Points or Home-based Carementioning

confidence: 87%

Section: Community Art Distribution Points or Home-based Carementioning

confidence: 93%

Section: Decentralization or Task-shiftingmentioning

confidence: 99%

Section: Community Art Distribution Points or Home-based Carementioning

confidence: 99%

Section: Decentralization or Task-shiftingmentioning

confidence: 99%

See 3 more Smart Citations

Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya

Hagey

Barr‐Walker

et al. 2018

AIDS Care

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Does mhGAP training of primary health care providers improve the identification of child- and adolescent mental, neurological or substance use disorders? Results from a randomized controlled trial in Uganda

et al. 2018

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Background.Integrating child and adolescent mental health (CAMH) into primary health care (PHC) using the WHO mental health gap action program (mhGAP) is recommended for closing a mental health treatment gap in low- and middle-income countries, but PHC providers have limited ability to detect CAMH disorders. We aimed to evaluate the effect of PHC provider mhGAP training on CAMH disorder identification in Eastern Uganda.Methods.Thirty-six PHC clinics participated in a randomized controlled trial which compared the proportion of intervention (n = 18) to control (n = 18) clinics with a non-epilepsy CAMH diagnosis over 3 consecutive months following mhGAP-oriented CAMH training. Fisher's exact test and logistic regression based on intention to treat principles were applied. (clinicaltrials.gov registration NCT02552056).Results.Nearly two thirds (63.8%, 23/36) of all clinics identified and recorded at least one non-epilepsy CAMH diagnosis from 40 692 clinic visits of patients aged 1–18 recorded over 4 months. The proportion of clinics with a non-epilepsy CAMH diagnosis prior to training was 27.7% (10/36, similar between study arms). Training did not significantly improve intervention clinics’ non-epilepsy CAMH diagnosis (13/18, 72.2%) relative to the control (7/18, 38.9%) arm, p = 0.092. The odds of identifying and recording a non-epilepsy CAMH diagnosis were 2.5 times higher in the intervention than control arms at the end of 3 months of follow-up [adj.OR 2.48; 95% CI (1.31–4.68); p = 0.005].Conclusion.In this setting, mhGAP CAMH training of PHC providers increases PHC clinics’ identification and reporting of non-epilepsy CAMH cases but this increase did not reach statistical significance.

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Healthworker Preparedness for COVID-19 Management and Implementation Experiences: A Mixed Methods Study in Uganda’s Refugee-Hosting Districts

Seruwagi

Nakidde²,

Otieno³

et al. 2021

Preprint

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Background : The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts.Methods : A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including >370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p<0.05 for all statistical tests. Bloom's cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0%–100.0%), average (60.0%–79.0%) and low (≤59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed.Results: On average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCWs safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs also reported moderate control over their work environment, high level of support from supervisors (88%) and colleagues (93%). Conclusions: HCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.

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Retrospective review of task-shifting community-based programs supporting ARV treatment and retention in Uganda

Cited by 5 publications

References 22 publications

Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya

Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya

Does mhGAP training of primary health care providers improve the identification of child- and adolescent mental, neurological or substance use disorders? Results from a randomized controlled trial in Uganda

Healthworker Preparedness for COVID-19 Management and Implementation Experiences: A Mixed Methods Study in Uganda’s Refugee-Hosting Districts

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