Sustainability of the streamlined ART (START-ART) implementation intervention strategy among ART-eligible adult patients in HIV clinics in public health centers in Uganda: a mixed methods study

Abstract

Background: Despite increasing access to antiretroviral therapy (ART), the proportion of eligible patients initiated on treatment remains suboptimal. Only 64.6% of the people living with HIV (PLHIV) globally were initiated on ART by June 2019. The streamlined ART (START-ART) implementation study was based on the PRECEDE model, which suggests that "predisposing, enabling, and reinforcing" factors are needed to create behavior change. START-ART increased ART initiation within 2 weeks of eligibility by 42%. However, the gains from some implementation interventions erode over time. We evaluated facilitators and barriers to sustainability of this streamlined ART initiation in the year following the implementation period. Methods: We designed a mixed-methods explanatory sequential study to examine the sustainability of START-ART implementation. Quantitative component consisted of cross-sectional patient chart reviews of routinely collected data; qualitative component consisted of key informant interviews of health workers in START-ART facilities 2 years after conclusion of the implementation period. We analyzed data from 15 public health centers of Mbarara district, where the START-ART implementation was carried out.

Analogous computations in working memory input, output and motor gating: Electrophysiological and computational modeling evidence

“…However, it is likely that the decision process engaged during working memory gating diverges from that assumed by the standard DDM, and other models should be considered in future work (including those with time-varying drift rates and/or boundaries). Such models are difficult to estimate, but recent tools open the door for such investigations [ 87 ]. Moreover, future research could also employ a model-based approach where neural patterns are linked to cognitive mechanisms through computational models (e.g., [ 58 , 88 ]).…”

Perspectives of people living with HIV on barriers to timely ART initiation following referral for antiretroviral therapy: A qualitative study at an urban HIV clinic in Kampala, Uganda

“…A quick decision to initiate ART by the patient at this point cannot be over-emphasized and needs close attention by HIV testing service providers. Training and support of the providers of HIV testing services helps to empower them to support patients to cope with their diagnosis, decide to initiate ART and navigate the health system more easily [ 33 , 34 ].…”

Same Week: Feasibility of Rapid Antiretroviral Initiation in Brazil

“…Although this problem is multifactorial, it may be reinforced in our country at some units that do not routinely offer immediate HIV testing, and rather mischaracterize rapid testing by scheduling this test, leading to many losses of diagnostic opportunities. Unavailability of immediate or rapid collection of pre-ART admission exams, as the CD4 count test, in which the sample cannot be stored for more than 24 hours is another limitation to identify cases with advanced disease and new testing technologies, as CD4 Pima (Abbott) or another point of care technology, 13 could favor the immediate ART initiation, without the need to return on another day, which may favor linkage to care 14 and improve management of advanced disease cases.…”