Sunday, November 29, 2015

Population Level Usage of Health Services & HIV Testing & Care, Prior to Decentralization of Antiretroviral Therapy in Agago District in Rural Northern Uganda

Decentralization of ART services scaled up significantly with the country wide roll out of option B plus in Uganda. Little work has been undertaken to examine population level access to HIV care particularly in hard to reach areas in rural Africa. Most work on ART scale up has been done at health facility level which omits people not accessing healthcare in the community. This study describes health service usage, particularly HIV testing and care in 2/6 parishes of Lapono sub-county of northern Uganda, prior to introduction of ART services in Lira Kato Health Centre (a local lower-level health centre III), as part of ART decentralization.

Household and individual questionnaires were administered to household members (aged 15–59 years). Logit random effects models were used to test for differences in proportions (allowing for clustering within villages).

2124 adults from 1351 households were interviewed (755 [36 %] males, 1369 [64 %] females). 2051 (97 %) participants reported seeking care locally for fever, most on foot and over half at Lira Kato Health Centre. 574 (76 %) men and 1156 (84 %) women reported ever-testing for HIV (P < 0.001 for difference); 34/574 (6 %) men and 102/1156 (9 %) women reported testing positive (P = 0.04). 818/850 (96 %) women who had given birth in the last 5 years had attended antenatal care in their last pregnancy: 7 women were already diagnosed with HIV (3 on ART) and 790 (97 %) reported being tested for HIV (34 tested newly positive). 124/136 (91 %) HIV-positive adults were in HIV-care, 123/136 (90 %) were taking cotrimoxazole and 74/136 (54 %) were on ART. Of adults in HIV-care, most were seen at Kalongo hospital (n = 87), Patongo Health Centre (n = 7) or Lira Kato Health Centre (n = 23; no ART services). 58/87, 5/7 and 20/23 individuals walked to Kalongo hospital (56 km round-trip, District Health Office information), Patongo Health Centre (76 km round-trip, District Health Office information) and Lira Kato Health Centre (local) respectively. 8 HIV-infected children were reported; only 2 were diagnosed aged <24 months: 7/8 were in HIV-care including 3 on ART.

Higher proportions of women compared to men reported ever-testing for HIV and testing HIV-positive, similar to other surveys. HIV-infected men and women travelled considerable distances for ART services. Children appeared to be under-accessing testing and referral for treatment. Decentralization of ART services to a local health facility would decrease travel time and transport costs, making care and treatment more easily accessible.

Below:  Map of Lapono sub-county, dots indicate villages included in the survey (village 1 = pilot)

Full article at:

By:  G. Abongomera12*, S. Kiwuwa-Muyingo3, P. Revill4, L. Chiwaula5, T. Mabugu6, A. Phillips7, E. Katabira8, V. Musiime19, C. Gilks1011, A. Chan125, J. Hakim6, R. Colebunders2, C. Kityo1, D. M. Gibb13, J. Seeley143, D. Ford13 and for the Lablite Project Team
1Joint Clinical Research Centre, Kampala, Uganda
2University of Antwerp, Antwerp, Belgium
3Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
4University of York, York, UK
5Dignitas International, Zomba, Malawi
6University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
7University College London, London, UK
8Infectious Diseases Institute, Makerere University, Kampala, Uganda
9Makerere University College of Health Sciences, Kampala, Uganda
10Imperial College London, London, UK
11School of Population Health, University of Queensland, Brisbane, Australia
12Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
13Medical Research Council Clinical Trials Unit at UCL, London, UK
14London School of Hygiene and Tropical Medicine, London, UK

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