Background
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.
Methods
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).
Results
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.
Conclusions
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)
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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