Lessons for test and treat in an antiretroviral programme after decentralisation in Uganda: a retrospective analysis of outcomes in public healthcare facilities within the Lablite project

2019

Lessons from ART Decentralisation in Uganda

Sample size: 2100 publication 10 minutes Evidence: moderate

Author Information

Author(s): Kiwuwa-Muyingo S, Abongomera G, Mambule I, Senjovu D, Katabira E, Kityo C, Gibb D M, Ford D, Seeley J

Primary Institution: Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine

Hypothesis

How does decentralisation of antiretroviral therapy (ART) affect patient outcomes in Uganda?

Conclusion

Decentralisation of ART in Uganda improved access but retention varied significantly across facilities, with younger adults and pregnant women facing higher attrition rates.

Supporting Evidence

ART initiation increased at primary care facilities after decentralisation.
Retention rates varied significantly between hubs and spokes.
Older age was associated with lower risk of attrition.
Option B+ women had higher attrition rates compared to other groups.
Retention was better at hubs compared to spokes.
High rates of loss to follow-up were due to undocumented transfers.
Statistical analysis showed significant differences in retention rates.
Interventions are needed to support vulnerable groups in ART retention.

Takeaway

This study shows that when HIV treatment is moved closer to where people live, more people can start treatment, but some groups, like young adults and pregnant women, need extra help to stay on treatment.

Methodology

Routine data were retrospectively extracted from ART registers for all adults and children initiating ART at two primary care facilities and their corresponding district hospitals in Uganda.