TY - JOUR
T1 - The effects of an HIV project on HIV and non-HIV services at local government clinics in urban Kampala
AU - Matsubayashi, Toru
AU - Manabe, Yukari C.
AU - Etonu, Allan
AU - Kyegombe, Nambusi
AU - Muganzi, Alex
AU - Coutinho, Alex
AU - Peters, David H.
N1 - Funding Information:
The team is grateful for the support of the Bill and Melinda Gates Foundation for funding this work through the “Partnership for Building the Capacity of Makerere University to Improve Health Outcomes in Uganda”, a Collaborative Learning Initiative with Johns Hopkins University (Grant # 49504). We are grateful for the contributions of Johnson Kawule, Eric Yee, Laura Colman, Jill Hagey, all clinic staff at the KCC clinics and the patients who agreed to participate in our interviews. We also appreciate the help of the nurses-in-charge at the six KCC clinics who provided the monthly summary data used for the analysis. This article has been published as part of BMC International Health and Human Right Volume 11 Supplement 1, 2011: An innovative approach to building capacity at an African university to improve health outcomes. The full contents of the supplement are available online at http://www.biomedcentral.com/1472-698X/11?issue=S1.
Funding Information:
Mulago-Mbarara Teaching Hospitals’ Joint AIDS Program received funding from PEPFAR in May 2006 to support six urban and peri-urban primary health clinics run by the Kampala City Council (KCC) with the aim of providing sustainable antiretroviral treatment (ART) through a partnership with the Infectious Diseases Institute (IDI) and Makerere University College of Health Sciences (MakCHS). IDI has expertise in treatment, training and systems capacity building related to HIV/AIDS. Initially, IDI was providing care for many of the patients served by the KCC clinics. In order to decongest the Mulago Hospital Complex and, specifically, the IDI clinic, the IDI sought funding to support HIV/AIDS program development and care in the KCC clinics. IDI had no direct relationship with the KCC or the clinics prior to the project. Another key goal of the partnership was to enhance the responsiveness of IDI and MakCHS to the needs of the community and key organizations in civil society. This project represented an opportunity to provide more coherent care to the community, to build capacity and to forge meaningful relationships with an important local stakeholder. Reflecting this philosophy, the HIV/AIDS projects launched at the six KCC clinics attempted to work through, and improve, existing service delivery and administrative systems rather than set up parallel systems.
PY - 2011
Y1 - 2011
N2 - Background: HIV/AIDS is a major public health concern in Uganda. There is widespread consensus that weak health systems hamper the effective provision of HIV/AIDS services. In recent years, the ways in which HIV/AIDS-focused programs interact with the delivery of other health services is often discussed, but the evidence as to whether HIV/AIDS programs strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV/AIDS program on six government-run general clinics in Kampala. Methods. Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analyzed by using multilevel models to examine the effect of an HIV/AIDS program on health service delivery. We also conducted a cross-sectional survey utilizing patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care. Results: All HIV service indicators showed a positive change after the HIV program began. In particular, the number of HIV lab tests (10.58, 95% Confidence Interval (C.I.): 5.92, 15.23) and the number of pregnant women diagnosed with HIV tests (0.52, 95%C.I.: 0.15, 0.90) increased significantly after the introduction of the project. For non-HIV/AIDS health services, TB lab tests (1.19, 95%C.I.: 0.25, 2.14) and diagnoses (0.34, 95%C.I.: 0.05, 0.64) increased significantly. Noticeable increases in trends were identified in pediatric care, including immunization (52.43, 95%C.I.: 32.42, 74.43), malaria lab tests (1.21, 95%C.I.: 0.67, 1.75), malaria diagnoses (7.10, 95%C.I.: 0.73, 13.46), and skin disease diagnoses (4.92, 95%C.I.: 2.19, 7.65). Patients overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favorably about their experiences. Conclusions: This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV/AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV/AIDS services, but also on many other essential services. There was no evidence that the HIV program had any deleterious effects on health services offered at the clinics studied.
AB - Background: HIV/AIDS is a major public health concern in Uganda. There is widespread consensus that weak health systems hamper the effective provision of HIV/AIDS services. In recent years, the ways in which HIV/AIDS-focused programs interact with the delivery of other health services is often discussed, but the evidence as to whether HIV/AIDS programs strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV/AIDS program on six government-run general clinics in Kampala. Methods. Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analyzed by using multilevel models to examine the effect of an HIV/AIDS program on health service delivery. We also conducted a cross-sectional survey utilizing patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care. Results: All HIV service indicators showed a positive change after the HIV program began. In particular, the number of HIV lab tests (10.58, 95% Confidence Interval (C.I.): 5.92, 15.23) and the number of pregnant women diagnosed with HIV tests (0.52, 95%C.I.: 0.15, 0.90) increased significantly after the introduction of the project. For non-HIV/AIDS health services, TB lab tests (1.19, 95%C.I.: 0.25, 2.14) and diagnoses (0.34, 95%C.I.: 0.05, 0.64) increased significantly. Noticeable increases in trends were identified in pediatric care, including immunization (52.43, 95%C.I.: 32.42, 74.43), malaria lab tests (1.21, 95%C.I.: 0.67, 1.75), malaria diagnoses (7.10, 95%C.I.: 0.73, 13.46), and skin disease diagnoses (4.92, 95%C.I.: 2.19, 7.65). Patients overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favorably about their experiences. Conclusions: This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV/AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV/AIDS services, but also on many other essential services. There was no evidence that the HIV program had any deleterious effects on health services offered at the clinics studied.
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U2 - 10.1186/1472-698X-11-S1-S9
DO - 10.1186/1472-698X-11-S1-S9
M3 - Article
C2 - 21411009
AN - SCOPUS:79952514938
SN - 1471-2458
VL - 11
JO - BMC International Health and Human Rights
JF - BMC International Health and Human Rights
IS - SUPPL. 1
M1 - S9
ER -