TY - JOUR
T1 - The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda
AU - Wilhelm, Jess Alan
AU - Qiu, Mary
AU - Paina, Ligia
AU - Colantuoni, Elizabeth
AU - Mukuru, Moses
AU - Ssengooba, Freddie
AU - Bennett, Sara
N1 - Funding Information:
This work was supported by Project SOAR (http://www.projsoar.org/) through Cooperative agreement AID-OAA-140060, made possible by the generous support of the American people through the United States President?s Emergency Plan for AIDS Relief (PEPFAR) and United States Agency for International Development (USAID). Sara Bennett is the principal recipient of the sub-agreement funding the activity on which this manuscript is based. Both Project SOAR and USAID were permitted to review and comment on the manuscript prior to submission but do not have control over the content or the decision to publish. The contents of this paper are the sole responsibility of the authors and do not necessarily reflect the views of PEPFAR, USAID, or the United States Government. We would like to acknowledge the input of Dr. Daniela Rodr?guez and Dr. Henry Zakumumpa in study design. Dr. Tim Roberton helped with the ODK data collection software. We also appreciate the efforts of survey enumerators and Ugandan health worker respondents, who provided the data collected through the facility survey. The Ugandan Ministry of Health Resource Center made the DHIS2 data set available for this analysis.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background Since 2004, the President’s Emergency Plan for AIDS Relief (PEPFAR) has played a large role in Uganda’s HIV/AIDS response. To better target resources to high burden regions and facilities, PEPFAR planned to withdraw from 29% of previously-supported health facilities in Uganda between 2015 and 2017. Methods We conducted a cross-sectional survey of 226 PEPFAR-supported health facilities in Uganda in mid-2017. The survey gathered information on availability, perceived quality, and access to HIV services before and after transition. We compare responses for facilities transitioned to those maintained on PEPFAR, accounting for survey design. We also extracted data from DHIS2 for the period October 2013–December 2017 on the number of HIV tests and counseling (HTC), number of patients on antiretroviral therapy (Current on ART), and retention on first-line ART (Retention) at 12 months. Using mixed effect models, we compare trends in service volume around the transition period. Results There were 206 facilities that reported transition and 20 that reported maintenance on PEPFAR. Some facilities reporting transition may have been in a gap between implementing partners. The median transition date was September 2016, nine months prior to the survey. Transition facilities were more likely to discontinue HIV outreach following transition (51.6% vs. 1.4%, p<0.001) and to report declines in HIV care access (43.5% vs. 3.1%, p<0.001) and quality (35.6% vs. 0%, p<0.001). However, transition facilities did not differ in their trends in HIV service volume relative to maintenance facilities. Conclusions Transition from PEPFAR resulted in facilities reporting worsening patient access and service quality for HIV care, but there is insufficient evidence to suggest negative impacts on volume of HIV services. Facility respondents’ perceptions about access and quality may be overly pessimistic, or they may signal forthcoming impacts. Unrelated to transition, declining retention on ART in Uganda is a cause for concern.
AB - Background Since 2004, the President’s Emergency Plan for AIDS Relief (PEPFAR) has played a large role in Uganda’s HIV/AIDS response. To better target resources to high burden regions and facilities, PEPFAR planned to withdraw from 29% of previously-supported health facilities in Uganda between 2015 and 2017. Methods We conducted a cross-sectional survey of 226 PEPFAR-supported health facilities in Uganda in mid-2017. The survey gathered information on availability, perceived quality, and access to HIV services before and after transition. We compare responses for facilities transitioned to those maintained on PEPFAR, accounting for survey design. We also extracted data from DHIS2 for the period October 2013–December 2017 on the number of HIV tests and counseling (HTC), number of patients on antiretroviral therapy (Current on ART), and retention on first-line ART (Retention) at 12 months. Using mixed effect models, we compare trends in service volume around the transition period. Results There were 206 facilities that reported transition and 20 that reported maintenance on PEPFAR. Some facilities reporting transition may have been in a gap between implementing partners. The median transition date was September 2016, nine months prior to the survey. Transition facilities were more likely to discontinue HIV outreach following transition (51.6% vs. 1.4%, p<0.001) and to report declines in HIV care access (43.5% vs. 3.1%, p<0.001) and quality (35.6% vs. 0%, p<0.001). However, transition facilities did not differ in their trends in HIV service volume relative to maintenance facilities. Conclusions Transition from PEPFAR resulted in facilities reporting worsening patient access and service quality for HIV care, but there is insufficient evidence to suggest negative impacts on volume of HIV services. Facility respondents’ perceptions about access and quality may be overly pessimistic, or they may signal forthcoming impacts. Unrelated to transition, declining retention on ART in Uganda is a cause for concern.
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U2 - 10.1371/journal.pone.0223426
DO - 10.1371/journal.pone.0223426
M3 - Article
C2 - 31596884
AN - SCOPUS:85073061372
VL - 14
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 10
M1 - e0223426
ER -