Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda

Mary Qiu,Sara Bennett,Ligia Paina,Henry Zakumumpa,Caroline Mackenzie,Daniela C Rodríguez,Alexandra Searle,Ezinne Eze-Ajoku,Jess A Wilhelm,Freddie Ssengooba

doi:10.1186/s12992-021-00729-w

Mary Qiu, Sara Bennett + Show 8 more

Open Access

https://doi.org/10.1186/s12992-021-00729-w

Copy DOI

Abstract

IntroductionIn 2015, the President’s Emergency Plan for AIDS Relief undertook policy shifts to increase efficiencies in its programming, including transitioning HIV/AIDS funding away from low burden areas. We examine the impact of these changes on HIV outreach in Kenya and Uganda.MethodsQualitative data collection was conducted as a part of a broader mixed-methods evaluation. Two rounds of facility-level case studies and national-level interviews were conducted in Kenya and Uganda, with health facility, sub-national and central Ministry of Health staff, HIV clients, and implementing partners.ResultsIn both countries, the loss of outreach support affected community-based HIV/AIDS education, testing, peer support, and defaulter tracing.DiscussionLoss of external support for outreach raises concerns for countries’ ability to reach the 90–90-90 UNAIDS target, as key linkages between vulnerable communities and health systems can be adversely affected.ConclusionDevelopment partners should consider how to mitigate potential consequences of transition policies to prevent negative effects at the community level.

Highlights

In 2015, the President’s Emergency Plan for AIDS Relief undertook policy shifts to increase efficiencies in its programming, including transitioning HIV/AIDS funding away from low burden areas
We present findings on the experience of outreach and perceived impacts from loss of outreach by the broad categories of community-based services as defined above, followed by data from national-level Key informant interview (KII) that further corroborate the experiences described by respondents at the facility level
Education programs previously supported under President’s Emergency Plan for AIDS Relief (PEPFAR)-funded mechanisms were described by providers and Sub-national unit (SNU) staff as focusing on raising overall disease awareness, stigma reduction, encouragement of community members to seek testing and treatment, and to maintain treatment

Summary

Introduction

In 2015, the President’s Emergency Plan for AIDS Relief undertook policy shifts to increase efficiencies in its programming, including transitioning HIV/AIDS funding away from low burden areas. Existing evidence demonstrates that community-based services can successfully support clients in bridging these barriers and entering the formal health system, improving retention along the HIV care continuum [6,7,8]. UNAIDS recognizes that community-based services are critical to successful HIV programming, and that such strategies need to be at the forefront of national and global HIV responses in order to reach each of the 90–90-90 goals [10]. Research suggests that bringing services into the community is critical to reaching marginalized populations and groups that have fewer interactions with the health system [11, 12]

Objectives

Methods

Results

Discussion

Conclusion