Abstract
The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ('hubs') and lower-level health facilities ('spokes') in Phalombe district, Malawi and in Kalungu district, Uganda. We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1-Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1-Q2; p<0.001). In Uganda, 7% of patients mapped to Q1-Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1-Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30-120) in Malawi and 30 min (IQR 20-60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.
Highlights
The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities (‘hubs’) and lower-level health facilities (‘spokes’) in Phalombe district, Malawi and in Kalungu district, Uganda
In Malawi, 44 patients were interviewed at the hub and 104 patients were interviewed at the spokes; 54/104 (52%) patients at the spokes had started ART elsewhere and transferred in for care (20% of transfers had received treatment at the hub prior to transfer, 67% had transferred from other large primary care facilities in the district with longer-established ART provision and 13% had transferred from other facilities, including some out of the district)
In Uganda, 46 patients were interviewed at the hub and 77 patients were interviewed at the spokes; 33/77 (45%) patients at the spokes had transferred into care (36% of transfers had received treatment at the hub prior to transfer and the remainder had transferred from a variety of facilities; see Table 1)
Summary
The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities (‘hubs’) and lower-level health facilities (‘spokes’) in Phalombe district, Malawi and in Kalungu district, Uganda. Challenges remain at each step of the HIV treatment cascade, from identifying and testing HIV-positive individuals to retaining those who have started treatment in care.[10,11,12]
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