The Lablite project: a cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe

Chan, Adrienne K., Ford, Deborah, Namata, Harriet, Muzambi, Margaret, Nkhata, Misheck J., Abongomera, George, Mambule, Ivan, South, Annabelle, Revill, Paul, Grundy, Caroline, Mabugu, Travor, Chiwaula, Levison, Cataldo, Fabian, Hakim, James, Seeley, Janet, Kityo, Cissy, Reid, Andrew, Katabira, Elly, Sodhi, Sumeet, Gilks, Charles F. and Gibb, Diana M. (2014) The Lablite project: a cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe. BMC Health Services Research, 14 352: 1-16. doi:10.1186/1472-6963-14-352


Author Chan, Adrienne K.
Ford, Deborah
Namata, Harriet
Muzambi, Margaret
Nkhata, Misheck J.
Abongomera, George
Mambule, Ivan
South, Annabelle
Revill, Paul
Grundy, Caroline
Mabugu, Travor
Chiwaula, Levison
Cataldo, Fabian
Hakim, James
Seeley, Janet
Kityo, Cissy
Reid, Andrew
Katabira, Elly
Sodhi, Sumeet
Gilks, Charles F.
Gibb, Diana M.
Title The Lablite project: a cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe
Journal name BMC Health Services Research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2014-08-19
Year available 2014
Sub-type Article (original research)
DOI 10.1186/1472-6963-14-352
Open Access Status DOI
Volume 14
Issue 352
Start page 1
End page 16
Total pages 16
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Formatted abstract
Background

In sub-Saharan Africa antiretroviral therapy (ART) is being decentralized from tertiary/secondary care facilities to primary care. The Lablite project supports effective decentralization in 3 countries. It began with a cross-sectional survey to describe HIV and ART services.

Methods

81 purposively sampled health facilities in Malawi, Uganda and Zimbabwe were surveyed.

Results

The lowest level primary health centres comprised 16/20, 21/39 and 16/22 facilities included in Malawi, Uganda and Zimbabwe respectively. In Malawi and Uganda most primary health facilities had at least 1 medical assistant/clinical officer, with average 2.5 and 4 nurses/midwives for median catchment populations of 29,275 and 9,000 respectively. Primary health facilities in Zimbabwe were run by nurses/midwives, with average 6 for a median catchment population of 8,616. All primary health facilities provided HIV testing and counselling, 50/53 (94%) cotrimoxazole preventive therapy (CPT), 52/53 (98%) prevention of mother-to-child transmission of HIV (PMTCT) and 30/53 (57%) ART management (1/30 post ART-initiation follow-up only). All secondary and tertiary-level facilities provided HIV and ART services. In total, 58/81 had ART provision. Stock-outs during the 3 months prior to survey occurred across facility levels for HIV test-kits in 55%, 26% and 9% facilities in Malawi, Uganda and Zimbabwe respectively; for CPT in 58%, 32% and 9% and for PMTCT drugs in 26%, 10% and 0% of facilities (excluding facilities where patients were referred out for either drug). Across all countries, in facilities with ART stored on-site, adult ART stock-outs were reported in 3/44 (7%) facilities compared with 10/43 (23%) facility stock-outs of paediatric ART. Laboratory services at primary health facilities were limited: CD4 was used for ART initiation in 4/9, 5/6 and 13/14 in Malawi, Uganda and Zimbabwe respectively, but frequently only in selected patients. Routine viral load monitoring was not used; 6/58 (10%) facilities with ART provision accessed centralised viral loads for selected patients.

Conclusions

Although coverage of HIV testing, PMTCT and cotrimoxazole prophylaxis was high in all countries, decentralization of ART services was variable and incomplete. Challenges of staffing and stock management were evident. Laboratory testing for toxicity and treatment effectiveness monitoring was not available in most primary level facilities.
Keyword HIV services
Sub-Saharan Africa
Antiretroviral therapy rollout
Primary care health facilities
Stock-outs
Decentralization
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Public Health Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 8 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 16 Sep 2014, 00:25:39 EST by System User on behalf of School of Public Health