title: The HIV basic care package: where is it available and who receives it? Findings from a mixed methods evaluation in Kenya and Uganda.
abstract: An evidence-based basic care package (BCP) of seven interventions (Family testing, Cotrimoxazole, Condoms, Multivitamins, Access to safe water treatment, Isoniazid preventive therapy (IPT), and Insecticide-treated bednet) has been advocated to prevent infections among people with HIV in low-income settings. We examined the availability and receipt of the BCP in HIV outpatient clinics in Kenya and Uganda. A survey of 120 PEPFAR-funded facilities determined the services offered. At each of the 12 largest facilities, a longitudinal cohort of 100 patients was recruited to examine care received and health status over three months. The full BCP was offered in 14% (n = 17/120) of facilities; interventions most commonly offered were Support for family testing (87%) and Condoms (87%), and least commonly IPT (38%). Patients (n = 1335) most commonly reported receiving Cotrimoxazole (57%) and Multivitamins (36%), and least commonly IPT (4%), directly from the facility attended. The BCP (excluding Isoniazid) was received by 3% of patients directly from the facility and 24% from any location. BCP receipt was associated with using antiretroviral therapy (ART; OR 1.1 (95% CI 1.0-1.1), receipt from any location) but not with patient gender, wealth, education level or health. The BCP should be offered at more HIV care facilities, especially Isoniazid, and to more people irrespective of ART use. Coordinating local BCP suppliers could help improve availability through addressing logistical challenges or reducing costs.
authors: a Cicely Saunders Institute , King's College London , London , UK.
authors: Suzanne
authors: S
authors: Penfold
authors: Victoria
authors: V
authors: Simms
authors: Julia
authors: J
authors: Downing
authors: Richard A
authors: RA
authors: Powell
authors: Faith
authors: F
authors: Mwangi-Powell
authors: Eve
authors: E
authors: Namisango
authors: Scott
authors: S
authors: Moreland
authors: Mackuline
authors: M
authors: Atieno
authors: Nancy
authors: N
authors: Gikaara
authors: Jeniffer
authors: J
authors: Kataike
authors: Clare
authors: C
authors: Kwebiha
authors: Grace
authors: G
authors: Munene
authors: Geoffrey
authors: G
authors: Banga
authors: Irene J
authors: IJ
authors: Higginson
authors: Richard
authors: R
authors: Harding
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage; D003140:Communicable Disease Control / Q000295:instrumentation*; D017280:Condoms / Q000600:supply & distribution; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D057148:Insecticide-Treated Bednets; D007407:Interviews as Topic; D007538:Isoniazid / Q000008:administration & dosage; D007630:Kenya; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D014454:Uganda; D014815:Vitamins / Q000600:supply & distribution; D014881:Water Supply / Q000592:standards
chemical_list: D000890:Anti-Infective Agents; D014815:Vitamins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D007538:Isoniazid
keywords: East Africa; HIV; delivery of healthcare; opportunistic infections