title: The Lablite project: a cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe.
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.
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: MRC Clinical Trials Unit at University College London, London, U,K. deborah.ford@ucl.ac.uk.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ford
authors.forename: Harriet
authors.initials: H
authors.lastname: Namata
authors.forename: Margaret
authors.initials: M
authors.lastname: Muzambi
authors.forename: Misheck J
authors.initials: MJ
authors.lastname: Nkhata
authors.forename: George
authors.initials: G
authors.lastname: Abongomera
authors.forename: Ivan
authors.initials: I
authors.lastname: Mambule
authors.forename: Annabelle
authors.initials: A
authors.lastname: South
authors.forename: Paul
authors.initials: P
authors.lastname: Revill
authors.forename: Caroline
authors.initials: C
authors.lastname: Grundy
authors.forename: Travor
authors.initials: T
authors.lastname: Mabugu
authors.forename: Levison
authors.initials: L
authors.lastname: Chiwaula
authors.forename: Fabian
authors.initials: F
authors.lastname: Cataldo
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.forename: Cissy
authors.initials: C
authors.lastname: Kityo
authors.forename: Andrew
authors.initials: A
authors.lastname: Reid
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Sumeet
authors.initials: S
authors.lastname: Sodhi
authors.forename: Charles F
authors.initials: CF
authors.lastname: Gilks
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D008295:Malawi; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011933:Reagent Kits, Diagnostic / Q000600:supply & distribution; D011795:Surveys and Questionnaires; D014454:Uganda; D019562:Viral Load; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D044966:Anti-Retroviral Agents; D011933:Reagent Kits, Diagnostic