Adherence to standards of quality HIV/AIDS care and antiretroviral therapy in the West Nile Region of Uganda.
BACKGROUND
Over one million people in Uganda are estimated to be infected with HIV and about 20% of these were already accessing antiretroviral therapy (ART), by 2010. There is a dearth of data on adherence to antiretroviral therapy and yet high client load on a weak and resource constrained health system impacts on provision of quality HIV/AIDS care. We assessed adherence to standards of HIV care among health workers in the West Nile Region of Uganda.


METHODS
We conducted a cross sectional study in nine health facilities. Records of a cohort of 270 HIV clients that enrolled on ART 12 months prior were assessed. The performance of each health facility on the different indicators of standards of HIV/AIDS care was determined and compared with the recommended national guidelines.


RESULTS
We found that 94% of HIV clients at all the facilities were assessed for ART eligibility using WHO clinical staging while only two thirds (64.8%) were assessed using CD4. Only 42% and 37% of HIV clients at district hospitals and health centers respectively, received basic laboratory work up prior to ART initiation and about a half (46.7%) of HIV clients at these facilities received the alternative standard 1st line antiretroviral (ARV) regimen. Standards of ART adherence and tuberculosis assessment declined from over 70% to less than 50% and from over 90% to less than 70% respectively, during follow up visits with performance being poorer at the higher level regional referral facility compared to the lower level facilities.


CONCLUSIONS
Adherence to standards of HIV/AIDS care at facilities was inadequate. Performance was better at the start of ART but declined during the follow up period. Higher level facilities were more likely to adhere to standards like CD4 monitoring and maintaining HIV clients on standard ARV regimen. Efforts geared towards strengthening the health system, including support supervision and provision of care guidelines and job aides are needed, especially for lower level facilities.
Makerere University School of Public Health, College of Health Sciences, Kampala, Uganda. burualdo@yahoo.co.uk.|Management Sciences for Health, Kampala, Uganda. burualdo@yahoo.co.uk.
Aldomoro
A
Burua
Makerere University School of Public Health, College of Health Sciences, Kampala, Uganda. fnuwaha@musph.ac.ug.
Fred
F
Nuwaha
Makerere University School of Public Health, College of Health Sciences, Kampala, Uganda. pwaiswa2001@yahoo.com.|Division of Global Health, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden. pwaiswa2001@yahoo.com.
Peter
P
Waiswa
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000592:standards*; D003141:Communicable Diseases / Q000188:drug therapy; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy*; D006268:Health Facilities / Q000592:standards*; D006282:Health Personnel; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D014454:Uganda
D019380:Anti-HIV Agents