Impact of decentralisation of antiretroviral therapy services on HIV testing and care at a population level in Agago District in rural Northern Uganda: results from the Lablite population surveys.
We conducted unlinked cross-sectional population-based surveys in Northern Uganda before and after antiretroviral therapy (ART) provision (including Option B+ [lifelong ART for pregnant/breast-feeding women]) at a local primary care facility (Lira Kato Health Centre [HC]). Prior to decentralisation, people travelled 56-76 km round-trip for ART; we aimed to evaluate changes in uptake of HIV-testing, ART coverage and access to ART following decentralisation.



A total of 2124 adults in 1351 households in two parishes closest to Lira Kato HC were interviewed using questionnaires between March and April 2013 and 2123 adults in 1229 households between January and March 2015.



Adults reporting HIV-testing in the last year increased from 1077/2124 (50.7%) to 1298/2123 (61.1%) between surveys (p<0.001). ART coverage increased from 74/136 (54.4%) self-reported HIV-positive adults in 2013 to 108/133 (81.2%) in 2015 (p<0.001). Post-decentralisation, 47/108 (43.5%) of those on ART were in care at Lira Kato HC (including 37 new initiations). Most of the remainder (47/61, 77%) started ART prior to any ART provision at Lira Kato HC; the most common reason given for not accessing ART locally was concern about drug-stock-outs (30/59, 51%).



HIV-testing and ART coverage increased after decentralisation combined with Option B+ roll-out. However, patients on ART before decentralisation were reluctant to transfer to their local facility.
Department of Research, Joint Clinical Research Centre, P.O. Box 10005, Kampala, Uganda.|Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
George
G
Abongomera
Department of Statistics, Medical Research Council/Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.
Sylvia
S
Kiwuwa-Muyingo
Centre for Health Economics, University of York, York, YO10 5DD, UK.
Paul
P
Revill
Department of Research, Dignitas International, P.O. Box 1071, Zomba, Malawi.
Levison
L
Chiwaula
Clinical Research Centre, University of Zimbabwe, P.O. Box MP 167 Harare, Zimbabwe.
Travor
T
Mabugu
Department of Infection & Population Health, University College London, London, WC1E 6JB, UK.
Andrew N
AN
Phillips
Department of Research, Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda.
Elly
E
Katabira
Department of Research, Dignitas International, P.O. Box 1071, Zomba, Malawi.|Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Adrienne K
AK
Chan
Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK.|School of Population Health, University of Queensland, Brisbane, QLD 4072, Australia.
Charles
C
Gilks
Department of Research, Joint Clinical Research Centre, P.O. Box 10005, Kampala, Uganda.|Faculty of Paediatrics, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
Victor
V
Musiime
Clinical Research Centre, University of Zimbabwe, P.O. Box MP 167 Harare, Zimbabwe.
James
J
Hakim
Department of Research, Joint Clinical Research Centre, P.O. Box 10005, Kampala, Uganda.
Cissy
C
Kityo
Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
Robert
R
Colebunders
Medical Research Council, Clinical Trials Unit at University College London, London, WC2B 6NH, UK.
Diana M
DM
Gibb
Department of Statistics, Medical Research Council/Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.|Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
Janet
J
Seeley
Medical Research Council, Clinical Trials Unit at University College London, London, WC2B 6NH, UK.
Deborah
D
Ford
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D011057:Politics; D011320:Primary Health Care / Q000458:organization & administration*; D012424:Rural Population; D011795:Surveys and Questionnaires; D014195:Travel; D014454:Uganda / Q000453:epidemiology
D044966:Anti-Retroviral Agents
Antiretroviral therapy decentralisation; HIV services; Population survey; Sub-Saharan Africa; Uganda