How to organize services for delivery of antiretroviral drugs in HIV treatment centers in Africa

Thesis summary

The African region, is home to only 12% of the world’s population but bears a disproportionately large share of the global Human immunodeficiency virus (HIV) burden accounting for 23.4 million (69%) of all people living with HIV. Antiretroviral therapy (ART) is effective in decreasing HIV-related morbidity and mortality, and transmission of the virus. Unfortunately, many people who require ART are unable to get it. In Africa, only 7.5 million (68%) of those in need of ART received it at the end of 2012. In Uganda by 2010, only 50% of eligible patients received ART.

The goal of ART is to achieve sustained viral suppression with its associated clinical and public health benefits. For that to happen, people with HIV need to remain in care and adhere to their treatment. However, as more HIV patients access treatment, health facilities are finding it increasingly difficult to cope with the escalating case-load.

The overarching goal of this thesis is to determine how to organize services for delivery of antiretroviral drugs in HIV treatment centres in Africa. The themes and specific objectives are to: 1. Improve the implementation of a model of task shifting: the Pharmacy-only Refill Program (PRP) through a) establishing the criteria for referring patients to the PRP and b) assessing the patients’ experience and satisfaction with the PRP. 2. Improve patient retention  in care through: a) identifying the risk factors for loss to follow-up (LTFU), b) determining when and how to track patients after a missed appointment visit, and c) determining the retention rate of patients who return to care after a missed appointment.

Our studies were conducted in Kampala, Uganda at the Infectious Disease institute (IDI), Makerere University College of Health Sciences.