‘’They took us to the community to die from there’’: Patients’ and HIV service managers’ experiences of Differentiated ART delivery following national scale-up in Uganda

• DOI: 10.21203/rs.2.18363/v1
• Publication Date: 2019-12-07T00:23:02Z
• Authors: Henry Zakumumpa; Joseph Rujumba; Japheth Kwiringira; Cordelia Katureebe; Neil Spicer
• Keywords: Thematic Analysis; Stigma

Abstract Background Although Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)’s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perceptions the early implementation experiences national DSD roll-out across Uganda. Methods We utilized a qualitative design involving 124 participants. Between April June 2019 we conducted 76 semi-structured interviews with national-level program managers (n=18), District Team leaders (n=24), representatives PEPFAR implementing organizations (11), ART clinic in-charges (23) six purposively selected Uganda districts high burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held patients enrolled models case-study districts. Data analyzed by thematic approach as guided multi-level analytical framework Levesque et al. (2013): Individual-level factors; Health-system Community Context. Results Our data shows that multiple barriers have encountered implementation. factors: Individualized stigma fear detachment from health facilities stable community-based reported bottlenecks. Socio-economic status an influence on patient selection models. Insufficient training workers delivery supply chain multi-month dispensing identified constraints. Patients perceived current be provider-intensive not sufficiently patient-centred. Community-level insufficient funding providers fully operationalize community drug pick-up points limitations. Contextual Frequent changes physical addresses among urban clients impede running groups rotating pick-ups. Conclusion This one first multi-stakeholder evaluations initial 2017. Multi-level interventions are needed accelerate further demand-side (addressing self-stigma barriers, engagement) supply-side dimensions (strengthening capacities, increasing improve patient-centeredness).