Diminishing Availability of Publicly Funded Slots for Antiretroviral Initiation among HIV-Infected ART-Eligible Patients in Uganda
Open Access
- 24 November 2010
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 5 (11), e14098
- https://doi.org/10.1371/journal.pone.0014098
Abstract
The impact of flat-line funding in the global scale up of antiretroviral therapy (ART) for HIV-infected patients in Africa has not yet been well described. We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, Uganda between April 1, 2009 and May 14, 2010 where four stakeholders sponsor treatment – two PEPFAR implementing organizations, the Ugandan Ministry of Health – Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF). We assessed temporal trends in the number of eligible patients, the number starting ART and tabulated the distribution of the stakeholders supporting ART initiation by month and quartile of time during this interval. We used survival analyses to assess changes in the rate of ART initiation over calendar time. A total of 1309 patients who were eligible for ART made visits over the 14 month period of the study and of these 819 started ART. The median number of ART eligible patients each month was 88 (IQR: 74 to 115). By quartile of calendar time, PEPFAR and MOH sponsored 290, 192, 180, and 49 ART initiations whereas the FTF started 1, 2, 1 and 104 patients respectively. By May of 2010 (the last calendar month of observation) FTF sponsored 88% of all ART initiations. Becoming eligible for ART in the 3rd (HR = 0.58, 95% 0.45–0.74) and 4th quartiles (HR = 0.49, 95% CI: 0.36–0.65) was associated with delay in ART initiation compared to the first quartile in multivariable analyses. During a period of flat line funding from multinational donors for ART programs, reductions in the number of ART initiations by public programs (i.e., PEPFAR and MOH-GF) and delays in ART initiation became apparent at the a large prototypical scale-up ART clinic in Uganda.Keywords
This publication has 10 references indexed in Scilit:
- Mortality Reduction Associated with HIV/AIDS Care and Antiretroviral Treatment in Rural Malawi: Evidence from Registers, Coffin Sales and FuneralsPLOS ONE, 2010
- Bridging The Resource Gap: Improving Value For Money In HIV/AIDS TreatmentHealth Affairs, 2009
- Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic StudyPLoS Medicine, 2009
- Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan AfricaAIDS, 2008
- The Economic Impact of AIDS TreatmentThe Journal of Human Resources, 2008
- The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya2008
- Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic ReviewPLoS Medicine, 2007
- Adherence as therapeutic citizenship: impact of the history of access to antiretroviral drugs on adherence to treatmentAIDS, 2007
- Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North AmericaJAMA, 2006
- The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settingsThe Lancet, 2006