Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda.
Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda.
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DOI：
10.1186/s12913-015-1194-4
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发表时间：
2015-11-28
影响因子：
2.8
通讯作者：
Lablite Project Team
中科院分区：
文献类型：
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作者：
Abongomera G;Kiwuwa-Muyingo S;Revill P;Chiwaula L;Mabugu T;Phillips A;Katabira E;Musiime V;Gilks C;Chan A;Hakim J;Colebunders R;Kityo C;Gibb DM;Seeley J;Ford D;Lablite Project Team
随着乌干达在全国范围内推出 B+ 方案，ART 服务的权力下放显着扩大。几乎没有开展工作来检查人群获得艾滋病毒护理的情况，特别是在非洲农村难以到达的地区。大多数扩大 ART 规模的工作都是在医疗机构层面完成的，这忽略了无法在社区获得医疗保健的人们。本研究描述了乌干达北部拉波诺县 2/6 教区的卫生服务使用情况，特别是艾滋病毒检测和护理，然后在里拉加藤卫生中心（当地的一个下级卫生中心 III）引入 ART 服务，作为 ART 权力下放的一部分。对家庭成员（15-59 岁）进行家庭和个人问卷调查。 Logit 随机效应模型用于测试比例差异（允许村庄内聚类）。来自 1351 个家庭的 2124 名成年人接受了采访（755 [36%] 男性，1369 [64%] 女性）。 2051 名 (97%) 参与者报告因发烧而在当地就医，大多数是步行，一半以上是在里拉加藤健康中心 (Lira Kato Health Centre)。 574 名 (76%) 男性和 1156 名 (84%) 女性报告曾接受过 HIV 检测（差异 P < 0.001）； 34/574 (6%) 男性和 102/1156 (9%) 女性报告检测呈阳性 (P = 0.04)。过去 5 年内生育过的 818/850 (96%) 名妇女在上次怀孕时接受了产前护理：7 名妇女已被诊断出感染艾滋病毒（3 名接受 ART），790 名 (97%) 名妇女报告接受了艾滋病毒检测（34 名新检测呈阳性）。 124/136 (91%) 的 HIV 阳性成年人接受 HIV 护理，123/136 (90%) 的人服用复方新诺明，74/136 (54%) 的人接受 ART。在接受艾滋病毒护理的成年人中，大多数是在卡隆戈医院 (n = 87)、巴东戈健康中心 (n = 7) 或里拉加藤健康中心 (n = 23；无 ART 服务) 就诊。 58/87、5/7 和 20/23 人分别步行前往 Kalongo 医院（往返 56 公里，地区卫生办公室信息）、Patongo 健康中心（往返 76 公里，地区卫生办公室信息）和 Lira Kato 健康中心（当地）。报告有 8 名感染艾滋病毒的儿童；只有 2 人被诊断年龄<24 个月：7/8 接受艾滋病毒护理，其中 3 人接受抗逆转录病毒治疗。与其他调查类似，与男性相比，报告曾进行艾滋病毒检测并检测出艾滋病毒呈阳性的女性比例较高。感染艾滋病毒的男性和女性需要长途跋涉才能获得抗逆转录病毒治疗服务。儿童似乎无法获得足够的检测和转诊治疗。将辅助生殖技术服务分散到当地医疗机构将减少旅行时间和交通成本，使护理和治疗更容易获得。本文的在线版本 (doi:10.1186/s12913-015-1194-4) 包含补充材料，可供授权用户使用。
Decentralization of ART services scaled up significantly with the country wide roll out of option B plus in Uganda. Little work has been undertaken to examine population level access to HIV care particularly in hard to reach areas in rural Africa. Most work on ART scale up has been done at health facility level which omits people not accessing healthcare in the community. This study describes health service usage, particularly HIV testing and care in 2/6 parishes of Lapono sub-county of northern Uganda, prior to introduction of ART services in Lira Kato Health Centre (a local lower-level health centre III), as part of ART decentralization. Household and individual questionnaires were administered to household members (aged 15–59 years). Logit random effects models were used to test for differences in proportions (allowing for clustering within villages). 2124 adults from 1351 households were interviewed (755 [36 %] males, 1369 [64 %] females). 2051 (97 %) participants reported seeking care locally for fever, most on foot and over half at Lira Kato Health Centre. 574 (76 %) men and 1156 (84 %) women reported ever-testing for HIV (P < 0.001 for difference); 34/574 (6 %) men and 102/1156 (9 %) women reported testing positive (P = 0.04). 818/850 (96 %) women who had given birth in the last 5 years had attended antenatal care in their last pregnancy: 7 women were already diagnosed with HIV (3 on ART) and 790 (97 %) reported being tested for HIV (34 tested newly positive). 124/136 (91 %) HIV-positive adults were in HIV-care, 123/136 (90 %) were taking cotrimoxazole and 74/136 (54 %) were on ART. Of adults in HIV-care, most were seen at Kalongo hospital (n = 87), Patongo Health Centre (n = 7) or Lira Kato Health Centre (n = 23; no ART services). 58/87, 5/7 and 20/23 individuals walked to Kalongo hospital (56 km round-trip, District Health Office information), Patongo Health Centre (76 km round-trip, District Health Office information) and Lira Kato Health Centre (local) respectively. 8 HIV-infected children were reported; only 2 were diagnosed aged <24 months: 7/8 were in HIV-care including 3 on ART. Higher proportions of women compared to men reported ever-testing for HIV and testing HIV-positive, similar to other surveys. HIV-infected men and women travelled considerable distances for ART services. Children appeared to be under-accessing testing and referral for treatment. Decentralization of ART services to a local health facility would decrease travel time and transport costs, making care and treatment more easily accessible. The online version of this article (doi:10.1186/s12913-015-1194-4) contains supplementary material, which is available to authorized users.