Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Background: The notion of health-system resilience has received little empirical attention in the current literature
on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with
regard to strategies for dispensing antiretrovirals during Covid-19 lockdown.
Methods: We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western
Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders
(n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six
focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using
thematic approach.
Results: Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating
home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable
patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites
in the community; increasing reliance on health information systems, including geospatial technologies, to support
ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak
response funding to deliver ART refills to homesteads in rural communities.
Conclusion: While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they
revived interest by providers and demand by patients for community-based ART delivery models in case-study
districts in Uganda.
Description
Keywords
Dispensing antiretrovirals, Covid-19, lockdown, re-discovering community-based, delivery models