ORCID Profile
0000-0001-8632-0600
Current Organisation
University of York
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Publisher: Elsevier BV
Date: 2014
Publisher: Oxford University Press (OUP)
Date: 30-03-2016
Publisher: Springer Science and Business Media LLC
Date: 06-2015
Publisher: Springer Science and Business Media LLC
Date: 16-11-2016
Publisher: Oxford University Press (OUP)
Date: 03-2017
Abstract: We conducted unlinked cross-sectional population-based surveys in Northern Uganda before and after antiretroviral therapy (ART) provision (including Option B+ [lifelong ART for pregnant/breast-feeding women]) at a local primary care facility (Lira Kato Health Centre [HC]). Prior to decentralisation, people travelled 56-76 km round-trip for ART we aimed to evaluate changes in uptake of HIV-testing, ART coverage and access to ART following decentralisation. A total of 2124 adults in 1351 households in two parishes closest to Lira Kato HC were interviewed using questionnaires between March and April 2013 and 2123 adults in 1229 households between January and March 2015. Adults reporting HIV-testing in the last year increased from 1077/2124 (50.7%) to 1298/2123 (61.1%) between surveys (p<0.001). ART coverage increased from 74/136 (54.4%) self-reported HIV-positive adults in 2013 to 108/133 (81.2%) in 2015 (p<0.001). Post-decentralisation, 47/108 (43.5%) of those on ART were in care at Lira Kato HC (including 37 new initiations). Most of the remainder (47/61, 77%) started ART prior to any ART provision at Lira Kato HC the most common reason given for not accessing ART locally was concern about drug-stock-outs (30/59, 51%). HIV-testing and ART coverage increased after decentralisation combined with Option B+ roll-out. However, patients on ART before decentralisation were reluctant to transfer to their local facility.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2014
Publisher: Oxford University Press (OUP)
Date: 2018
Abstract: The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ('hubs') and lower-level health facilities ('spokes') in Phalombe district, Malawi and in Kalungu district, Uganda. We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54 Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50 Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44 Uganda, n=46). In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1-Q2) patients at spokes were poorer than at a hub (57% vs 23% in Q1-Q2 p<0.001). In Uganda, 7% of patients mapped to Q1-Q2 patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1-Q2 p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30-120) in Malawi and 30 min (IQR 20-60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Paul Revill.