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Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda.

Geng EH, Bwana MB, Kabakyenga J, Muyindike W, Emenyonu NI, Musinguzi N, Mugyenyi P, Martin JN, Bangsberg DR - PLoS ONE (2010)

Bottom Line: 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).Becoming eligible for ART in the 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) 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.

View Article: PubMed Central - PubMed

Affiliation: Division of HIV/AIDS, Department of Medicine, San Francisco General Hospital, San Francisco, California, USA.

ABSTRACT

Background: 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.

Methods: 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.

Findings: 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 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) 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.

Interpretation: 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.

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The percentage of monthly ART initiations by stakeholder, ISS Clinic, Mbarara, Uganda.The total number starting per month is shown across the top of the bars.
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pone-0014098-g002: The percentage of monthly ART initiations by stakeholder, ISS Clinic, Mbarara, Uganda.The total number starting per month is shown across the top of the bars.

Mentions: Secular trends show large shifts in the stakeholder providing therapy (Figure 1). Overall, the contribution of PEPFAR-sponsored ART initiations fell markedly between April 1st, 2009 and May 14th, 2010. 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. When examined by monthly fractions, the trends are more apparent (Figure 2). At the beginning of the interval – in April of 2009 – PEPFAR implementing partners accounted for 68/93 (73%) or ART initiations. In October PEPFAR sponsored initiations dropped rapidly to 10/39 (26%) and then continued to decline subsequently. MOH sponsored ART initiations rose in number when PEPFAR initiations declined in October 2009: while the MOH started an average of 20 patients a month between April 2009 and October 2009, by November MOH initiations rose to 61/67 (92%) of all ART initiations. MOH maintained a high proportion of starts until April and May of 2010 when MOH sponsored ART initiations then fell to 5/75 (7%). Over this 14 month interval, FTF sponsored very few ART initiations until February when FTF sponsored initiations grew to 7/57 (12%). In March FTF sponsored 18/50 (36%) ART initiations; in April FTF sponsored 45/51 (88%) initiations and at the time of the database closure on May 14th, FTF sponsored 21/24 (88%) initiations in May.


Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda.

Geng EH, Bwana MB, Kabakyenga J, Muyindike W, Emenyonu NI, Musinguzi N, Mugyenyi P, Martin JN, Bangsberg DR - PLoS ONE (2010)

The percentage of monthly ART initiations by stakeholder, ISS Clinic, Mbarara, Uganda.The total number starting per month is shown across the top of the bars.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2991339&req=5

pone-0014098-g002: The percentage of monthly ART initiations by stakeholder, ISS Clinic, Mbarara, Uganda.The total number starting per month is shown across the top of the bars.
Mentions: Secular trends show large shifts in the stakeholder providing therapy (Figure 1). Overall, the contribution of PEPFAR-sponsored ART initiations fell markedly between April 1st, 2009 and May 14th, 2010. 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. When examined by monthly fractions, the trends are more apparent (Figure 2). At the beginning of the interval – in April of 2009 – PEPFAR implementing partners accounted for 68/93 (73%) or ART initiations. In October PEPFAR sponsored initiations dropped rapidly to 10/39 (26%) and then continued to decline subsequently. MOH sponsored ART initiations rose in number when PEPFAR initiations declined in October 2009: while the MOH started an average of 20 patients a month between April 2009 and October 2009, by November MOH initiations rose to 61/67 (92%) of all ART initiations. MOH maintained a high proportion of starts until April and May of 2010 when MOH sponsored ART initiations then fell to 5/75 (7%). Over this 14 month interval, FTF sponsored very few ART initiations until February when FTF sponsored initiations grew to 7/57 (12%). In March FTF sponsored 18/50 (36%) ART initiations; in April FTF sponsored 45/51 (88%) initiations and at the time of the database closure on May 14th, FTF sponsored 21/24 (88%) initiations in May.

Bottom Line: 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).Becoming eligible for ART in the 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) 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.

View Article: PubMed Central - PubMed

Affiliation: Division of HIV/AIDS, Department of Medicine, San Francisco General Hospital, San Francisco, California, USA.

ABSTRACT

Background: 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.

Methods: 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.

Findings: 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 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) 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.

Interpretation: 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.

Show MeSH