ABSTRACT
Background: Improving laboratory service delivery requires a functioning logistics and supply system. Uganda's Ministry of Health uses the credit-line approach to provide laboratory supplies including commodities for CD4 test equipment.Objectives: We examined the effectiveness of the credit-line approach in improving laboratory service delivery by using the functionality of CD4 test equipment as a proxy indicator. Method: A cross-sectional survey was conducted at 7 level-three health centres (HC IIIs); 18 level-four health centres (HC IVs); and 10 hospitals in 15 districts of mid-northern Uganda; including the Lango (17 facilities) and Acholi sub-regions (18 facilities); between July 2013 and August 2013. Functionality; was determined through self- and interviewer-administered questionnaires. The chi-squared test was used to assess differences in functionality by subregion; facility type; and equipment type.Results: A total of 38 CD4 test analysers were assessed. Of these; 26 (68%) were functional. In hospitals; 85% of CD4 analysers were functional; in HC IVs; 67% were functional and in HCIIIs; 43% were functional. The differences did not reach statistical significance. In the Langosub-region; 72% of analysers were functional; in the Acholi sub-region; 65% were functional. Non-functionality was mainly due to lack of reagents and cartridges; as well as low staffing levels of laboratory technicians with the skills necessary to operate the equipment.Conclusion: The credit-line approach supported the functionality of CD4 equipment in the surveyed facilities. However; there is a need to address issues of staffing and availability of reagents to enhance the functionality of CD4 equipment and improve patient care; especiallyat HC IIIs
Subject(s)
Cross-Sectional Studies , Equipment and Supplies , Patient Credit and Collection , UgandaABSTRACT
Introduction: Opportunistic infections (OIs) remain the single main cause of ill-health and death among HIV/AIDS patients in resource poor countries. We assessed the prevalence of 17 OIs and associated factors among HIV positive patients on highly active antiretroviral therapy (HAART) in Uganda. Methods: Observational data from 2004 to 2013 for adult HIV positive patients (>=15yrs) obtaining care and treatment from the AIDS support organization (TASO) in Uganda were reviewed. Electronic data were obtained from TASO HIV clinics representing 4 different geographical areas of Uganda. Descriptive statistics were summarized in terms of frequencies and percentages. Logistic regression was used to assess the factors associated with occurrence of OIs. Results: Between 2004 and 2013, a total of 36,133 HIV patients were enrolled on HAART of which two thirds (66%) were female and one third (34%) were male. In univariate analysis, significant differences were observed between male and female ART clients with men being older (median age 36yrs IQR 29-43 vs 32 yrs IQR 26-39, p<0.0001); likely to be more educated(>secondary 31% vs 19%, p<0.0001); likely to be more severely ill(CD4 count<100 26% vs 21%, p<0.0001); were more likely to be married (65% vs 42%, p<0.0001) and were more likely to be formally employed (27% vs 12%, p<0.0001). Mean annual prevalence for any OI in 2004 was 57.6% and in 2013 was 27.5% (X2 trend = 122, b= -0.0283, p <0.0001). The most commonly encountered OIs were geohelminths (35%), diarrhea<1 month (18%) and mycobacterium tuberculosis (11%). Factors associated with any OI after HAART were male gender, if from Northern Uganda, low education (<primary), baseline WHO stages III&IV, stavudine ART regimen, baseline CD4 count <100cells/μl, low baseline weight <55 kg and period 2004-2008 (p<0.05). Conclusion and Recommendations: In these settings, the burden of OIs is still high in spite of increased access to HAART. The prevalence of geohelminthes and diarrhoea is worrying among HIV patients on HAART. Men remain at greater risk of OIs and should be the main target for early HAART initiation.