Determinants of primary healthcare providers' readiness for integration of ART services at departmental levels: A case study of Lira City and District, Uganda.

BACKGROUND: Decreasing or flattening funding for vertical HIV services means that new and innovative ways of providing care are necessary. This study aimed to assess the determinants of readiness for integration of Antiretroviral Therapy (ART) services at the departmental level among primary health care providers (PHCP) at selected health facilities in Lira District. METHODS: A cross-sectional survey employing mixed methods approaches was conducted between January and February 2022 among 340 primary healthcare practitioners (PHCP) at selected health facilities in Lira district. An interviewer-administered questionnaire was used to collect quantitative data. Quantitative data was analyzed using Stata version 15. and presented as proportions, means, percentages, frequencies, and odds ratios. Logistic regression was used to determine associations of the factors with readiness for ART integration at a 95% level of significance. Thematic analysis was used to analyze qualitative data. RESULTS: The majority 75.2% (95% CI; 0.703-0.795) of the respondents reported being ready for the integration of ART services. PHCPs who were aware of the integration of services and those who had worked in the same facility for at least 6 years had higher odds of readiness for integration of ART, compared with their counterparts [aOR = 7.36; 95% CI = 3.857-14.028, p-value <0.001] for knowledge and duration at the current facility [aOR = 2.92; 95% CI = 1.293-6.599, p-value < 0.05] respectively. From the qualitative data, the dominant view was that integration is a good thing that should be implemented immediately. However, several challenges were noted, key among which include limited staffing and drug supplies at the facilities, coupled with limited space. CONCLUSIONS: The study reveals a high level of readiness for the integration of ART services at departmental levels among Primary Healthcare Providers. Notably, PHCPs knowledgeable about integration and those who spent at least six years at the current health facility of work, were strong determinants for the integration of ART services in resource limited settings. In light of these findings, we recommend that policymakers prioritize the implementation of training programs aimed at upskilling healthcare workers. Furthermore, we advocate that a cluster randomized controlled trial be conducted, to evaluate the long-term effects of this integration on overall health outcomes.

Knowledge and perceptions of primary healthcare providers towards integration of antiretroviral therapy (ART) services at departmental levels at selected health facilities Lira district, Uganda.

BACKGROUND: Investigations conducted among healthcare providers to assess their knowledge and perceptions towards the integration of anti-retroviral therapy (ART) related services in Sub-Saharan Africa are limited. This study explored the knowledge and perceptions of primary healthcare providers towards the integration of ART management services at departmental levels in health facilities in Lira district. METHODS: We conducted a descriptive cross-sectional survey that employed qualitative methods of data collection in four selected health facilities in Lira district between January and February 2022. The study involved in-depth interviews with key informants and focus group discussions. The study population consisted exclusively of primary healthcare providers; however, those who were not full-time employees of the participating health facilities were excluded. We used thematic content analysis. RESULTS: A significant proportion of staff (especially those who are not directly involved in ART) still lack full knowledge of ART services integration. There was generally a positive perception, with some suggesting ART integration can minimize stigma and discrimination. The potential barriers to integration included limited knowledge and skills for providing comprehensive ART services, insufficient staffing and space, funding gaps, and inadequate drug supplies, coupled with increased workload due to enlarged clientele. CONCLUSION: Whereas healthcare workers are generally knowledgeable about ART integration, but their knowledge was limited to partial integration. The participants had a basic understanding of ART services being provided by different health facilities. Furthermore, participants viewed integration as critical, but it should be implemented in conjunction with ART management training. Given that respondents reported a lack of infrastructure, increased workload, and understaffing, additional investments in staff recruitment, motivation through training and incentives, and other means are needed if ART integration is to be implemented.