Strengthening health systems at facility-Level: feasibility of integrating antiretroviral therapy into primary health care services in Lusaka, Zambia

Topp, Stephanie M., Chipukuma, Julien M., Giganti, Mark, Mwango, Linah K., Chiko, Like M., Tambatamba-Chapula, Bushimbwa, Wamulume, Chibesa S., and Reid, Stewart (2010) Strengthening health systems at facility-Level: feasibility of integrating antiretroviral therapy into primary health care services in Lusaka, Zambia. PLoS ONE, 5 (7). e11522. pp. 1-11.

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Introduction: HIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics.

Methods: Integration involved three key modifications: i) amalgamation of space and patient flow; ii) standardization of medical records and iii) introduction of routine provider initiated testing and counseling (PITC). Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Qualitative data on patient/provider perceptions was also collected.

Findings: Provider and patient interviews at both sites indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. Over six months in Clinic 1, PITC was provided to 2760 patients; 1485 (53%) accepted testing, 192 (13%) were HIV positive and 80 (42%) enrolled. Median OPD patientprovider contact time increased 55% (6.9 vs. 10.7 minutes; p,0.001) and decreased 1% for ART patients (27.9 vs. 27.7 minutes; p = 0.94). Median waiting times increased by 36 (p,0.001) and 23 minutes (p,0.001) for ART and OPD patients respectively. In Clinic 2, PITC was offered to 1510 patients, with 882 (58%) accepting testing, 208 (24%) HIV positive and 121(58%) enrolled. Median OPD patient-provider contact time increased 110% (6.1 vs. 12.8 minutes; p,0.001) and decreased for ART patients by 23% (23 vs. 17.7 minutes; p,0.001). Median waiting times increased by 47 (p,0.001) and 34 minutes(p,0.001) for ART and OPD patients, respectively.

Conclusions: Integrating vertical ART and OPD services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is urgently required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalizability.

Item ID: 39578
Item Type: Article (Research - C1)
ISSN: 1932-6203
Additional Information:

© 2010 Topp et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funders: Elizabeth Glaser Pediatric AIDS Foundation, Centers for Disease Control and Prevention (CDCP)
Projects and Grants: CDCP U62/CCU12354
Date Deposited: 28 Jul 2015 01:51
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 30%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 70%
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