The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda

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  • Wollum, Alexandra
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Dansereau, Emily
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Fullman, Nancy
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Achan, Jane
    • Other Affiliation: Medical Research Council Unit, Banjul, The Gambia
  • Bannon, Kelsey A
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Burstein, Roy
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Conner, Ruben O
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • DeCenso, Brendan
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Gasasira, Anne
    • Other Affiliation: African Leaders Malaria Alliance, Kampala, Uganda
  • Haakenstad, Annie
    • Other Affiliation: Harvard School of Public Health, Boston, MA, USA
  • Hanlon, Michael
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Ikilezi, Gloria
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA; Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
  • Kisia, Caroline
    • Other Affiliation: Action Africa Help-International, Nairobi, Kenya
  • Levine, Aubrey J
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Masters, Samuel H
  • Njuguna, Pamela
    • Other Affiliation: Afya Resource Associates, Nairobi, Kenya
  • Okiro, Emelda A
    • Other Affiliation: Bill & Melinda Gates Foundation, Seattle, WA, USA
  • Odeny, Thomas A
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Roberts, D. Allen
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Gakidou, Emmanuela
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
  • Duber, Herbert C
    • Other Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121, USA
Abstract
  • Abstract Background Considerable debate exists concerning the effects of antiretroviral therapy (ART) service scale-up on non-HIV services and overall health system performance in sub-Saharan Africa. In this study, we examined whether ART services affected trends in non-ART outpatient department (OPD) visits in Kenya and Uganda. Methods Using a nationally representative sample of health facilities in Kenya and Uganda, we estimated the effect of ART programs on OPD visits from 2007 to 2012. We modeled the annual percent change in non-ART OPD visits using hierarchical mixed-effects linear regressions, controlling for a range of facility characteristics. We used four different constructs of ART services to capture the different ways in which the presence, growth, overall, and relative size of ART programs may affect non-ART OPD services. Results Our final sample included 321 health facilities (140 in Kenya and 181 in Uganda). On average, OPD and ART visits increased steadily in Kenya and Uganda between 2007 and 2012. For facilities where ART services were not offered, the average annual increase in OPD visits was 4·2% in Kenya and 13·5% in Uganda. Among facilities that provided ART services, we found average annual OPD volume increases of 7·2% in Kenya and 5·6% in Uganda, with simultaneous annual increases of 13·7% and 12·5% in ART volumes. We did not find a statistically significant relationship between annual changes in OPD services and the presence, growth, overall, or relative size of ART services. However, in a subgroup analysis, we found that Ugandan hospitals that offered ART services had statistically significantly less growth in OPD visits than Ugandan hospitals that did not provide ART services. Conclusions Our findings suggest that ART services in Kenya and Uganda did not have a statistically significant deleterious effects on OPD services between 2007 and 2012, although subgroup analyses indicate variation by facility type. Our findings are encouraging, particularly given recent recommendations for universal access to ART, demonstrating that expanding ART services is not inherently linked to declines in other health services in sub-Saharan Africa.
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  • Article
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  • In Copyright
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  • The Author(s).
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  • English
Bibliographic citation
  • BMC Health Services Research. 2017 Aug 16;17(1):564
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  • BioMed Central

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