Background The World Health Organization and Uganda Ministry of Health recommend differentiated service delivery models (DSDM) as patient-focussed approaches for delivering antiretroviral therapy for people living with HIV/AIDS (PLHIV) who have undetectable viral loads. We sought to determine the factors significantly associated with patient satisfaction with ART services amongst PLHIV enrolled in DSDMs. Methods This was a cross-sectional study of a random sample of PLHIVs accessing ART within DSDMs at nine facilities in East Central Uganda. Eligible patients were adult PLHIVs active on ART and enrolled in a DSDM (Community Client Led ART Delivery (CCLAD), Community Drug Distribution Points (CDDP) and Fast-Track Drug Refill (FTDR) models) for at-least twelve months. Data was collected over two months (June-July 2019). A validated tool was used to assess PLHIV satisfaction with service delivery in DSD. Logistic regression was used to establish factors associated with patient satisfaction with DSD services. Results Overall out of the 842 participants enrolled onto the study, 530(63.5%) accessed HIV care through CDDPs, 166(20.1%) through CCLAD, and 146 (16.3%) through FTDR DSDMs. Generally, 541 (64.2%) were satisfied with DSDM services : 78.7% in CDDP, 42.8% in CCLAD and 36.3% in CCLAD. The factors associated with patient satisfaction were being on CDDP [aOR = 3.42, 95% CI = 2.15–5.44] and FTDR[aOR = 2.92, 95% CI = 1.34–6.31] DSDMs relative to CCLAD, greater than three years on DSDM [aOR = 2.32, 95% CI = 1.12–4.87], lower transport costs (< $ 1.35) per clinic visit [aOR = 2.39, 95% CI = 1.59–3.60] being employed either in agriculture[aOR = 4.41, 95% CI = 2.62–7.41] or any other employment sector [aOR = 4.22, 95% CI = 2.46–7.27]relative to being unemployed, participation of a friend/relative [aOR = 1.79, 95% CI = 1.22–2.61] and not drinking alcohol [aOR = 2.33, 95% CI = 1.24–4.29]. Conclusions The study highlighted that 64.2% of the patients are satisfied with services in DSDM. Service delivery factors (DSDM model type, time spent in DSDM, and having friend or relative enrolled at the ART point providing social support), social factors (employment, and alcohol consumption), and transport costs were all associated with patient satisfaction with DSDM. Implementers of DSDMs need to further adapt services to address these factors to improve patient satisfaction in DSDMs.
The International Initiative for Impact Evaluation (3ie) promotes evidence-informed equitable, inclusive and sustainable development. We support the generation and effective use of high-quality evidence to inform decision-making and improve the lives of people living in poverty in low-and middle-income countries. We provide guidance and support to produce, synthesise and quality assure evidence of what works, for whom, how, why and at what cost. 3ie working papersThese papers cover a range of content. They may focus on current issues, debates and enduring challenges facing development policymakers, programme managers, practitioners and the impact evaluation and systematic review communities. Policyrelevant papers in this series synthesise or draw on relevant findings from mixed-method impact evaluations, systematic reviews funded by 3ie, as well as other rigorous evidence to offer new analyses, findings, insights and recommendations. Papers focusing on methods and technical guides also draw on similar sources to help advance understanding, design and use of rigorous and appropriate evaluations and reviews. We also use this series to publish lessons learned from 3ie grant-making and contributions from 3ie's senior research fellows. About this working paperThis paper, Literature review on selected factors influencing Iron Folic Acid Supplementation in Kenya and East Africa, is a review of published literature using a grounded theory approach to better understand what is known about the identified bottlenecks of the delivery system for IFA supplementation during pregnancy and how they affect consumption and adherence to IFA supplements. The desk study sought to generate preliminary theories about factors affecting the consumption of IFA supplements during pregnancy. The goal was to generate a list of factors for each bottleneck that influences consumption of IFA supplements, which could inform future behavioral change interventions. This paper has not been copyedited but has been formatted for publication by 3ie.
The International Initiative for Impact Evaluation (3ie) promotes evidence-informed equitable, inclusive and sustainable development. We support the generation and effective use of high-quality evidence to inform decision-making and improve the lives of people living in poverty in low-and middle-income countries. We provide guidance and support to produce, synthesise and quality assure evidence of what works, for whom, how, why and at what cost. 3ie working papersThese papers cover a range of content. They may focus on current issues, debates and enduring challenges facing development policymakers, programme managers, practitioners and the impact evaluation and systematic review communities. Policyrelevant papers in this series synthesise or draw on relevant findings from mixed-method impact evaluations, systematic reviews funded by 3ie, as well as other rigorous evidence to offer new analyses, findings, insights and recommendations. Papers focusing on methods and technical guides also draw on similar sources to help advance understanding, design and use of rigorous and appropriate evaluations and reviews. We also use this series to publish lessons learned from 3ie grant-making and contributions from 3ie's senior research fellows. About this working paperThe bottleneck assessment and inventory are core components of the Implementation Science Initiative. It was conducted with national stakeholders to identify major systems-level challenges affecting access to and utilization of iron-folic acid supplements for pregnant women in East Central Uganda. It was routinely updated to track progress on bottlenecks, actions undertaken, results achieved, and lessons learned during the Implementation Science Initiative in Uganda (2018Uganda ( -2020. A summary of insights from the workshop are presented in this paper, Assessing bottlenecks within Iron and Folic Acid Supplementation Delivery in Uganda: a workshop report. This paper has not been copyedited but has been formatted for publication by 3ie.
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