Diminishing Availability of Publicly Funded Slots for Antiretroviral Initiation among HIV-Infected ART-Eligible Patients in Uganda

被引:36
作者
Geng, Elvin H. [1 ]
Bwana, Mwebesa B. [3 ]
Kabakyenga, Jerome [3 ]
Muyindike, Winnie [3 ]
Emenyonu, Nneka I. [3 ,4 ]
Musinguzi, Nicholas [3 ]
Mugyenyi, Peter [3 ]
Martin, Jeffrey N. [1 ,2 ]
Bangsberg, David R. [3 ,4 ]
机构
[1] San Francisco Gen Hosp, Dept Med, Div HIV AIDS, San Francisco, CA 94110 USA
[2] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[3] Mbarara Univ Sci & Technol, Mbarara, Uganda
[4] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Ragon Inst,Massachusetts Inst Technol & Harvard,C, Boston, MA USA
来源
PLOS ONE | 2010年 / 5卷 / 11期
基金
美国国家卫生研究院;
关键词
SUB-SAHARAN AFRICA; ADHERENCE; IMPACT;
D O I
10.1371/journal.pone.0014098
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background: The impact of flat-line funding in the global scale up of antiretroviral therapy (ART) for HIV-infected patients in Africa has not yet been well described. Methods: We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, Uganda between April 1, 2009 and May 14, 2010 where four stakeholders sponsor treatment - two PEPFAR implementing organizations, the Ugandan Ministry of Health - Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF). We assessed temporal trends in the number of eligible patients, the number starting ART and tabulated the distribution of the stakeholders supporting ART initiation by month and quartile of time during this interval. We used survival analyses to assess changes in the rate of ART initiation over calendar time. Findings: A total of 1309 patients who were eligible for ART made visits over the 14 month period of the study and of these 819 started ART. The median number of ART eligible patients each month was 88 (IQR: 74 to 115). By quartile of calendar time, PEPFAR and MOH sponsored 290, 192, 180, and 49 ART initiations whereas the FTF started 1, 2, 1 and 104 patients respectively. By May of 2010 (the last calendar month of observation) FTF sponsored 88% of all ART initiations. Becoming eligible for ART in the 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) quartiles (HR = 0.49, 95% CI: 0.36-0.65) was associated with delay in ART initiation compared to the first quartile in multivariable analyses. Interpretation: During a period of flat line funding from multinational donors for ART programs, reductions in the number of ART initiations by public programs (i.e., PEPFAR and MOH-GF) and delays in ART initiation became apparent at the a large prototypical scale-up ART clinic in Uganda.
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页数:5
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