TY - JOUR
T1 - The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda
AU - Wollum, Alexandra
AU - Dansereau, Emily
AU - Fullman, Nancy
AU - Achan, Jane
AU - Bannon, Kelsey A.
AU - Burstein, Roy
AU - Conner, Ruben O.
AU - Decenso, Brendan
AU - Gasasira, Anne
AU - Haakenstad, Annie
AU - Hanlon, Michael
AU - Ikilezi, Gloria
AU - Kisia, Caroline
AU - Levine, Aubrey J.
AU - Masters, Samuel H.
AU - Njuguna, Pamela
AU - Okiro, Emelda A.
AU - Odeny, Thomas A.
AU - Allen Roberts, D.
AU - Gakidou, Emmanuela
AU - Duber, Herbert C.
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/8/16
Y1 - 2017/8/16
N2 - 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.
AB - 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.
KW - Antiretroviral therapy
KW - HIV/AIDS
KW - Health systems
KW - Kenya
KW - Uganda
UR - http://www.scopus.com/inward/record.url?scp=85027509505&partnerID=8YFLogxK
U2 - 10.1186/s12913-017-2512-9
DO - 10.1186/s12913-017-2512-9
M3 - Article
C2 - 28814295
AN - SCOPUS:85027509505
SN - 1472-6963
VL - 17
JO - BMC health services research
JF - BMC health services research
IS - 1
M1 - 564
ER -