Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Strengthening health systems at facility-level: Feasibility of integrating antiretroviral therapy into primary health care services in Lusaka, Zambia
PLoS ONE, Volume 5, No. 7, Article e11522, Year 2010
Notification
URL copied to clipboard!
Description
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. © 2010 Topp et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2903482/bin/pone.0011522.s001.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC2903482/bin/pone.0011522.s002.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC2903482/bin/pone.0011522.s003.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC2903482/bin/pone.0011522.s004.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC2903482/bin/pone.0011522.s005.tif
Authors & Co-Authors
Topp, Stephanie M.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Chipukuma, Julien M.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Giganti, Mark Joseph
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Mwango, Linah K.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Chiko, Like M.
Zambia, Lusaka
Lusaka District Health Management Team
Tambatamba, Bushimbwa
Zambia, Lusaka
Zambian Ministry of Health
Wamulume, Chibesa S.
Zambia, Lusaka
Lusaka District Health Management Team
Reid, Stewart E.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Statistics
Citations: 82
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0011522
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Approach
Qualitative
Study Locations
Zambia