Burua Aldomoro, Nuwaha Fred, Waiswa Peter
Makerere University School of Public Health, College of Health Sciences, Kampala, Uganda.
Management Sciences for Health, Kampala, Uganda.
BMC Health Serv Res. 2014 Nov 18;14:521. doi: 10.1186/s12913-014-0521-5.
Over one million people in Uganda are estimated to be infected with HIV and about 20% of these were already accessing antiretroviral therapy (ART), by 2010. There is a dearth of data on adherence to antiretroviral therapy and yet high client load on a weak and resource constrained health system impacts on provision of quality HIV/AIDS care. We assessed adherence to standards of HIV care among health workers in the West Nile Region of Uganda.
We conducted a cross sectional study in nine health facilities. Records of a cohort of 270 HIV clients that enrolled on ART 12 months prior were assessed. The performance of each health facility on the different indicators of standards of HIV/AIDS care was determined and compared with the recommended national guidelines.
We found that 94% of HIV clients at all the facilities were assessed for ART eligibility using WHO clinical staging while only two thirds (64.8%) were assessed using CD4. Only 42% and 37% of HIV clients at district hospitals and health centers respectively, received basic laboratory work up prior to ART initiation and about a half (46.7%) of HIV clients at these facilities received the alternative standard 1st line antiretroviral (ARV) regimen. Standards of ART adherence and tuberculosis assessment declined from over 70% to less than 50% and from over 90% to less than 70% respectively, during follow up visits with performance being poorer at the higher level regional referral facility compared to the lower level facilities.
Adherence to standards of HIV/AIDS care at facilities was inadequate. Performance was better at the start of ART but declined during the follow up period. Higher level facilities were more likely to adhere to standards like CD4 monitoring and maintaining HIV clients on standard ARV regimen. Efforts geared towards strengthening the health system, including support supervision and provision of care guidelines and job aides are needed, especially for lower level facilities.
据估计，乌干达有超过100万人感染了艾滋病毒，到2010年，其中约20%的人已经在接受抗逆转录病毒疗法（ART）。关于抗逆转录病毒疗法依从性的数据匮乏，然而，在薄弱且资源有限的卫生系统中，大量的患者给提供高质量的艾滋病毒/艾滋病护理带来了影响。我们评估了乌干达西尼罗河地区卫生工作者对艾滋病毒护理标准的依从性。
我们在9个卫生机构进行了一项横断面研究。评估了一组12个月前开始接受抗逆转录病毒疗法的270名艾滋病毒患者的记录。确定了每个卫生机构在艾滋病毒/艾滋病护理标准不同指标方面的表现，并与推荐的国家指南进行比较。
我们发现，所有机构中94%的艾滋病毒患者使用世界卫生组织临床分期评估了抗逆转录病毒疗法的适用性，而只有三分之二（64.8%）的患者使用CD4进行了评估。地区医院和卫生中心分别只有42%和37%的艾滋病毒患者在开始抗逆转录病毒疗法之前接受了基本的实验室检查，这些机构中约一半（46.7%）的艾滋病毒患者接受了替代标准的一线抗逆转录病毒（ARV）方案。在随访期间，抗逆转录病毒疗法依从性和结核病评估标准分别从超过70%下降到不到50%，从超过90%下降到不到70%，与较低级别的机构相比，较高级别的地区转诊机构的表现更差。
各机构对艾滋病毒/艾滋病护理标准的依从性不足。在抗逆转录病毒疗法开始时表现较好，但在随访期间有所下降。较高级别的机构更有可能遵守CD4监测等标准，并让艾滋病毒患者维持标准的抗逆转录病毒方案。需要努力加强卫生系统，包括支持监督、提供护理指南和工作辅助工具，特别是针对较低级别的机构。
