Abongomera George, Chiwaula Levison, Revill Paul, Mabugu Travor, Tumwesige Edward, Nkhata Misheck, Cataldo Fabian, van Oosterhout J, Colebunders Robert, Chan Adrienne K, Kityo Cissy, Gilks Charles, Hakim James, Seeley Janet, Gibb Diana M, Ford Deborah
Department of Research, Joint Clinical Research Centre, Kampala, Uganda.
Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
Int Health. 2018 Jan 1;10(1):8-19. doi: 10.1093/inthealth/ihx061.
The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ('hubs') and lower-level health facilities ('spokes') in Phalombe district, Malawi and in Kalungu district, Uganda.
We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46).
In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1-Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1-Q2; p<0.001). In Uganda, 7% of patients mapped to Q1-Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1-Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30-120) in Malawi and 30 min (IQR 20-60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs.
Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.
Lablite项目收集了马拉维法隆贝区和乌干达卡伦古区较大型医疗机构（“枢纽”）及较低层级医疗机构（“分支”）的抗逆转录病毒疗法（ART）获取情况信息。
我们对治疗开始后转至分支的患者（马拉维，n = 54；乌干达，n = 33）、在分支开始治疗的患者（马拉维，n = 50；乌干达，n = 44）以及在枢纽接受治疗的患者（马拉维，n = 44；乌干达，n = 46）进行了横断面调查。
在马拉维，47%的患者属于最贫困的两个财富五分位数（Q1 - Q2）；分支的患者比枢纽的患者更贫困（Q1 - Q2中分别为57%和23%；p < 0.001）。在乌干达，7%的患者属于Q1 - Q2；农村分支的患者比两个城郊医疗机构的患者更贫困（Q1 - Q2中分别为15%和4%；p < 0.001）。在马拉维，前往当前ART医疗机构的单程中位时间为60分钟（四分位间距3照 - 120），在乌干达为30分钟（四分位间距20 - 60）。转至分支的患者报告称，在马拉维旅行时间中位减少了90分钟，在乌干达减少了30分钟，同时距离和食品成本也有所降低。
抗逆转录病毒疗法的去中心化改善了治疗可及性。应考虑在社区层面提供治疗，以进一步降低成本和减少时间。
