Makerere University, School of Public Health, Kampala, Uganda.
Kabale University, School of Medicine, Kabale, Uganda.
BMC Health Serv Res. 2021 Jul 13;21(1):692. doi: 10.1186/s12913-021-06607-w.
The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown.
We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach.
Five broad strategies for distributing antiretrovirals during 'lockdown' emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities.
While Covid-19 'lockdown' restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.
在当前关于新冠疫情应对的文献中，卫生系统弹性的概念很少受到实证关注。我们旨在探讨乌干达省级以下卫生系统在新冠疫情封锁期间分发抗逆转录病毒药物的弹性策略。
我们对乌干达东部和西部的 8 个地区进行了一项定性案例研究。在 2020 年 6 月至 9 月期间，我们对地区卫生团队负责人（n=9）、抗逆转录病毒治疗（ART）诊所经理（n=36）、PEPFAR 实施组织代表（n=6）进行了定性访谈。此外，还与 6 名接受艾滋病毒护理的人员（48 名参与者）进行了 6 次焦点小组讨论。使用主题方法分析定性数据。
在我们的分析中，出现了五种在“封锁”期间分发抗逆转录病毒药物的广泛策略：加速家庭为基础的抗逆转录病毒药物的交付；将稳定患者的多剂量配药从三个月延长至六个月；利用社区药物分发点（CDDP）模式在社区外展点进行 ART 补药领取；增加对卫生信息系统的依赖，包括地理空间技术，以支持在未映射的农村地区进行 ART 补充分发。地区卫生团队报告说，他们利用新冠疫情爆发应对资金向农村社区的家庭提供 ART 补药。
虽然新冠疫情“封锁”限制无疑阻碍了获得以机构为基础的艾滋病毒服务，但它们激发了提供者和患者对乌干达案例研究地区以社区为基础的 ART 交付模式的兴趣。
