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Private-for-Profit HIV/AIDS Care in Uganda: An Assessment

Kyayise AM | Kyeyagalire R | Livesley N | Kirunda I | Tumwesigye B | Kinoti S | Katungu D
Organization: USAID Health Care Improvement Project/URC

Improvement Topics: Adherence to treatment, HIV/AIDS, Antiretroviral therapy/ART/ARV, HIV/AIDS basic care and support, PMTCT, Retention in care

Region and Country: Uganda


Nearly half of Uganda’s health care facilities are private and for-profit, and a small percentage has been accredited to provide care and treatment to people with HIV/AIDS. However, little is known about the quality of care offered by private-for-profit (PFP) providers. This study assessed 30 of the 36 accredited PFP providers in Uganda to determine the scope and quality of their HIV/AIDS services. A major finding of the assessment was that PFP provider adherence with standards of care was good in the first visit, particularly for clinical activities, but declined over time; provider adherence to standards was also generally higher for ART services that for pre-ART care. The assessment found that recordkeeping, essential for care of a long-term illness, was poor: Of 1500 patient records sought, only 371 were located. Finally, patient retention in care was also poor: Of the 210 ART patients whose records were assessed, 93% were still in care after one month, 86% after three months, 76% after six months, but only 66% after nine months. After the initial visit, pre-ART patients returned to the facility a median of four times in the next 12 months, well short of the Ministry’s recommendation that a patient return monthly.  Moreover, rates for starting eligible patients are ART were also low: 21% of pre-ART patients became eligible in the second six months after registration on the basis of CD4 count, but only 20% of them started ART.  The study recommended that PFPs receive support to enable them to regularly measure and report on indicators of patient retention, adherence with standards, and patient outcomes and to use these data to improve care.  The full report includes the study instruments.