ArticlePloS one2019
The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Article
- Article
- Transitioning a large-scale HIV/AIDS treatment program from an international partner to a local Nigerian implementing partner: a before-after early outcomes assessment study.BMC health services research · 2025Article
- Potential Clinical and Economic Impacts of Cutbacks in the President's Emergency Plan for AIDS Relief Program in South Africa : A Modeling Analysis.Annals of internal medicine · 2025Article
- Shaping sustainable paths for HIV/AIDS funding: a review and reminder.Annals of medicine and surgery (2012) · 2025Review
- The impact of shifts in PEPFAR funding policy on HIV services in Eastern Uganda (2015-21).Health policy and planning · 2024Article
- From External to Local: Opportunities and Lessons Learned from Transitioning COMSA-Mozambique.The American journal of tropical medicine and hygiene · 2023Article
- Geographic prioritisation in Kenya and Uganda: a power analysis of donor transition.BMJ global health · 2023Article
- Stakeholders' Perspectives on the Financial Sustainability of the HIV Response in Nigeria: A Qualitative Study.Global health, science and practice · 2023Article
- Perspectives of frontline health workers on transition from development assistance for health in Ghana: A qualitative study.PLOS global public health · 2022Article
- Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda.Globalization and health · 2021Article
- Associations between Natural Resource Extraction and Incidence of Acute and Chronic Health Conditions: Evidence from Tanzania.International journal of environmental research and public health · 2021Article
- Effects of transition on HIV and non-HIV services and health systems in Kenya: a mixed methods evaluation of donor transition.BMC health services research · 2021Article
- The impact of loss of PEPFAR support on HIV services at health facilities in low-burden districts in Uganda.BMC health services research · 2021Article
- Program sustainability post PEPFAR direct service support in the Western Cape, South Africa.PloS one · 2021Article
- Data cleaning process for HIV-indicator data extracted from DHIS2 national reporting system: a case study of Kenya.BMC medical informatics and decision making · 2020Article
- How donors support civil society as government accountability advocates: a review of strategies and implications for transition of donor funding in global health.Globalization and health · 2020Review
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Authors and funding
7 authors.
Funding
Abstract
backgroundSince 2004, the President's Emergency Plan for AIDS Relief (PEPFAR) has played a large role in Uganda's HIV/AIDS response. To better target resources to high burden regions and facilities, PEPFAR planned to withdraw from 29% of previously-supported health facilities in Uganda between 2015 and 2017.
methodsWe conducted a cross-sectional survey of 226 PEPFAR-supported health facilities in Uganda in mid-2017. The survey gathered information on availability, perceived quality, and access to HIV services before and after transition. We compare responses for facilities transitioned to those maintained on PEPFAR, accounting for survey design. We also extracted data from DHIS2 for the period October 2013-December 2017 on the number of HIV tests and counseling (HTC), number of patients on antiretroviral therapy (Current on ART), and retention on first-line ART (Retention) at 12 months. Using mixed effect models, we compare trends in service volume around the transition period.
resultsThere were 206 facilities that reported transition and 20 that reported maintenance on PEPFAR. Some facilities reporting transition may have been in a gap between implementing partners. The median transition date was September 2016, nine months prior to the survey. Transition facilities were more likely to discontinue HIV outreach following transition (51.6% vs. 1.4%, p<0.001) and to report declines in HIV care access (43.5% vs. 3.1%, p<0.001) and quality (35.6% vs. 0%, p<0.001). However, transition facilities did not differ in their trends in HIV service volume relative to maintenance facilities.
conclusionsTransition from PEPFAR resulted in facilities reporting worsening patient access and service quality for HIV care, but there is insufficient evidence to suggest negative impacts on volume of HIV services. Facility respondents' perceptions about access and quality may be overly pessimistic, or they may signal forthcoming impacts. Unrelated to transition, declining retention on ART in Uganda is a cause for concern.
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