Many of the 1.3 million people living with HIV in Uganda are responding well to antiretroviral therapy (ART). However, to access their medication, patients on ART need to visit a healthcare centre every three months, which can be onerous for both recipients of care and the facilities that serve them. To help people living with HIV access their chronic medication easily, increase ART adherence rates and decongest health facilities, the Ministry of Health’s (MoH) AIDS Control Programme (ACP) has been working with its partners to implement alternative drug distribution models.
The ACP approached the Africa Resource Centre (ARC) to explore possible alternative drug distribution models suitable for the Ugandan context. In the first phase of the process, ARC did an extensive assessment of the geographical distribution of people living with HIV and public and private healthcare facilities in Uganda. It then developed and proposed two differentiated channel delivery models – one for rural recipients of care and the other for urban recipients of care. The project’s first phase also included advocacy initiatives to encourage buy-in from recipients of care, healthcare workers, pharmacies, and MoH stakeholders. Pilots of both the urban community retail pharmacy drug distribution (CRPDDP) model and the rural community led drug distribution point (CLDDP) were then implemented. The next phase of the project to roll out and scale up the models is now underway, and ARC is applying learnings and feedback from the pilot phase to refine and extend the reach of the two approaches. Online dashboards were created to track the progress of the pilots. This information has been vital in preparing for the scaling up of CRPDDP.
OUTCOMES AND IMPACT
ARC’s support to ministries of health focuses on strengthening six supply chain elements. The rollout phase of work on ADDPs in Uganda will strengthen four of these six areas: strategy, improvement roadmap, governance, and policies and research.
LARGE-SCALE COMMUNICATIONS STRATEGY
Key element: strategy
Communities are embracing the decentralised services to make their lives and adherence to medication better. A campaign will be launched on TV and social media about the alternative drug distribution models to encourage more extensive uptake amongst people living with HIV.
Dashboard data showed that uptake during the pilots was higher among female recipients of care. These insights will inform advocacy and communications approaches in the scaling up of the models.
RESPONSIVE ENGAGEMENT WITH HEALTHCARE WORKERS
Key element: improvement roadmap
ARC and its partners engaged with healthcare workers, pharmacy stakeholders and MoH officials to equip them to implement the piloted models effectively. They also hosted information sessions to get feedback for the scaling up of the alternative distribution approaches.
There is consistent demand in communities for healthcare services and access to medications, which will be increasingly met through patient-centric models like CRPDDP and CLDDP.
POSITIVE UPTAKE DURING THE PILOT PHASE
Key elements: governance and policies and research
Communities are embracing the decentralised services to make their lives and adherence to medication better.
During the pilot phase, 85.6% of the target number of pharmacies completed the process to become part of the CRPDDP model.