262907 Methods for determining the Impact of Global HIV/AIDS investment on the health systems of low income countries: A case study from Uganda

Wednesday, October 31, 2012 : 8:30 AM - 8:50 AM

Amy Hagopian, PhD , School of Public Health, Dept of Global Health, University of Washington, Seattle, WA
Samuel Luboga, MBChB, MMed (Surg), PhD , Medical School, Makerere University, Kampala, Uganda
Nagesh Borse, PhD , CGH/Hesib/Hshr, Centers for Disease Control & Prevention, Atlanta, GA
Eddie Mukooyo, MbChB , Resource Center, Uganda Ministry of Health, Kampala, Uganda
Bert Stover, PhD , University of Washington, Seattle, WA
Fred Makumbi, PhD , School of Public Health, Makerere University, Kampala, Uganda
Noah Kiwanuka, PhD , School of Public Health, Makerere University, Kampala, Uganda
Chijioke Okoro, MPH , Health System and Human Resources Division of Global HIV/AIDS Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA
Michael Friedman, MD, MPH , DGH, CDC, Atlanta, GA
Scott Barnhart, MD, MPH , Department of Global Health, University of Washington, Seattle, WA
The US President's Emergency Plan for AIDS Relief (PEPFAR) has invested more than $30 billion in the care, treatment and prevention of HIV/AIDS. While many studies show the impact of this program in successfully controlling the HIV epidemic in many low-resource settings, there is a growing interest in understanding the collateral impact of large disease-specific programs on services for other diseases and the country's health system. For example, has the focus on HIV/AIDS helped to improve the competency of health workers in other disease areas? Conversely, has PEPFAR investment shifted health care workers away from care of patients with non-HIV conditions? Using the case study of Uganda, we explore how PEPFAR investments affected utilization of other health services and the broader health system. We collected qualitative and quantitative data from 112 health district offices and 336 health facilities across Uganda, looking for changes in the health system between 2005 (when PEPFAR investments began) and the current time. We describe the variation in PEPFAR investments by district, and associated utilization changes in non-HIV services, especially outpatient, maternity and newborn care. We controlled for confounders and effect modifiers. Findings from this study can inform how future investments in disease-specific interventions can simultaneously strengthen the whole health system.

Learning Areas:
Administer health education strategies, interventions and programs

Learning Objectives:
1. Integrate thinking about vertical and horizontal health interventions; 2. Explore the variable effects of PEPFAR interventions in a single high-focus country; 3. Demonstrate an understanding of the health information system in a developing country.

Keywords: HIV Interventions, System Involvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am co-PI on the study in Uganda, and teach global public health at the university of Washington.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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