A comparative analysis of primary antiretroviral therapy outcomes by service provider type in Blantyre District, Malawi
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Date
2022-03-01
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Abstract
The Antiretroviral Therapy (ART) Program for Malawi started in 2004 and the key
providers in provision of ART services in Malawi include; the public sector, the private
sector for-profit and non-profit and Christian Health Association of Malawi (CHAM).
Since then, no known studies have been conducted to compare primary ART treatment
outcomes by service provider type thus public, private and CHAM. In addition,
information on variation of primary ART treatment outcomes by service provider type is
not known and probably has not been published The Objective was to examine primary
Antiretroviral Therapy outcomes in Blantyre District using ART data from 1st January
2017 to 31st December, 2018 in public, private and Christian Health Association of
Malawi ART clinics
This was a cross-sectional study and utilized both quantitative and qualitative methods.
The quantitative method used facility level secondary data from the Malawi National ART
Program in the Ministry of Health HIV AIDS Department. The qualitative method used
in-depth interviews using an interview guide to key informants. Data was analysed using
STATA statistical software package version 15.Analysis of Variance (ANOVA) was used
to compare the variations of primary ART outcomes among in public, private and CHAM
ART sites. To compare proportions, the researcher used Scheffe's-Test. The qualitative
data was analyzed using thematic analysis to explain the relationship between the
variables.
Overall the findings indicate that Primary Antiretroviral Therapy Outcomes in Public,
Private and CHAM ART Clinics are different. According to the results, there are more
defaulters in the public ART clinics followed by private and lowest in the CHAM ART
sites. This may be attributed lack of privacy and confidentiality, stigma and discrimination
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and long distance to the health facility which result in high cost expenses.Overall died on
ART outcome is higher in private ART clinics compared to public and CHAM ART
clinics and no significant differences between public and private ART clinics. The study
has also clearly demonstrated that the private ART clinics have more transfer outs than
public and CHAM due to change of location for work related issues of the clients.
Retention in care (Alive on ART) is high in CHAM ART Clinics followed by public then
lastly private. Generally, stop on ART is not a common outcome in all service provider
types.
Overall the findings indicate that Primary Antiretroviral Therapy Outcomes in Public,
Private and CHAM ART Clinics are different. Some of the factors contributing to the
primary Art outcomes include; lack of privacy and confidentiality, stigma and
discrimination and long distance to the health facility which result in high cost expenses
and change of location for work related issues of the clients. Generally, stop on ART is not
a common outcome in all service provider types.