Antiretroviral treatment of HIV in Uganda: a comparison of three different delivery models in a single hospital.

This exploratory study examined health worker's perspectives and the type of HIV care received in three different delivery models of antiretroviral treatment (ART) at St Francis Hospital, Kampala, Uganda. Two of the clinics were financed by external donors and the third through out-of-pocket payments. Key informant interviews with health workers investigated potential challenges with ART care, and exit interviews with patients collected data on the care received. Despite the fact that all three clinics were located in the same hospital, services offered and quality of care varied extensively. Health staff at all ART clinics identified the lack of collaboration between different HIV programmes and low patient adherence as the main challenges. More women than men accessed ART through the externally financed programmes. These programmes provided more comprehensive care because of higher staff density and more frequent laboratory monitoring compared to the private clinic. Despite these shortcomings and the fact that prescriptions were often renewed without a preceding medical check-up at the private clinic, many chose to pay a monthly average equivalent of US$60 for ART in return for privacy and access to drugs without HIV disclosure requirements. Stigma and fear of abandonment were thought to be the main barriers for access to ART.