Health system facilitators and barriers to the implementation of cotrimoxazole preventive therapy recommendations among HIV positive adults in Mityana District, Uganda

Abstract

Introduction: In Sub Saharan Africa, only 36% of those eligible for Anti Retroviral Therapy (ART) receive it. Well implemented Septrin use among HIV positives can reduce morbidity, mortality, the rate of HIV progression and the demand for ART. By July 2012, there was no published data on the implementation outcomes of the 2009 Uganda national Septrin guidelines. Objective: The objective of this study was to assess the barriers and facilitators to the implementation of the 2009 Uganda Septrin guidelines in Mityana district, Uganda. Methodology: A cross sectional review the 2008 and 2010 HIV/AIDS records to determine improvements in the outcomes of taking septrin was conducted. KI interviews and FGDs were conducted on the perspectives towards Septrin guidelines implementation using a deductive approach guided by the seven Health Policy Initiative Policy Implementation Barriers Analysis dimensions. Analysis was done by comparing proportions and deductive content analysis. Results and interpretation: Results did not show significant improvement in the outcomes of Septrin among adult persons living with HIV/AIDS. Inadequate policy dissemination, inadequate planning, inadequate coordination and low motivation among implementers were significant explanatory variables to the outcomes. Conclusions and recommendations: From this study, implementation of the 2009 Uganda Septrin guidelines had not yet resulted into improved Septrin outcomes among adults living with HIV/AIDS in Mityana district. District multi departmental capacity building in policy implementation through training, joint planning with Implementing Partners, empowerment of Network Support Agents and Expert clients and conduction of Septrin refills at lower health facilities can improve the implementation success of Septrin guidelines in Mityana district.