Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda

Abstract Background The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities (‘hubs’) and lower-level health facilities (‘spokes’) in Phalombe district, Malawi and in Kalungu district, Uganda. Methods We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). Results In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1–Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1–Q2; p