Benefit incidence analysis of antiretroviral drugs in Uganda : a case study of Kampala and Masaka districts

Master Thesis


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University of Cape Town

In the face of rising morbidity and mortality due to HIV / AIDS epidemic in Sub-Saharan Africa, there has been an increasing pressure to provide life sustaining antiretroviral (ARV) drugs to countries in most urgent need of them. Antiretroviral Therapy (ART) has been identified by policy-makers in Uganda as a potential programme aimed at mitigating the pervasive effect of HIV / AIDS on the social and economic life of the country. Since 2000, the country has shifted its focus from primarily HIV prevention to paying equal attention to care and treatment including ART. Provision of the ART programmes have been made possible through concerted efforts of international and national organizations such as the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank, Multi-country AIDS Programme (MAP), Great Lakes Initiative on AIDS (GLIA), the USA President's Emergency Plan for AIDS Relief (PEPFAR), UN agencies, Bi-lateral and Government of Uganda inputs (UAC 2004). New and increased funding notwithstanding, the Ugandan population has continued to grow exponentially at a rate of 3.5% and even though the economy has been growing at a rate of 6 % per annum, there is a widening disparity in incomes attributed largely to high levels of unemployment in the country (Ministry of Finance 2002). These income disparities have also greatly contributed to health inequities in Uganda, thus affecting the equitable allocation of the limited health resources including ART. The main aim of the study was to establish the socioeconomic status of those individuals who benefit most from the provision of free ARV drugs and to explore factors that influence the distribution of such benefits. The study was carried out in Kampala district (Uganda's capital city) and Masaka district. The study employed both qualitative and quantitative methods. Facility-exit interviews with patients accessing free ARVs formed the quantitative method, while Focus Group discussions with community representatives and in-depth interviews with key informants formed the qualitative part of the study. Quantitative data was obtained by use of a questionnaire, which was structured to obtain information on socioeconomic characteristics, including asset possession as a measure of wealth. A principal component analysis was run for both the Uganda Demographic Health Survey (UDHS) and facility-exit asset data to determine utilization of ARV by wealth quintiles. A benefit incidence costing model was also employed to determine monetary benefit of free ARVs in Uganda.

Includes bibliographical references (leaves 118-127).