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The potential to expand antiretroviral therapy by improving health facility efficiency: evidence from Kenya, Uganda, and Zambia

Overview of attention for article published in BMC Medicine, July 2016
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (93rd percentile)
  • Good Attention Score compared to outputs of the same age and source (75th percentile)

Mentioned by

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4 news outlets
twitter
10 X users
facebook
1 Facebook page

Citations

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20 Dimensions

Readers on

mendeley
85 Mendeley
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Title
The potential to expand antiretroviral therapy by improving health facility efficiency: evidence from Kenya, Uganda, and Zambia
Published in
BMC Medicine, July 2016
DOI 10.1186/s12916-016-0653-z
Pubmed ID
Authors

Laura Di Giorgio, Mark W. Moses, Nancy Fullman, Alexandra Wollum, Ruben O. Conner, Jane Achan, Tom Achoki, Kelsey A. Bannon, Roy Burstein, Emily Dansereau, Brendan DeCenso, Kristen Delwiche, Herbert C. Duber, Emmanuela Gakidou, Anne Gasasira, Annie Haakenstad, Michael Hanlon, Gloria Ikilezi, Caroline Kisia, Aubrey J. Levine, Mashekwa Maboshe, Felix Masiye, Samuel H. Masters, Chrispin Mphuka, Pamela Njuguna, Thomas A. Odeny, Emelda A. Okiro, D. Allen Roberts, Christopher J. L. Murray, Abraham D. Flaxman

Abstract

Since 2000, international funding for HIV has supported scaling up antiretroviral therapy (ART) in sub-Saharan Africa. However, such funding has stagnated for years, threatening the sustainability and reach of ART programs amid efforts to achieve universal treatment. Improving health system efficiencies, particularly at the facility level, is an increasingly critical avenue for extending limited resources for ART; nevertheless, the potential impact of increased facility efficiency on ART capacity remains largely unknown. Through the present study, we sought to quantify facility-level technical efficiency across countries, assess potential determinants of efficiency, and predict the potential for additional ART expansion. Using nationally-representative facility datasets from Kenya, Uganda and Zambia, and measures adjusting for structural quality, we estimated facility-level technical efficiency using an ensemble approach that combined restricted versions of Data Envelopment Analysis and Stochastic Distance Function. We then conducted a series of bivariate and multivariate regression analyses to evaluate possible determinants of higher or lower technical efficiency. Finally, we predicted the potential for ART expansion across efficiency improvement scenarios, estimating how many additional ART visits could be accommodated if facilities with low efficiency thresholds reached those levels of efficiency. In each country, national averages of efficiency fell below 50 % and facility-level efficiency markedly varied. Among facilities providing ART, average efficiency scores spanned from 50 % (95 % uncertainty interval (UI), 48-62 %) in Uganda to 59 % (95 % UI, 53-67 %) in Zambia. Of the facility determinants analyzed, few were consistently associated with higher or lower technical efficiency scores, suggesting that other factors may be more strongly related to facility-level efficiency. Based on observed facility resources and an efficiency improvement scenario where all facilities providing ART reached 80 % efficiency, we predicted a 33 % potential increase in ART visits in Kenya, 62 % in Uganda, and 33 % in Zambia. Given observed resources in facilities offering ART, we estimated that 459,000 new ART patients could be seen if facilities in these countries reached 80 % efficiency, equating to a 40 % increase in new patients. Health facilities in Kenya, Uganda, and Zambia could notably expand ART services if the efficiency with which they operate increased. Improving how facility resources are used, and not simply increasing their quantity, has the potential to substantially elevate the impact of global health investments and reduce treatment gaps for people living with HIV.

X Demographics

X Demographics

The data shown below were collected from the profiles of 10 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 85 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
South Africa 1 1%
Unknown 84 99%

Demographic breakdown

Readers by professional status Count As %
Researcher 14 16%
Student > Master 13 15%
Student > Doctoral Student 8 9%
Student > Bachelor 8 9%
Student > Ph. D. Student 8 9%
Other 12 14%
Unknown 22 26%
Readers by discipline Count As %
Medicine and Dentistry 17 20%
Nursing and Health Professions 11 13%
Social Sciences 6 7%
Agricultural and Biological Sciences 4 5%
Unspecified 4 5%
Other 15 18%
Unknown 28 33%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 32. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 June 2017.
All research outputs
#1,196,493
of 24,855,923 outputs
Outputs from BMC Medicine
#841
of 3,866 outputs
Outputs of similar age
#23,021
of 372,093 outputs
Outputs of similar age from BMC Medicine
#12
of 45 outputs
Altmetric has tracked 24,855,923 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,866 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 45.2. This one has done well, scoring higher than 78% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 372,093 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 45 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 75% of its contemporaries.