SUSTAINABILITY AND EQUITY IN HIV SERVICE DELIVERY FOLLOWING USAID SUPPORT CLOSE-OUT IN UGANDA: LESSONS LEARNT.
1
Bushenyi Health, Kampala, Uganda
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
USAID has been a major contributor to HIV/AIDS programs in Uganda, providing antiretroviral therapy (ART), laboratory support, and health system strengthening. While external funding has significantly improved access and outcomes, sustainability and equitable distribution of services remain pressing challenges. Understanding how programs transition from donor reliance to locally sustained models is critical for long-term epidemic control.
OBJECTIVE:
To assess the sustainability and equity of HIV service delivery among Ugandan patients following USAID donations in 2025, with a focus on ART continuity, access disparities, and health system resilience.
METHODS:
A mixed-methods study was conducted across 15 high-burden districts. Quantitative data included ART coverage, viral suppression rates, and retention-in-care metrics extracted from national HIV program databases. Equity analysis used the concentration index to evaluate disparities by geography, socioeconomic status, and gender. Qualitative data were collected through key informant interviews with healthcare providers, program managers, and patients to explore barriers and facilitators of sustainability.
RESULTS:
Following USAID support, national ART coverage increased from 82% to 91%, with viral suppression improving from 75% to 85%. However, geographic inequities persisted: rural districts experienced 12% lower ART coverage and 10% lower viral suppression compared to urban areas. Socioeconomic disparities were evident, with patients from the lowest income quintile facing greater challenges in ART adherence and retention. Qualitative findings indicated reliance on donor-supplied logistics, stockouts, and limited local funding as key barriers to sustainability. Participants emphasized the need for locally financed supply chains, decentralized community ART delivery, and capacity-building to maintain gains post-donor transition.
CONCLUSIONS:
USAID donations in 2025 significantly enhanced HIV service coverage and treatment outcomes in Uganda, but persistent geographic and socioeconomic inequities threaten long-term sustainability. Strengthening local health systems, fostering community-based service delivery, and integrating sustainable financing strategies are essential to maintain equity and continuity of HIV care.
USAID has been a major contributor to HIV/AIDS programs in Uganda, providing antiretroviral therapy (ART), laboratory support, and health system strengthening. While external funding has significantly improved access and outcomes, sustainability and equitable distribution of services remain pressing challenges. Understanding how programs transition from donor reliance to locally sustained models is critical for long-term epidemic control.
OBJECTIVE:
To assess the sustainability and equity of HIV service delivery among Ugandan patients following USAID donations in 2025, with a focus on ART continuity, access disparities, and health system resilience.
METHODS:
A mixed-methods study was conducted across 15 high-burden districts. Quantitative data included ART coverage, viral suppression rates, and retention-in-care metrics extracted from national HIV program databases. Equity analysis used the concentration index to evaluate disparities by geography, socioeconomic status, and gender. Qualitative data were collected through key informant interviews with healthcare providers, program managers, and patients to explore barriers and facilitators of sustainability.
RESULTS:
Following USAID support, national ART coverage increased from 82% to 91%, with viral suppression improving from 75% to 85%. However, geographic inequities persisted: rural districts experienced 12% lower ART coverage and 10% lower viral suppression compared to urban areas. Socioeconomic disparities were evident, with patients from the lowest income quintile facing greater challenges in ART adherence and retention. Qualitative findings indicated reliance on donor-supplied logistics, stockouts, and limited local funding as key barriers to sustainability. Participants emphasized the need for locally financed supply chains, decentralized community ART delivery, and capacity-building to maintain gains post-donor transition.
CONCLUSIONS:
USAID donations in 2025 significantly enhanced HIV service coverage and treatment outcomes in Uganda, but persistent geographic and socioeconomic inequities threaten long-term sustainability. Strengthening local health systems, fostering community-based service delivery, and integrating sustainable financing strategies are essential to maintain equity and continuity of HIV care.
| eISSN: | 2654-1459 |
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