1. Zakumumpa Henry1, Galarraga Omar2, Bennett Sara3, Ssengooba Freddie.1
WEPED885.
A comparison of the institutionalization of ART interventions in four categories of health facilities in Uganda
Zakumumpa Henry1, Galarraga Omar2, Bennett Sara3, Ssengooba Freddie.1
1Makerere University, School of Public Health, Kampala, Uganda, 2Brown University, School of Public Health, Providence, United States, 3Johns Hopkins University, School of Public Health, Baltimore, United States

2. Background Objectives:
Uganda implemented a national antiretroviral therapy (ART) roll-out program between 2004 and 2009 with external donor support.
ART was delivered in vertical mode and was not integrated with other facility services.
There has been limited research evaluating program sustainability outcomes since the initial implementation phase.
Institutionalization is widely regarded as an important indicator of program sustainability.
Objectives:
To measure the level of institutionalization of ART in 195 health facilities which received donor support between 2004 and 2009.
To compare level of institutionalization scores by health facility category.

3. Methods Data collection: Study population: Data analysis:
Nationally-representative sample of health facilities across Uganda (n=195).
Health facilities which initiated ART between 2004 and 2009 based on MoH June 2010 Report.
Health facilities were categorized as Public, Private for Profit (PFP), Private Not for Profit (PNFP) and
HIV Research Clinics
Data collection:
Adapted Level of Institutionalization (LoIn) instrument developed by Goodman, et al (1993) was filled by 195 ART Clinic Managers.
Data analysis:
Descriptive statistics were generated and used to describe organizational characteristics and calculate and then rank health facilities into quartiles based on their mean institutionalization scores.

4. Methods cont’d The LoIn Questionnaire:
b) Institutionalization was measured on two levels:
The 45-item questionnaire assessed institutionalization based on :
a) Four ‘Sub-systems’ (Production, Maintenance, Supportive, Managerial) theorized to make up a health facility.
i) Routines (Lower). Assesses the extent ART procedures are integrated within a facility.
ii) Niche saturation (Highest) the maximum possible expansion of ART within an organization.

5. Summary of overall Total Means
Results
Score comparison by health facility category:
The overall mean institutionalization score for participating health facilities was 3.5 (Range, 1-4).
The mean score for niche saturation, the highest level of institutionalization, was 3.2 (Range,1-4).
Facility type
Summary of overall Total Means
Mean
Standard Deviation
Public
12.0
5.0
Private FP
10.8
5.7
Private NFP
13.2
5.2
HIV Research Clinics
17.7
7.0
Of the four systems, the production sub system, concerned with ART product delivery activities, scored the highest mean component score.
The Managerial sub system concerned with ART program supervision and evaluation had the lowest mean component score.

6. Conclusion
ART interventions have become institutionalized at participating health facilities. However, scores for the highest level of institutionalization were moderate.
Programs aimed at deepening the institutionalization of ART interventions in Private (PFPs) health facilities are recommended.
ART program supervision and evaluation is deficient across all health facility categories and needs strengthening.
Mainstreaming best practices of health facilities with the highest institutionalization scores could enhance the sustainability of ART in Uganda and other resource-limited settings.