Health facilities in Uganda, Kenya and Zambia could extend life-sustaining antiretroviral therapy (ART) to hundreds of thousands of people living with HIV if facilities improved the efficiency of service delivery.

This is one of the main findings from a paper authored by the Institute for Health Metrics and Evaluation (IHME) and collaborators from the Infectious Diseases Research Collaboration (IDRC) in Uganda.

In this study, researchers measured the efficiency of facilities, including those providing ART services, in Uganda, Kenya and Zambia. They analyzed how efficiently health services were produced and predicted how many more ART patient visits facilities could accommodate, given their resources, if they increased efficiency.

The results of the study showed that if facilities improved their efficiency to 80 percent, there could be a 62 percent in ART visits Uganda, 33 percent increase in Kenya and 33 percent in Zambia. This means that increases in efficiency could support facilities seeing almost 460,000 new ART patients across all three countries.

Most of the health facilities according to the report relatively low in terms of efficiency – indicating that facilities could produce more services and accommodate more patients given their resources.

“Improving efficiency can support major gains in expanding ART to people who need treatment, especially when funding is limited,” IHME Assistant Professor Abraham Flaxman, senior author of the study says. “Now we, as a global health community, need to figure out how.”

The global scale-up of ART to treat HIV is one of world’s greatest success stories in health, transforming the diagnosis of HIV from an early death sentence to a controllable, chronic condition. Access to ART has rapidly increased over the past 15 years largely due to the escalation of funding for HIV/AIDS, particularly in sub-Saharan Africa.

The World Health Organization (WHO) recently recommended that all people living with HIV start ART, which establishes millions more people as eligible for treatment at a time when funding for HIV has plateaued. With constrained resources and ever-increasing demand, expanding ART services depends on the efficiency with which facilities use their resources.