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This study aimed at assessing the experiences of people living with HIV who participated in an agricultural livelihood support initiative in selected districts of Uganda. The initiative, implemented from 2017 to 2018, involved the provision of agricultural inputs such as beans, cassava cuttings, goats, chickens, and pigs to participants. In-depth interviews were conducted with 37 people (28 women and 9 men) from the districts of Kampala, Masaka and Wakiso (specifically Entebbe) in central Uganda, who had participated in the project. Data were analysed thematically focusing on facilitators, challenges and outcomes from the project. The following themes emerged as facilitators: access to land and animal feed, prior farming experience and supportive family and friends. Some participants experienced challenges including animal/poultry diseases, livestock theft, “low quality” agricultural inputs, unfavourable weather conditions, limited finance and land to support livelihood activities and difficulties working in groups. Several participants reported positive livelihood outcomes including improved food security, better nutrition, increased income and improved mental health. However, some participants reported negative outcomes which took the form of a loss of money and time invested when their livestock died from disease. Although participants in the agricultural livelihood initiative faced challenges which reduced the profitability of their projects, the initiative was regarded as beneficial and worthwhile. These findings have relevance to the broader field of livelihoods programming. Future interventions can draw from the experiences of our participants while also taking seriously into consideration the different circumstances of individuals in a targeted population so as to increase the chances of producing more positive outcomes. [ABSTRACT FROM AUTHOR]

While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President's Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of transition on facilities with differing ownership statuses. We used a survey conducted in mid-2017 among 145 public, 29 PNFP and 32 PFP facilities reporting transition from PEPFAR. The survey collected information on current and prior PEPFAR support, service provision, laboratory services and staff time allocation. We used both bivariate and logistic regression to analyse the association between ownership and survey responses. All analyses adjust for survey design. Public facilities were more likely to report increased disruption of sputum microscopy tests following transition than PFPs [odds ratio (OR) = 5.85, 1.79-19.23, P = 0.005]. Compared with public facilities, PNFPs were more likely to report declining frequency of supervision for human immunodeficiency virus (HIV) since transition (OR = 2.27, 1.136-4.518, P = 0.022). Workers in PFP facilities were more likely to report reduced time spent on HIV care since transition (OR = 6.241, 2.709-14.38, P < 0.001), and PFP facilities were also more likely to discontinue HIV outreach following transition (OR = 3.029, 1.325-6.925; P = 0.011). PNFP facilities' loss of supervision may require that public sector supervision be extended to them. Reduced HIV clinical care in PFPs, primarily HIV testing and counselling, increases burdens on public facilities. Prior PFP clients who preferred the confidentiality and service of private facilities may opt to forgo HIV testing altogether. Donors and governments should consider the roles and responses of PNFPs and PFPs when transitioning donor-funded health programs. [ABSTRACT FROM AUTHOR]