Beyond viral suppression: Quality of life among stable ART clients in a differentiated service delivery intervention in Tanzania

Abstract

Background With antiretroviral therapy, more people living with HIV (PLHIV) in resource-limited settings are virally suppressed and living longer. WHO recommends differentiated service delivery (DSD) as an alternative, less resource-demanding way of expanding HIV services access. Monitoring client’s health-related quality of life (HRQoL) is necessary to understand patients’ perceptions of treatment and services but is understudied in sub-Saharan Africa. We assessed HRQoL among ART clients in Tanzania accessing two service models. Methods Cross-sectional survey from May–August 2019 among stable ART clients randomly sampled from clinics and clubs in the Shinyanga region providing DSD and clinic-based care. HRQoL data were collected using a validated HIV-specific instrument—Functional Assessment of HIV infection (FAHI), in addition to socio-demographic, HIV care, and service accessibility data. Descriptive analysis of HRQoL, logistic regression and a stepwise multiple linear regression were performed to examine HRQoL determinants. Results 629 participants were enrolled, of which 40% accessed DSD. Similar HRQoL scores [mean (SD), p-value]; FAHI total [152.2 (22.2) vs 153.8 (20.6), p 0.687] were observed among DSD and clinic-based care participants. Accessibility factors contributed more to emotional wellbeing among DSD participants compared to the clinic-based care participants (53.4% vs 18.5%, p = < 0.001). Satisfactory (> 80% of maximum score) HRQoL scoring was associated with (OR [95% CI], p-value) being male (2.59 [1.36–4.92], p 0.004) among clinic participants and with urban residence (4.72 [1.70–13.1], p 0.001) among DSD participants. Conclusions Similar HRQoL was observed in DSD and clinic-based care. Our research highlights focus areas to identify supporting interventions, ultimately optimizing HRQoL among PLHIV.

Reducing time to differentiated service delivery for newly-diagnosed people living with HIV in Kigali, Rwanda: a pilot, unblinded, randomized controlled trial

“…We observed no significant differences in acceptability with care between study arms or when comparing participants who entered DSD and those who did not, suggesting that early DSD is acceptable to Rwandan PWH. Our results are similar to research showing similar quality of life among people enrolled in DSD and those in traditional models [ 26 ], although some studies have described lower satisfaction with care among patients in DSD models for shorter compared to longer periods of time [ 27 ]. We found that acceptability did not differ between study arms or between those enrolled in DSD and those in TAU, suggesting that differences were not related to frequency of encounters.…”

Predictors of ‘No Problem’ as the Health‑related Quality of Life Status of People Living with HIV on Differentiated Service Delivery in a Nigerian State using the EQ-5D-5L

“…While PLHIV in high-income countries (HIC) reports signi cantly lower health-related quality of life than the general population, research on HRQoL of PLHIV in low-and middle-income countries (LMIC) is limited (21). Based on these concerns, there is the need to conduct a study to evaluate the quality of life of people living with HIV on differentiated service delivery and to determine the sociodemographic predictors of 'no problems' in PLHIV in a South-eastern Nigerian State.…”

Physiologically-based pharmacokinetic modelling of long-acting injectable cabotegravir and rilpivirine in pregnancy

“…Many countries around the world have adopted the test-and-treat strategy for managing HIV treatment as recommended by WHO [2,3]. This implementation has contributed to improvement of viral suppression and has been associated with a reduced risk of HIV transmission, better quality of life, and increased life expectancy in people living with HIV [4][5][6][7]. Despite this overwhelming evidence, UNAIDS estimates that only 81% of pregnant women accessed antiretroviral drugs in 2021 to prevent transmission of HIV to their children [1].…”