Differentiated Care Preferences of Stable Patients on Antiretroviral Therapy in Zambia: A Discrete Choice Experiment

Eshun‐Wilson, Ingrid; Mukumbwa-Mwenechanya, Mpande; Kim, Hae Young; Zannolini, Arianna; Mwamba, Chanda; Dowdy, David W.; Kalunkumya, Estella; Lumpa, Mwansa; Beres, Laura K.; Roy, Monika; Sharma, Anjali; Topp, Stephanie M.; Glidden, David V.; Padian, Nancy; Ehrenkranz, Peter; Sikazwe, Izukanji; Holmes, Charles B.; Bolton‐Moore, Carolyn; Geng, Elvin

doi:10.1097/qai.0000000000002070

Cited by 65 publications

(79 citation statements)

References 24 publications

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“…The preferences of stable, ART-experienced adult patients at these urban HIV treatment sites most often aligned with the characteristics of facility-based individual models, such as appointment spacing with multi-month prescribing and fast-track visits, rather than group or community-based models. These findings are consistent with the results of a recent DCE in Zambia [20]. The qualitative data showed that convenience, efficiency and privacy outweighed concerns about the cost of HF-based services and the potential advantages of group models, such as peer support.…”

Section: Discussionsupporting

confidence: 88%

“…Because DART models are opt-in, understanding patient preferences is critical to program planning [10]. MoHCC program data suggests that DART uptake varies across urban vs. rural settings, consistent with studies from other countries [11]. We conducted a mixed methods study in Zimbabwe's capital city of Harare to explore patient and HCW perspectives with the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U. S. Government.…”

Section: Introductionmentioning

confidence: 64%

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Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study

et al. 2020

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Introduction Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. Methods The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 64%

Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study

et al. 2020

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“…Since April 2019, following a Ministry of Health directive, Zambia also has scaled up 6-month refills for stable patients. Another study from Zambia found that patients preferred longer ART refill intervals-a 5-month interval was preferable to 3 months, which was preferable to 1 month [35,36].…”

Section: Antiretroviral Delivery For Stable Clientsmentioning

confidence: 99%

Emerging priorities for HIV service delivery

Ford

Geng²,

Ellman

et al. 2020

PLoS Med

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“…On the other hand, a select number of urban patients expressed a preference for facility-based individualized care and a willingness to meet the costs associated with more frequent visits to facilities. There is some support in the literature for this notion of heterogeneity in patient preferences [17], [30], [38], [43]. This may call for planning and programming that puts the complex and diverse preferences of patients into consideration in the quest to scale-up differentiated models of HIV care.…”

Section: Study Implications For Countries With Similar Setting As Ugandamentioning

confidence: 99%

Understanding implementation barriers in the national scale-up of Differentiated ART delivery in Uganda

Zakumumpa

Rujumba

Kwiringira

et al. 2020

Preprint

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Background Although Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)’s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perspectives on barriers to implementation of Differentiated ART delivery in Uganda. Methods We employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n=18), District Health Team leaders (n=24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context. Results Our data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in community-based models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. Context: Frequent changes in physical addresses among urban clients were reported as an impediment to the running of patient groups of rotating ART refill pick-ups. Conclusion This is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).

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Differentiated Care Preferences of Stable Patients on Antiretroviral Therapy in Zambia: A Discrete Choice Experiment

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 65 publications

References 24 publications

Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study

Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study

Emerging priorities for HIV service delivery

Understanding implementation barriers in the national scale-up of Differentiated ART delivery in Uganda

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