Investigating the implementation of differentiated HIV services and implications for pregnant and postpartum women: A mixed methods multi-country study

Chimukuche, Rujeko Samanthia; Wringe, Alison; Songo, John; Hassan, Farida; Luwanda, Lameck; Kalua, Thokozani; Moshabela, Mosa; Renju, Jenny; Seeley, Janet

doi:10.1080/17441692.2020.1795221

Cited by 8 publications

(11 citation statements)

References 26 publications

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“…However, a recent report among pregnant and post-partum women in South Africa indicated that fast-track services were not necessarily used, even when available. [20] The underuse of some DART models can reflect the preference of some clients for routine care, which provides more face-to-face time and to which they are used.…”

Section: Discussionmentioning

confidence: 99%

Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges

Christ¹,

Dijk²,

Ballif³

et al. 2020

Preprint

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Introduction: The traditional “one-size-fits-all” model of HIV care whereby people living with HIV (PLWH) have regular individual clinical visits does not reflect the various preferences and needs of PLWH and stretches the capacity of health facilities (HFs). Little is known about the availability and the experience of differentiated HIV care delivery in the rural areas of Zimbabwe.Methods: We used a mixed-method approach to collect data from clients and providers at 26 HFs in Zimbabwe in 2019. We collected quantitative data about antiretroviral therapy (ART) delivery and time spent at the HF during a visit from one representative healthcare providers (HCP) and a stratified sample of PLWH at each HF. We performed semi-structured interviews among HCPs and focus group discussions (FGDs) among PLWH to collect information about the implementation of differentiated ART delivery (DART) models and their experience. We performed linear regression models to assess factors associated with the time spent in the HFs. We analyzed the interviews using an inductive approach. Transcripts were coded and constricted down to themes significant to the research objectives.Results: The majority (77%) of participating HFs offered at least one of the five DART models recommended in Zimbabwe: 13 (50%) offered community ART refill group (CARG), 1 (4%) club refill, 6 (23%) family refill, and 8 (31%) fast-track refill models. Mobile outreach was not available at any participating HF. In an unadjusted linear model, PLWH enrolled in the fast-track refill model spent 0.40 (95% confidence interval (CI): 0.15-0.56) less time at the HF than PLWH on routine care, whereas PLWH in the family refill model and delegated to go to the HF spent 2.63 (95% CI 1.42-4.88) more time at the HF during visit. Confidentiality and disclosure concerns were highlighted as the major barriers affecting the implementation of DART models, together with travel costs and waiting times. HCPs reported on the challenge of excessive workloads. Fast-track refill was perceived as the most adapted DART model to meet clients’ needs, followed by CARG and family refill.Conclusions: Confidentiality, travel costs and waiting times are key elements to consider in the implementation of differentiated care in rural Zimbabwe. More implementation research is needed to support the roll-out of differentiated HIV services in that region, especially DART models addressing the needs of PLWH. Our study supports the call for personalized care at ART programs in rural Africa.

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Section: Discussionmentioning

confidence: 99%

Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges

Christ¹,

Dijk²,

Ballif³

et al. 2020

Preprint

Self Cite

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“…Viral load is de ned as the amount of HIV in a sample of blood and is reported as the number of HIV RNA copies per millilitre of blood [10]. Results can be classi ed into 3, < 40copies/ml is undetectable viral load; 40-999copies per ml is low viral load and > 999copies/ml is high viral load.…”

Section: Viral Load Suppressionmentioning

confidence: 99%

“…The primary classi cation of the study LDL was de nes as < 999copies/ml and HDL being de ned as > 999copies/ml. Virological failure This is de ned as a type of treatment failure that occurs when ART fails to suppress and sustain an individual's viral load to < 200copies/ml of blood [10]. This was tested between 12 to 18 months after ART initiation.…”

Section: Viral Load Suppressionmentioning

confidence: 99%

Retrospective cohort study comparing antiretroviral treatment outcomes among adolescents in Teen Clubs and Standard Care Clinics: Blantyre, Malawi

Alibi

Mwapasa

Gwalangwa

2023

Preprint

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Introduction: Teen clubs are already known to improve retention rates for adolescents on antiretroviral therapy. This study aimed to find out if this model also improves virological suppression and reduces virological failure. Viral suppression monitoring is a golden ART programme performance indicator. HIV treatment outcomes are poor among adolescents compared to adults. Different service delivery models are being implemented to address this; among them is the Teen Club model. Currently, it is clear that teen clubs improve treatment adherence (short-term impact), but there is a knowledge gap regarding the long-term impact. The study compared the rates of virological suppression and failure among adolescents in Teen Clubs and those on the Standard of Care (SoC) model. Methods: This was a retrospective cohort study. A total of 110 adolescents in teen clubs and 123 adolescents in SOC from six health facilities were selected using stratified simple random sampling. The participants were followed for 24 months. The data were analysed using STATA version 16.0. Univariate analyses were performed for demographic and clinical variables. A chi-squared test was used to assess the difference between proportions. The crude and adjusted relative risks were calculated using a binomial regression model. Results: At 24 months, 56% of adolescents in the Standard of Care (SoC) arm had viral load suppression compared to 90% in the Teen Club arm. Of those who achieved viral load suppression at 24 months, about 22.7% (SoC) and 76.4% (Teen Club) achieved undetectable viral load suppression rates. Adolescents in the Teen Club arm had a lower viral load than those in the SoC arm (adjusted RR 0.23, 95% CI: 0.11-0.61; p = 0.002 adjusted for age and gender). Teen Club and SoC adolescents had virological failure rates of 3.1% and 10.9%, respectively. The adjusted RR was 0.16, 95% CI: 0.03-0.78; p = 0.023; those in Teen Clubs were less likely to have virological failure relative to those in SoC after adjusting for age, sex, and place of residence. Conclusion: The study found that Teen Club models are more effective at achieving virological suppression among HIV positive adolescents.

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“…In South Africa, Tanzania, and Malawi Rujeko et al examined the HIV treatment delivery systems operating at different levels, investigating policy on postpartum treatment provision at the country-, facility- and the provider level, and then using interviews to unearth the experiences of postpartum women living with HIV and actually navigating treatment access [22]. Although policies around multimonth treatment packs existed on the books, they were unevenly implemented.…”

Section: Contributions To the Hiv Prevention And Care Continua: Healt...mentioning

confidence: 99%

The innovative use of qualitative and mixed methods research to advance improvements along the HIV prevention and care continua

Arnold

Campbell²,

Koester³

2022

Current Opinion in HIV and AIDS

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Purpose of reviewDespite enormous advances in prevention and care modalities, HIV continues to burden populations around the globe and is largely driven by social and behavioral processes. Mixed methods and qualitative research endeavors are best suited to uncovering and making sense of these dynamics, producing unique and actionable findings to alleviate the burden of HIV. We reviewed the global literature published on PubMed from 2020 to 2021 to identify studies that produced new insights into the social and behavioral dynamics that drive the HIV epidemic, focusing on mixed methods or purely qualitative study designs. Recent findingsMixed methods and qualitative studies have revealed important nuances in the social and behavioral dynamics associated with the HIV prevention and care continua, from preexposure prophylaxis uptake and adherence to engagement in HIV care and treatment, and have important implications for attaining goals for controlling the epidemic. SummaryArticles reviewed contribute to advancing our understanding of complex social dynamics, structural level factors such as healthcare systems and policy, as well as the research endeavor itself and the need to diversify and sustain research to truly represent the perspectives of those most impacted by HIV. Numerous studies represent the unique ability of qualitative and mixed methods research to expand our understanding of and empathy for individuals living with and affected by HIV, offering new insights to help alleviate the burden of HIV.

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Investigating the implementation of differentiated HIV services and implications for pregnant and postpartum women: A mixed methods multi-country study

Cited by 8 publications

References 26 publications

Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges

Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges

Retrospective cohort study comparing antiretroviral treatment outcomes among adolescents in Teen Clubs and Standard Care Clinics: Blantyre, Malawi

The innovative use of qualitative and mixed methods research to advance improvements along the HIV prevention and care continua

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