Quality of care in a differentiated HIV service delivery intervention in Tanzania: A mixed-methods study

Okere, Nwanneka Ebelechukwu; Meta, Judith; Maokola, Werner; Martelli, Giulia; Praag, Eric van; Naniche, Denise; Gomez, Gabriela B.; Pozniak, Anton; Wit, Tobias Rinke de; Klerk, Josien de; Hermans, Sabine

doi:10.1371/journal.pone.0265307

Cited by 6 publications

(6 citation statements)

References 44 publications

(63 reference statements)

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“…RoC in both locations were concerned with privacy and the potential for stigma, making a deliberate choice to remain in their care location to avoid HIV-related stigma. While DSD is scaling up, frequently to community settings, previous studies suggest fear of unintended disclosure as a barrier to uptake of community-based DSD models [5,6,8,11,12,26]. In our study, some clinic-based RoC compromised travel and time concerns to receive care at LT, rather than in the community, to avoid being seen receiving HIV-related services.…”

Section: Discussionmentioning

confidence: 69%

“They provide the right kind of support.”A qualitative study of preferences for differentiated service delivery location among recipients of antiretroviral therapy at Lighthouse Trust in Lilongwe Malawi

Orii,

Wilson,

Huwa

et al. 2023

Preprint

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Differentiated service delivery (DSD) models for antiretroviral therapy (ART) allow stable recipients of care (RoC) to receive multi-month ART drug refills and complete rapid reviews in community sites. As DSD options expand across sub-Saharan Africa, RoC’s preferences and perspectives on community-versus clinic-based care models warrants attention. We describe the factors that influence RoC choice of ART delivery approaches at Lighthouse Trust (LT) clinics and community-based DSD sites in Lilongwe, Malawi. We conducted eight focus group discussions (FGDs) among LT RoC in the Nurse-led Community-based ART Program (NCAP) (n=4) and in clinic settings (n=4) to explore opinions, preferences, and perceptions about ART service delivery. FGDs were conducted and recorded in Chichewa and then translated and transcribed into English for analysis. Data was analyzed using thematic analysis and findings discussed with the LT and NCAP teams to jointly reflect on the findings. Sixty-three participants took part in the qualitative study. Results were largely similar across care locations. In both NCAP and clinic FGDs, RoC appreciated the convenience of integrating their appointment visits at their chosen care location into their daily lives, though some RoC traveled far to access LT’s high quality of care. RoC were satisfied with the quality of the care they received at their location of choice. Privacy protection was an important consideration for choosing care models. At LT clinics, RoC highlighted the importance of physical separation between LT’s HIV-specific service site and other service sites. In NCAP, RoC expressed that their choice of care model was reinforced by the sense of mutual support that they received through the peer support model. At LT, RoC in both clinic and NCAP care models expressed satisfaction with their chosen care model and preferred that choice over alternative options and locations. Overall, LT RoC appreciated the quality of care, the respectful provider-to-patient interactions, and the attention to privacy at community and clinic sites. These findings suggest continued emphasis on offering choices to RoC on where and how they receive ART delivery approaches may support ongoing engagement in care.

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Section: Discussionmentioning

confidence: 69%

“They provide the right kind of support.”A qualitative study of preferences for differentiated service delivery location among recipients of antiretroviral therapy at Lighthouse Trust in Lilongwe Malawi

Orii,

Wilson,

Huwa

et al. 2023

Preprint

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“…Fear of being recognised when participating in CHW‐DCM has been reported previously [22]. Recent qualitative data in the same region showed the opposite for some people: they preferred the anonymity of CHW‐DCM versus crowded facility [20].…”

Section: Discussionmentioning

confidence: 71%

“…The difference in stability in care seemed to be due to poorer adherence among clients in SoC; despite this, the proportion virally suppressed did not differ significantly, however, this may lag behind poor adherence. An important contributing factor to better treatment stability could be more individualised caregiving as reported in a study assessing quality of care in the same study population [20]. The authors of this study reported clients attending CHW‐DCM spend almost half the time as those attending SoC, having better access to health providers (CHW), and receiving adequate reminders for appointments and explanations on the benefits of regular use of ART [20].…”

Section: Discussionmentioning

confidence: 99%

“…The CHW‐DCM was formed within proximity to the clients' residences, lowering the distance to treatment services. We did not have data on the exact difference in distance, but the location of the CHW‐DCM ranged between 3 and 35 km from the health facility [20]. Longer distances to health facilities were associated with poor adherence to ART [26].…”

Section: Discussionmentioning

confidence: 99%

“…Recent qualitative data in the same region showed the opposite for some people: they preferred the anonymity of CHW-DCM versus crowded facility [20].…”

Section: Characteristicsmentioning

confidence: 95%

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Stability in care and risk of loss to follow‐up among clients receiving community health worker‐led differentiated HIV care: Results from a prospective cohort study in northern Tanzania

Abdul,

Rinke de Wit,

Martelli

et al. 2024

Tropical Med Int Health

Self Cite

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BackgroundHIV services in Tanzania are facility‐based but facilities are often overcrowded. Differentiated care models (DCM) have been introduced into the National Guidelines. We piloted a Community Health Worker (CHW)‐led HIV treatment club model (CHW‐DCM) in an urban region, and assessed its effectiveness in comparison to the standard of care (SoC, facility‐based model), in terms of stability in care, loss to follow‐up (LTFU) and treatment adherence.MethodsIn two clinics in the Shinyanga region, clients established on ART (defined as stable clients by national guidelines as on first‐line ART >6 months, undetectable viral load, no opportunistic infections or pregnancy, and good adherence) were offered CHW‐DCM. This prospective cohort study included all stable clients who enrolled in CHW‐DCM between July 2018 and March 2020 (CHW‐DCM) and compared them to stable clients who remained in SoC during that period. Multivariable Cox regression models were used to analyse factors associated with continued stability in care and the risk of LTFU during 18 months of follow‐up; treatment adherence was assessed by pill count and compared using Chi‐square tests.ResultsOf 2472 stable clients, 24.5% received CHW‐DCM and 75.5% SoC. CHW‐DCM clients were slightly older (mean 42.8 vs. 37.9 years) and more likely to be female (36.2% vs. 32.2%). Treatment adherence was better among CHW‐DCM than SoC: 96.6% versus 91.9% and 98.5% versus 92.2%, respectively (both p = 0.001). SoC clients were more likely to not remain stable over time than CHW‐DCM (adjusted Hazard ratio [AHR] = 2.68; 95% CI: 1.86–3.90). There was no difference in LTFU (adjusted hazard ratio [AHR] = 1.54; 95%CI: 0.82–2.93).ConclusionClients attending CHW‐DCM demonstrated better stability in care and treatment adherence than SoC, and the risk of LTFU was not increased. These findings demonstrate the potential of CHW in delivering community‐based HIV services in the local Tanzanian context. These results could be used to extend this CHW‐DCM model to similar settings.

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Understanding the impact of the COVID-19 pandemic on HIV/AIDS care and management in Tanzania: challenges, adaptations and lessons learnt—a review

Mwanja,

Mshenga,

Alexander

et al. 2024

bmjph

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This review examines the impact of the COVID-19 pandemic on HIV/AIDS care and management in Tanzania, highlighting challenges, adaptations and lessons learnt. The pandemic has led to disruptions in service delivery, reduced access to testing and treatment, and increased stigma and discrimination. Adaptations and innovations, such as telemedicine (telehealth and virtual care), multimonth dispensing of antiretroviral therapy, decentralised drug distribution initiatives, have been implemented to mitigate the challenges faced in HIV/AIDS care and management. Integration of HIV/AIDS and COVID-19 services is crucial to ensure the continuity of care and management in the postpandemic by strengthening healthcare systems, improving supply chain management and enhancing community engagement.

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Quality of care in a differentiated HIV service delivery intervention in Tanzania: A mixed-methods study

Cited by 6 publications

References 44 publications

“They provide the right kind of support.”A qualitative study of preferences for differentiated service delivery location among recipients of antiretroviral therapy at Lighthouse Trust in Lilongwe Malawi

“They provide the right kind of support.”A qualitative study of preferences for differentiated service delivery location among recipients of antiretroviral therapy at Lighthouse Trust in Lilongwe Malawi

Stability in care and risk of loss to follow‐up among clients receiving community health worker‐led differentiated HIV care: Results from a prospective cohort study in northern Tanzania

Understanding the impact of the COVID-19 pandemic on HIV/AIDS care and management in Tanzania: challenges, adaptations and lessons learnt—a review

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