Similar costs and outcomes for differentiated service delivery models for HIV treatment in Uganda

Guthrie, Teresa; Muheki, Charlotte; Rosen, Sydney; Kanoowe, Shiba; Lagony, Stephen; Greener, Ross; Miot, Jacqui; Balidawa, Hudson; Kiggundu, Josen; Calnan, Jacqueline; Dejene, Seyoum; Xulu, Thembi; Sigweblele, N; Lc, Long

doi:10.1101/2021.06.22.21259341

Cited by 5 publications

(3 citation statements)

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“…All were sponsored by the U.S. Agency for International Development and the U.S. President's Emergency Program for AIDS Relief (PEPFAR) under the EQUIP Health project. Clinical outcomes and costs of these studies have previously been reported [5][6][7][8][9][10][11] . All utilized primary healthcare clinics and/or hospital outpatient clinics to implement and evaluate between three and six differentiated models of delivery of antiretroviral therapy for stable, adult patients.…”

Section: Introductionmentioning

confidence: 99%

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

et al. 2022

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Introduction: “Differentiated service delivery” (DSD) for antiretroviral therapy (ART) for HIV is rapidly being scaled up throughout sub-Saharan Africa, but only recently have data become available on the costs of DSD models to healthcare providers and to patients. We synthesized recent studies of DSD model costs in five African countries. Methods: The studies included cluster randomized trials in Lesotho, Malawi, Zambia, and Zimbabwe and observational studies in Uganda and Zambia. For 3-5 models per country, studies collected patient-level data on clinical outcomes and provider costs for 12 months. We compared costs of differentiated models to those of conventional care, identified drivers of cost differences, and summarized patient costs of seeking care. Results: The studies described 22 models, including conventional care. Of these, 13 were facility-based and 9 community-based models; 15 were individual and 7 group models. Average provider cost/patient/year ranged from $100 for conventional care in Zambia to $187 for conventional care with 3-month dispensing in Zimbabwe. Most DSD models had comparable costs to conventional care, with a difference in mean annual cost per patient ranging from 11.4% less to 9.2% more, though some models in Zambia cost substantially more. Compared to all other models, models incorporating 6-month dispensing were consistently slightly less expensive to the provider per patient treated. Savings to patients were substantial for most models, with patients’ costs roughly halved. Conclusion: In five field studies of the costs of DSD models for HIV treatment, most models within each country had relatively similar costs to one another and to conventional care. 6-month dispensing models were slightly less expensive, and most models provided substantial savings to patients. Limitations of our analysis included differences in costs included in each study. Research is needed to understand the effect of DSD models on the costs of ART programmes as a whole.

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Section: Introductionmentioning

confidence: 99%

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

et al. 2022

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“…Evidence to support these assumptions is accumulating but remains scarce. A few DSD programs have been formally described and evaluated in the literature (2)(3)(4)(5)(6)(7)(8)(9)(10)(11); many others are being implemented officially or as pilot projects under routine care, without formal evaluation. Models that have been rigorously evaluated have often been implemented in the course of randomized trials, rather than routine practice (12).…”

Section: Introductionmentioning

confidence: 99%

The SENTINEL study of differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: research protocol for a prospective cohort study

Pascoe,

Huber,

Mokhele

et al. 2023

Preprint

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BackgroundMany countries in sub-Saharan Africa are rapidly scaling up “differentiated service delivery” (DSD) models for HIV treatment to improve the quality of care, increase access, reduce costs, and support the continued expansion and sustainability of antiretroviral therapy (ART) programs. Although there is some published evidence about the health outcomes of patients in DSD models, little is known about their impacts on healthcare providers’ job satisfaction, patients’ quality of life, costs to providers or patients, or how DSD models affect resource allocation at the facility level.MethodsSENTINEL is a multi-year observational study that will collect detailed data about DSD models for ART delivery and related services from 12 healthcare facilities in Malawi, 24 in South Africa, and 12 in Zambia. The first round of SENTINEL included a patient survey, provider survey, provider time-and-motion observations, and facility resource use inventory. A survey of clients testing for HIV and a supplement to the facility resource use component to describe service delivery integration will be added for the second round. The patient survey will ask up to 10 patients enrolled in each DSD model at each study site about their experiences in HIV care and in DSD models, costs incurred seeking treatment, and preferences for HIV service delivery. The provider survey will ask up to 10 providers per site about the impact of DSD models on their positions and clinics. The time-and-motion component will directly observe the time use of a sample of providers implementing DSD models. Finally, the resource utilization component will collect facility-level data about DSD model availability and enrollment and the human and other resources needed to implement them. SENTINEL is planned to include four or more approximately annual rounds of data collection between 2021 and 2026.DiscussionAs national DSD programs for HIV treatment mature, it is important to understand how individual healthcare facilities are interpreting and implementing national guidelines and how healthcare workers and clients are adapting to new models of service delivery. SENTINEL will help policy makers and program managers understand the benefits and costs of differentiated service delivery and improve resource allocation going forward.

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“…The INTERVAL trial, a cluster-randomized, non-inferiority trial conducted in Malawi and Zambia, found that 6-month ART dispensing was non-inferior in terms of 12-month retention, compared to standard of care [8]. DSD models have consistently been found to save substantial time and money for patients themselves, and satisfaction with the models among both providers and patients has been high [8–10].…”

Section: Introductionmentioning

confidence: 99%

How soon should patients be eligible for differentiated service delivery models for antiretroviral treatment? Evidence from Zambia

Jamieson

Rosen

Phiri

et al. 2021

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Background: Most differentiated service delivery (DSD) models for HIV treatment, which are intended to improve ART programme outcomes, require that a patient have spent >6 or >12 months on antiretroviral treatment (ART) ART for eligibility. Attrition from ART programmes, however, is highest among those newly initiated and thus ineligible for DSD models. Because some patients are enrolled "early", prior to 6 or 12 months on ART, we were able to evaluate loss to follow-up among patients in Zambia enrolled in DSD models after differing intervals on ART. Methods: Data were extracted from electronic medical records of patients (>15 years) enrolled in DSD models from October 2019-March 2020. We compared 12-month loss to follow-up (LTFU), defined as "lost to follow-up", "inactive", or "stopped ART" at 9-15 months after DSD enrolment, among patients enrolled in six DSD models after <6 months, 6-12 months, and >12 months on ART, with those enrolled with <6 or <12 months on ART termed "early enrollers" and those enrolled with >12 months termed "established". We adjusted for age, sex, urban/rural status, and duration of ART dispensing. Results: Of 88,556 patients enrolled in a DSD model, 4% (n=3,143) and 8% (n=6,714) had initiated ART <6 months or 6-12 months before DSD entry, respectively. Early enrollers were less likely to be LTFU at 12 months than established patients (adjusted risk ratio (aRR) [95% confidence interval] for <6 months on ART 0.72 [0.62-0.83]; aRR 0.74 [0.67-0.82] for 6-12 months on ART) for almost all DSD models and dispensing durations. A limitation of the analysis is that early enrollers may have been selected for DSD participation due to providers' expectations about future retention. Conclusions: Patients enrolled in DSD models in Zambia after less than a year on ART were more likely to be retained in care 12 months later than were patients established on ART at DSD enrollment. Offering enrollment to at least some newly-initiating ART patients may improve ART programme outcomes.

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Similar costs and outcomes for differentiated service delivery models for HIV treatment in Uganda

Cited by 5 publications

References 10 publications

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

The SENTINEL study of differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: research protocol for a prospective cohort study

How soon should patients be eligible for differentiated service delivery models for antiretroviral treatment? Evidence from Zambia

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