Acceptability and Preferences of Two Different Community Models of ART Delivery in a High Prevalence Urban Setting in Zambia: Cluster-Randomized Trial, Nested in the HPTN 071 (PopART) Study

Abstract

Community delivery of Antiretroviral therapy (ART) is a novel innovation to increase sustainable ART coverage for People living with HIV (PLHIV) in resource limited settings. Within a nested cluster-randomised sub-study in two urban communities that participated in the HPTN 071 (PopART) trial in Zambia we investigated individual acceptability and preferences for ART delivery models. Stable PLHIV were enrolled in a cluster-randomized trial of three different models of ART: Facility-based delivery (SoC), Home-based delivery (HBD) and Adherence clubs (AC). Consenting individuals were asked to express their stated preference for ART delivery options. Those assigned to the community models of ART delivery arms could choose (“revealed preference”) between the assigned arm and facility-based delivery. In total 2489 (99.6%) eligible individuals consented to the study and 95.6% chose community models of ART delivery rather than facility-based delivery when offered a choice. When asked to state their preference of model of ART delivery, 67.6% did not state a preference of one model over another, 22.8% stated a preference for HBD, 5.0% and 4.6% stated a preference for AC and SoC, respectively. Offering PLHIV choices of community models of ART delivery is feasible and acceptable with majority expressing HBD as their stated preferred option.

Development, Assessment, and Outcomes of a Community-Based Model of Antiretroviral Care in Western Kenya Through a Cluster-Randomized Control Trial

“…High retention rates in nonclinic-based groups (adherence clubs) in South Africa surpassed those of standard of care, 40 and in Zambia, retention rates were high and surpassed those of a home-based care model. 41 However, in this study, the number of patients remaining in their assigned study group was significantly lower in the intervention group. This high rate of attrition within the Co-ops group, most of which occurred before the first community meeting, had several causes.…”

The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review

“…Drug shops and pharmacies play an important role in the provision of contraceptives, filling gaps in public sector service coverage in urban areas, particularly for vulnerable and harder-to-reach populations such as young and unmarried women (and men), as they may feel more comfortable at these sites [56]. With targeting, it is likely that contraceptive uptake can be increased-for example, in Bangladesh, a program based in slums successfully increased modern contraceptive use among married women of reproductive age (15-49 years) by 9 percentage points to reach 62%, higher than even nonslum areas (56%), reversing the intra-urban differential [26,57]. Localized social networks in slums have been linked to the spread of misinformation about contraceptive methods and services that may create stigma for those seeking care and may dissuade young adults from utilizing SRH services [58].…”

“…The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review of stigma, particularly among adolescents and FSWs [24,29,31,59]. For HIV testing and treatment programs, one study in urban Zambia found a higher preference for home-based models because they reported harsh treatment by clinic workers and long wait times at facilities [57]. Most often at private facilities, providers may impose policies and procedures to restrict FP methods and impede clients' access to FP based on age, parity, partner consent, and marital status [60][61][62][63].…”

Scaling up access to HIV pre-exposure prophylaxis (PrEP): should nurses do the job?

“…21 A recent systematic review of studies from the USA concluded that nurses were 40% more likely than doctors to prescribe PrEP. 22 Experience from task sharing of ART shows that clients often prefer receiving care closer to their homes, 23 and that this preference translates into improved retention in care and long-term clinical outcomes when care is decentralised. 5 Task sharing can also improve the cost-effectiveness and efficiency of health systems.…”