Determinants of Six-Month Appointment Spacing Model Utilization Among ART Clients in the Public Health Facilities of Jimma Town, Southwest Ethiopia: Case–Control Study

Abstract

Background Ethiopia is currently implementing an Appointment Spacing Model (ASM) for ART. A study conducted in 6 hospitals that piloted ASM showed that 51% of eligible clients declined ASM. Studies conducted on ASM have focused on its benefits, not factors determining its utilization. This study aimed to identify determinants of ASM non-utilization. Objective To identify determinants of ASM non-utilization among stable ART clients. Methods An unmatched case–control study was conducted among 194 cases and 194 controls: consecutively selected stable clients on anti-retroviral therapy (ART) at four public health facilities in Jimma town. Data were collected through face-to-face interviews and observation techniques using semi-structured questionnaire and observation checklist. EpiData version 3.1 and SPSS version 23 were respectively used for data entry and analysis. Descriptive statistics, logistic regression, adjusted odds ratio and 95% CI were used to summarize descriptive data, identify determinants of ASM non-utilization, measure the strength of statistical association, and declare the statistical significance respectively. Results With 100% response rate, predictors of ASM non-utilization were residing in urban areas (AOR=2.61, 95% CI: 1.10–6.18), fear regarding drug safety (AOR=3.19, 95% CI: 1.56–6.54), duration of ART (<5 years) (AOR=2.45, 95% CI: 1.17–5.16), need for frequent checkups (AOR=2.70, 95% CI: 1.29–5.61), poor understanding of ASM (AOR=3.15, 95% CI: 1.54–6.43), high perceived difficulties of engagement in ASM (AOR=10.13, 95% CI: 4.31–23.84), perceived presence of high opportunistic cost (AOR=3.34, 95% CI: 1.64–6.83), low self-efficacy (AOR=7.44, 95% CI: 3.16–17.46), recent history of opportunistic infection (AOR=3.34, 95% CI: 1.64–6.83), absence of competing family activities (AOR=4.39, 95% CI: 2.05–9.44) and stigma (AOR=2.85, 95% CI: 1.39–5.81). Conclusion The majority of factors affecting ASM non-utilization were behavioral and community related, which can be addressed by health education both at client and community level and additionally, by training service providers to address factors connected with the provision of service. Qualitative study and impact assessment on client retention are recommended for further research.

Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia

“…Uptake of ASM. Eligible ART clients who fulfill the World Health Organization's (WHO) criteria of stable adult clients accepting the six months schedule for both clinical evaluation and medication refill were categorized as 'uptake' and coded as "1" whereas those who refused to be enrolled in ASM were categorized as 'non-uptake' and coded as "0" [6].…”

“…Although Ethiopia is close to reaching HIV epidemic control [4], treatment failure remains a major challenge due to discontinuation of ART, and poor ART adherence. Furthermore, patients endure long traveling distances, high transportation costs, long waiting times to get ART service, persistent HIV-related stigma and discrimination, poor attitudes by healthcare workers, and high caseloads within ART facilities which contribute to overall poor ART service in Ethiopia [2,5,6].…”

“…The target was set by considering the socio-cultural situation, degree of awareness, stigma, discrimination, resource demands, and the sustainability of the program [8]. This program has also a dual purpose for the patients to enhance patients health outcomes to achieve the three 90s targets set by the Joint United Nations Program on HIV/AIDS (UNAIDS), which aspires to have 90% of HIV-positive individuals know their status, with 90% receiving sustained ART, and 90% on ART achieving viral load suppressions (VLS) and health facility allow to expand access to HIV services [5,6,8,9,11,12].…”

Factors associated with enrollment into differentiated service delivery model among adults with HIV in Kenya

“…The finding that younger age was associated with a lower likelihood of being on ≥3MMD and higher risk of switching from ≥3MMD to <3MMD may reflect differences in client's preferences or bias/perceptions from healthcare workers. Previous research has found that some adult clients may prefer standard clinical care rather than MMD due to the ongoing support and counseling and fear of HIV stigma and discrimination due to the challenges to safely and privately storing MMD [17] or due to misunderstanding about MMD or mistrust in the health system. While this is plausible, young adults may also face stigma and discrimination while accessing HIV services [18], which could have impacted access and continuation of MMD.…”

Patient‐incurred costs in a differentiated service delivery club intervention compared to standard clinical care in Northwest Tanzania

“…Other service delivery models, for example six‐monthly appointments with reduced frequency of clinic visits by increasing months between ART refills may reduce patient‐incurred costs further. However, preference for this model still varies showing the complexity of preferences [42‐44].…”