Differentiated models of service delivery for antiretroviral treatment of HIV in sub-Saharan Africa: a rapid review protocol

Long, Lawrence; Kuchukhidze, Salome; Pascoe, Sophie; Nichols, Brooke E; Cele, Refiloe; Govathson, Caroline; Huber, Amy; Flynn, David; Rosen, Sydney

doi:10.1186/s13643-019-1210-6

Cited by 26 publications

(48 citation statements)

References 24 publications

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“…Following World Health Organization guidance for rapid reviews [6], we conducted a rapid systematic review of peer‐reviewed publications and conference abstracts that reported outcomes of differentiated service delivery (DSD) models for the provision of antiretroviral treatment (ART) in sub‐Saharan Africa since 2016 [7]. The search protocol was previously presented [7], and the review was registered on the International Prospective Register of Systematic Reviews (PROSPERO CRD42019118230).…”

Section: Methodsmentioning

confidence: 99%

“…In this report we focus on these outcomes only, to allow for a more detailed examination and discussion of consistently defined indicators. The full report of the review is available online [8].…”

Section: Methodsmentioning

confidence: 99%

“…by converting a reported percentage of patients lost to follow‐up to the percentage of patients retained). As explained in the search protocol [7], we feared that it would be misleading to conduct aggregate analyses due to the heterogeneity of model designs, participating populations and study settings, even where outcomes themselves were similar. We thus report only the disaggregated results.…”

Section: Methodsmentioning

confidence: 99%

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Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub‐Saharan Africa: a rapid systematic review

et al. 2020

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Introduction: Differentiated service delivery (DSD) models for antiretroviral treatment (ART) for HIV are being scaled up in the expectation that they will better meet the needs of patients, improve the quality and efficiency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes. We reviewed the recent literature on DSD models to describe what is known about clinical outcomes. Methods: We conducted a rapid systematic review of peer-reviewed publications in PubMed, Embase and the Web of Science and major international conference abstracts that reported outcomes of DSD models for the provision of ART in sub-Saharan Africa from January 1, 2016 to September 12, 2019. Sources reporting standard clinical HIV treatment metrics, primarily retention in care and viral load suppression, were reviewed and categorized by DSD model and source quality assessed. Results and discussion: Twenty-nine papers and abstracts describing 37 DSD models and reporting 52 discrete outcomes met search inclusion criteria. Of the 37 models, 7 (19%) were facility-based individual models, 12 (32%) out-of-facility-based individual models, 5 (14%) client-led groups and 13 (35%) healthcare worker-led groups. Retention was reported for 29 (78%) of the models and viral suppression for 22 (59%). Where a comparison with conventional care was provided, retention in most DSD models was within 5% of that for conventional care; where no comparison was provided, retention generally exceeded 80% (range 47% to 100%). For viral suppression, all those with a comparison to conventional care reported a small increase in suppression in the DSD model; reported suppression exceeded 90% (range 77% to 98%) in 11/21 models. Analysis was limited by the extensive heterogeneity of study designs, outcomes, models and populations. Most sources did not provide comparisons with conventional care, and metrics for assessing outcomes varied widely and were in many cases poorly defined. Conclusions: Existing evidence on the clinical outcomes of DSD models for HIV treatment in sub-Saharan Africa is limited in both quantity and quality but suggests that retention in care and viral suppression are roughly equivalent to those in conventional models of care.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub‐Saharan Africa: a rapid systematic review

et al. 2020

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“…Although a number of studies have evaluated the acceptability and clinical outcomes of DSD models [ 6 , 7 ], current evidence on the cost and cost-effectiveness of commonly implemented DSD models is limited [ 8 ]. There have been no published studies of patient-level healthcare resource utilization or provider costs for any DSD model of care in Zambia.…”

Section: Introductionmentioning

confidence: 99%

Community-based delivery of HIV treatment in Zambia: costs and outcomes

Nichols

Cele

Jamieson

et al. 2021

Aids

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Objective: The aim is to determine the total annual cost per patient treated and total cost per patient retained on antiretroviral therapy in Zambia in conventional care in facilities and across community-based differentiated service delivery (DSD) models. Design: Economic evaluation was conducted using retrospective electronic record review. Twenty healthcare facilities (13 with DSD models and 7 as comparison sites) in six of Zambia's 10 provinces were considered. Methods: All individuals on antiretroviral therapy (ART) >18 years old at the study sites were enrolled in a DSD model or conventional care by site type, respectively, with at least 12 months of follow-up data. Accessing care through DSD models [community adherence groups (CAGs), urban adherence groups (UAGs), home ART delivery and care, and mobile ART services] or facility-based conventional care with 3-monthly visits. Total annual cost per patient treated and the annual cost per patient retained in care 12 months after model enrolment. Retention in care was defined as attending a clinic visit at 12 months ± 3 months. Results: The DSD models assessed cost more per patient/year than conventional care. Costs ranged from an annual $116 to $199 for the DSD models, compared with $100 for conventional care. CAGs and UAGs increased retention by 2 and 14%, respectively. All DSD models cost more per patient retained at 12 months than conventional care. The CAG had the lowest cost/patient retained for DSD models ($140–157). Conclusions: Although they achieve equal or improved retention in care, out-of-facility models of ART were more expensive than conventional care.

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“…Given the numerous options for how and where to make improvements to HIV services, identifying which service features are most important to PLWH can aid future intervention design and prioritization. Differentiated services delivery models which aim to deliver more patient-centered services by varying several aspects of service delivery in Sub-Saharan Africa, such as visit frequency, waiting time, and service location, have to date shown modest effects on treatment outcomes [2,11], suggesting that more needs to be considered to improve engagement in HIV care. These models have been informed by the need to decongest health services and a wealth of research identifying barriers to HIV care including: competing work and family priorities, economic costs, stigma, overburdened and incoordinate health services, and disrespectful health workers [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review

et al. 2020

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Purpose of Review Aligning HIV treatment services with patient preferences can promote long-term engagement. A rising number of studies solicit such preferences using discrete choice experiments, but have not been systematically reviewed to seek generalizable insights. Using a systematic search, we identified eleven choice experiments evaluating preferences for HIV treatment services published between 2004 and 2020. Recent Findings Across settings, the strongest preference was for nice, patient-centered providers, for which participants were willing to trade considerable amounts of time, money, and travel distance. In low- and middle-income countries, participants also preferred collecting antiretroviral therapy (ART) less frequently than 1 monthly, but showed no strong preference for 3-compared with 6-month refill frequency. Facility waiting times and travel distances were also important but were frequently outranked by stronger preferences. Health facility–based services were preferred to community- or home-based services, but this preference varied by setting. In high-income countries, the availability of unscheduled appointments was highly valued. Stigma was rarely explored and costs were a ubiquitous driver of preferences. Summary While present improvement efforts have focused on designs to enhance access (reduced waiting time, travel distance, and ART refill frequency), few initiatives focus on the patient-provider interaction, which represents a promising critical area for inquiry and investment. If HIV programs hope to truly deliver patient-centered care, they will need to incorporate patient preferences into service delivery strategies. Discrete choice experiments can not only inform such strategies but also contribute to prioritization efforts for policy-making decisions.

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Differentiated models of service delivery for antiretroviral treatment of HIV in sub-Saharan Africa: a rapid review protocol

Cited by 26 publications

References 24 publications

Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub‐Saharan Africa: a rapid systematic review

Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub‐Saharan Africa: a rapid systematic review

Community-based delivery of HIV treatment in Zambia: costs and outcomes

Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review

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