Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID‐19 pandemic: descriptive analysis of programmatic data

Abstract

IntroductionThe rapid increase in the number of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Akwa Ibom and Cross River states in Nigeria led to overcrowding at clinics. Patients were devolved to receive ART refills through five differentiated service delivery (DSD) models: fast‐track (FT), adolescent refill clubs (ARCs), community pharmacy ART refill programs (CPARPs), community ART refill clubs (CARCs) and community ART refill groups (CARGs) designed to meet the needs of different groups of PLHIV. In the context of COVID‐19‐related travel restrictions, out‐of‐facility models offered critical mechanisms for continuity of treatment. We compared retention and viral suppression among those devolved to DSD with those who continued standard care at facilities.MethodsA retrospective cohort study was conducted among patients devolved to DSD from January 2018 to December 2020. Bivariate analyses were conducted to assess differences in retention and viral suppression by socio‐demographic characteristics. Kaplan–Meier assessed retention at 3, 6, 9 and 12 months. Differences in proportions were compared using the chi‐square test; a p‐value of <0.05 was considered significant.ResultsA total of 40,800 PLHIV from 84 facilities received ART through the five models: CARC (53%), FT (19.1%), ARC (12.1%), CPARP (10.4%) and CARG (5.4%). Retention rates at 6 months exceeded 96% for all models compared to 94% among those continuing standard care. Among those using DSD, retention rate at 12 months was higher among adults than children (97.8% vs. 96.7%, p = 0.04). No significant sex differences in retention rates were found among those enrolled in DSD. Viral suppression rates among PLHIV served through DSD were significantly higher among adults than children (95.4% vs. 89.2%; p <0.01). Among adults, 95.4% enrolled in DSD were virally suppressed compared to 91.8% of those in standard care (p <0.01). For children, 89.2% enrolled in DSD were virally suppressed compared to 83.2% in standard care (p <0.01).ConclusionsPLHIV receiving ART through DSD models had retention but higher viral suppression rates compared to those receiving standard care. Expanding DSD during COVID‐19 has helped ensure uninterrupted access to ART in Nigeria. Further scale‐up is warranted to decongest facilities and improve clinical outcomes.

Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients’ and Providers’ Perspectives in South Western Uganda

“…Longer refills of 5 to 6 months depending on drug stocks for the CCLAD members have been reported to significantly reduce the rate of frequent visits to the facility and to improve adherence outcomes to ART. 5 Group leaders felt like the model had also improved on ART adherence among the patients enrolled in CCLADS thus improving the quality of life. These findings are in line with those from Dakum’s study that concluded that community ART treatments are associated with adherence and treatment outcomes.…”

“…3 The World Health Organization (WHO) recommended differentiated HIV service delivery as a novel evidence based strategy to reduce congestion at the facility ART clinic, promote meaningful involvement of People Living with HIV (PLWHIV), and to enhance patients' self-management. 4,5 The differentiated delivery models included Community Client-Led ART Delivery Groups (CCLADs), Community Drug Distribution Points (CDDPs), Facility-Based Groups (FBGs), and Facility-Based Individual Management (FBIM). [6][7][8] In Uganda CCLADs have been implemented as one of the differentiated service delivery (DSD) model since 2017 by the ministry of health.…”

HIV care preferences among young people living with HIV in Lesotho: A secondary data analysis of the PEBRA cluster randomized trial

“…Despite the high interest and urgency statements by the WHO and other international organisations and the knowledge gaps regarding this population, the pace of interventional adolescent HIV research is still slow [2,14]. There is some research with promising findings regarding DSD models for young people in Africa [15][16][17]. A small number of studies on HIV preexposure prophylaxis preferences among young people exist [18,19], but none assessing service or care preferences among young people living with HIV.…”

Achieving HIV epidemic control through integrated community and facility-based strategies: Lessons learnt from ART-surge implementation in Akwa Ibom, Nigeria

“…We implemented same-day ART initiation, client navigation services for linkage to ART, structured age-appropriate counseling, support group enrollment, and other peer support services using expert clients. Six Decentralized Drug Distribution (DDD) models-Community Pharmacy ART Refills Program (CPARP), fast track, adolescent refill clubs, community ART refill clubs and groups, and home delivery-were introduced [19,20], and clients received multimonth dispensing (MMD) with refill frequencies of 3, 3-5 and 6-monthly based on national guidance in any of the models [12,19,21]. More adherent clients ultimately received 6 monthly refills.…”