Evidence for scale up: the differentiated care research agenda

Grimsrud, Anna; Barnabas, Ruanne V.; Ehrenkranz, Peter; Ford, Nathan

doi:10.7448/ias.20.5.22024

Cited by 132 publications

(155 citation statements)

References 40 publications

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“…Within a facility‐based setting, additional service delivery modifications may affect PrEP costs. For example, providing multiple months of PrEP prescription for established clients could improve retention by requiring fewer visits, as has been demonstrated in some ART programmes . Additionally, task shifting PrEP screening counselling to HTS counsellors may reduce costs and alleviate nurse time burden.…”

Section: Discussionmentioning

confidence: 99%

The role of costing in the introduction and scale‐up of HIV pre‐exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya

et al. 2019

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Introduction Understanding the cost of strategies to reach and deliver pre‐exposure prophylaxis (PrEP) to priority populations is essential to assess the cost‐effectiveness and budget impact of HIV prevention programmes. Providing PrEP through maternal and child health and family planning clinics offers a promising strategy to reach women in high HIV burden settings. We estimated incremental costs and explored the cost drivers of integrating PrEP delivery into routine maternal and child health and family planning services in Kenya. Methods We conducted a costing study from the provider perspective within the PrEP Implementation for Young Women and Adolescents programme in western Kenya. We identified all within‐ and above‐facility activities supporting PrEP delivery and measured clinical service time using time‐and‐motion studies. We obtained input costs from programme budgets, expenditure records and staff interviews. We estimated changes in costs if creatinine testing were postponed from initiation to first follow‐up visit and if PrEP were prioritized to clients at high HIV risk using a behavioural risk assessment tool. We also projected costs under Ministry of Health (MOH) implementation assuming MOH salaries and programme supervision. We estimated annual numbers of PrEP visits from programme data abstracted from 16 facilities between November 2017 and June 2018. We report the cost per client‐month of PrEP dispensed in 2017 USD. Results For an annual programme output of 24,005 screenings, 4198 PrEP initiations and 4427 follow‐up visits, the average cost per client‐month of PrEP dispensed in the study was $26.52. Personnel, drugs and laboratory tests comprised 43%, 25% and 14% of programme costs respectively. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk reduced total programme costs by 8% and 14% respectively. In the MOH scenario assuming no changes in outputs, the projected cost per client‐month of PrEP dispensed decreased to $16.54 and total programme costs decreased by 38%. Conclusions Incremental PrEP costs are sensitive to the service delivery strategy used to engage priority populations. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk may reduce costs. Context‐specific cost data are crucial to assess the cost‐effectiveness and affordability of PrEP delivery models.

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Section: Discussionmentioning

confidence: 99%

The role of costing in the introduction and scale‐up of HIV pre‐exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya

et al. 2019

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“…To ensure at least 90% of those diagnosed were linked to care, the study used rapid linkage at testing, appointment reminders, improved provider access through telephones and face-to-face meetings, and missed appointment tracking. To ensure that 90% of those in care have undetectable viral loads, SEARCH used a "streamlined care" approach designed to lengthen intervals between visits for stable patients, offer shorter waiting times and ensure a friendly environment in clinics [20]. SEARCH demonstrated the effectiveness of its model for high HIV "cascade coverage, " and increased population viral suppression from 45% to 81%, exceeding the "90-90-90" targets within two years in intervention communities [21].…”

Section: A Utt Intervention Trial In Kenya and Ugandamentioning

confidence: 99%

Qualitative research on community experiences in large HIV research trials: what have we learned?

Camlin

Seeley

2018

J Intern AIDS Soc

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IntroductionVery few pragmatic and community‐level effectiveness trials integrate the use of qualitative research over all stages of the trial, to inform trial design, implementation optimization, results interpretation and post‐trial policy recommendations. This is despite the growing demand for mixed methods research from funding agencies and awareness of the vital importance of qualitative and mixed methods research for understanding trial successes and challenges.DiscussionWe offer examples from work we have been involved in to illustrate how qualitative research conducted within trials can reveal vital contextual factors that influence implementation and outcomes, can enable an informed adaptation of trials as they are being conducted and can lead to the formulation of theory regarding the social and behavioural pathways of intervention, while also enabling community engagement in trial design and implementation. These examples are based on published findings from qualitative studies embedded within two ongoing large‐scale studies demonstrating the population‐level impacts of universal HIV testing and treatment strategies in southern and eastern Africa, and a qualitative study conducted alongside a clinical trial testing the adaptation, acceptability and experience of short‐cycle therapy in children and adolescents living with HIV.ConclusionsWe advocate for the integration of qualitative with clinical and survey research methods in pragmatic clinical and community‐level trials and implementation studies, and for increasing visibility of qualitative and mixed methods research in medical journals. Qualitative research from trials ideally should be published along with clinical outcome data, either integrated into the “main” trial papers or published concurrently in the same journal issue. Integration of qualitative research within trials can help not only to understand the why behind success or failure of interventions in different contexts, but also inform the adaptation of interventions that can facilitate their success, and lead to new alternative strategies and to policy changes that may be vital for achieving public health goals, including the end of AIDS.

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“…Advancing the effectiveness of the health system response to HIV requires integration of patient preferences in programmes and the identification of who requires more intensive services and who would benefit from less onerous treatment support 19. To achieve sustained treatment goals across populations, lighter-touch models including less frequent visit attendance, adherence clubs, peer or lay healthcare workers, fast-track visits may be viable solutions for many clinically stable patients, but will likely need to be accompanied by more resource-intensive strategies for patients more vulnerable to being lost to care 26.…”

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confidence: 99%

Remembering individual perspectives and needs in differentiated HIV care strategies

Schwartz

Baral

2018

BMJ Qual Saf

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Evidence for scale up: the differentiated care research agenda

Cited by 132 publications

References 40 publications

The role of costing in the introduction and scale‐up of HIV pre‐exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya

The role of costing in the introduction and scale‐up of HIV pre‐exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya

Qualitative research on community experiences in large HIV research trials: what have we learned?

Remembering individual perspectives and needs in differentiated HIV care strategies

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