Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a cluster-randomised, non-blinded, non-inferiority trial

Hoffman, Risa M.; Moyo, Crispin; Balakasi, Kelvin; Siwale, Zumbe; Hubbard, Julie; Bardon, Ashley; Fox, Matthew P.; Kakwesa, Gift; Kalua, Thokozani; Nyasa-Haambokoma, Mwiza; Dovel, Kathryn; Campbell, Pam; Tseng, Chi‐Hong; Pisa, Pedro T.; Cele, Refiloe; Gupta, Sundeep; Benade, Mariet; Long, Lawrence; Xulu, Thembi; Sanne, Ian; Rosen, Sydney

doi:10.1016/s2214-109x(21)00039-5

Cited by 60 publications

(60 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All were sponsored by the U.S. Agency for International Development and the U.S. President’s Emergency Program for AIDS Relief (PEPFAR) under the EQUIP Health project. Clinical outcomes and costs of these studies have previously been reported 5 – 11 . All utilized primary healthcare clinics and/or hospital outpatient clinics to implement and evaluate between three and six differentiated models of delivery of antiretroviral therapy for stable, adult patients.…”

Section: Introductionmentioning

confidence: 99%

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

et al. 2022

Self Cite

View full text Add to dashboard Cite

Introduction: “Differentiated service delivery” (DSD) for antiretroviral therapy (ART) for HIV is rapidly being scaled up throughout sub-Saharan Africa, but only recently have data become available on the costs of DSD models to healthcare providers and to patients. We synthesized recent studies of DSD model costs in five African countries. Methods: The studies included cluster randomized trials in Lesotho, Malawi, Zambia, and Zimbabwe and observational studies in Uganda and Zambia. For 3-5 models per country, studies collected patient-level data on clinical outcomes and provider costs for 12 months. We compared costs of differentiated models to those of conventional care, identified drivers of cost differences, and summarized patient costs of seeking care. Results: The studies described 22 models, including conventional care. Of these, 13 were facility-based and 9 community-based models; 15 were individual and 7 group models. Average provider cost/patient/year ranged from $100 for conventional care in Zambia to $187 for conventional care with 3-month dispensing in Zimbabwe. Most DSD models had comparable costs to conventional care, with a difference in mean annual cost per patient ranging from 11.4% less to 9.2% more, though some models in Zambia cost substantially more. Compared to all other models, models incorporating 6-month dispensing were consistently slightly less expensive to the provider per patient treated. Savings to patients were substantial for most models, with patients’ costs roughly halved. Conclusion: In five field studies of the costs of DSD models for HIV treatment, most models within each country had relatively similar costs to one another and to conventional care. 6-month dispensing models were slightly less expensive, and most models provided substantial savings to patients. Limitations of our analysis included differences in costs included in each study. Research is needed to understand the effect of DSD models on the costs of ART programmes as a whole.

show abstract

Section: Introductionmentioning

confidence: 99%

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…The overall retention in care was lower than that of patients with both controlled HIV and hypertension at baseline, which was at 98%. However, the retention in our cohort was higher than that in the general HIV population of about 76% [ 26 ] and 86% for stable patients [ 27 ]. Integrated MMD of both hypertension and ART medications in our cohort reduced the frequency of clinic visits, transportation costs and minimized patient loss to follow-up and improved retention in care as well as HIV and hypertension control.…”

Section: Discussionmentioning

confidence: 57%

Integrated multi-month dispensing of antihypertensive and antiretroviral therapy to sustain hypertension and HIV control

et al. 2022

View full text Add to dashboard Cite

Multi-month dispensing (MMD) is a patient-centered approach in which stable patients receive medicine refills of three months or more. In this pre-post longitudinal study, we determined hypertension and HIV treatment outcomes in a cohort of hypertensive PLHIV at baseline and 12 months of receiving integrated MMD. At each clinical encounter, one healthcare provider attended to both hypertension and HIV needs of each patient in an HIV clinic. Among the 1,082 patients who received MMD, the mean age was 51 (SD = 9) years and 677 (63%) were female. At the start of MMD, 1,071(98.9%) patients had achieved HIV viral suppression, and 767 (73.5%) had achieved hypertension control. Mean blood pressure reduced from 135/87 (SD = 15.6/15.2) mmHg at the start of MMD to 132/86 (SD = 15.2/10.5) mmHg at 12 months (p < 0.0001). Hypertension control improved from 73.5% to 78.5% (p = 0.01) without a significant difference in the proportion of patients with HIV viral suppression at baseline and at 12 months, 98.9% vs 99.0% (p = 0.65). Patients who received MMD with elevated systolic blood pressure at baseline were less likely to have controlled blood pressure at 12 months (OR-0.9, 95% CI, 0.90,0.92). Overall, 1,043 (96.4%) patients were retained at 12 months. Integrated MMD for stable hypertensive PLHIV improved hypertension control and sustained optimal HIV viral suppression and retention of patients in care. Therefore, it is feasible to provide integrated MMD for both hypertension and HIV treatment and achieve dual control in the setting of sub-Saharan Africa.

show abstract

“…This analysis is thus not reflective of the total scope of 4‐ to 6‐month dispensing during the COVID‐19 pandemic, but of new DSD enrolees alone. It is possible that new DSD enrolees receive ≤3‐month dispensing at first, but then switched to 4‐ to 6‐month dispensing during the pandemic period [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

Changes in HIV treatment differentiated care uptake during the COVID‐19 pandemic in Zambia: interrupted time series analysis

Rosen

et al. 2021

J Int AIDS Soc.

Self Cite

View full text Add to dashboard Cite

IntroductionDifferentiated service delivery (DSD) models aim to improve the access of human immunodeficiency virus treatment on clients and reduce requirements for facility visits by extending dispensing intervals. With the advent of the COVID‐19 pandemic, minimising client contact with healthcare facilities and other clients, while maintaining treatment continuity and avoiding loss to care, has become more urgent, resulting in efforts to increase DSD uptake. We assessed the extent to which DSD coverage and antiretroviral treatment (ART) dispensing intervals have changed during the COVID‐19 pandemic in Zambia.MethodsWe used client data from Zambia's electronic medical record system (SmartCare) for 737 health facilities, representing about three‐fourths of all ART clients nationally. We compared the numbers and proportional distributions of clients enrolled in DSD models in the 6 months before and 6 months after the first case of COVID‐19 was diagnosed in Zambia in March 2020. Segmented linear regression was used to determine whether the outbreak of COVID‐19 in Zambia further accelerated the increase in DSD scale‐up.Results and discussionBetween September 2019 and August 2020, 181,317 clients aged 15 or older (81,520 and 99,797 from 1 September 2019 to 1 March 2020 and from 1 March to 31 August 2020, respectively) enrolled in DSD models in Zambia. Overall participation in all DSD models increased over the study period, but uptake varied by model. The rate of acceleration increased in the second period for home ART delivery (152%), 2‐month fast‐track (143%) and 3‐month MMD (139%). There was a significant reduction in the enrolment rates for 4‐ to 6‐month fast‐track (−28%) and “other“ models (−19%).ConclusionsParticipation in DSD models for stable ART clients in Zambia increased after the advent of COVID‐19, but dispensing intervals diminished. Eliminating obstacles to longer dispensing intervals, including those related to supply chain management, should be prioritized to achieve the expected benefits of DSD models and minimize COVID‐19 risk.

show abstract

Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a cluster-randomised, non-blinded, non-inferiority trial

Cited by 60 publications

References 16 publications

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

Integrated multi-month dispensing of antihypertensive and antiretroviral therapy to sustain hypertension and HIV control

Changes in HIV treatment differentiated care uptake during the COVID‐19 pandemic in Zambia: interrupted time series analysis

Contact Info

Product

Resources

About