Out-of-Facility Multimonth Dispensing of Antiretroviral Treatment: A Pooled Analysis Using Individual Patient Data From Cluster-Randomized Trials in Southern Africa

Lopes, Jaqueline Santos Silva; Grimwood, Ashraf; Ngorima‐Mabhena, Nicoletta; Tiam, Appolinaire; Tukei, Betty Bawuba; Kasu, Tonderai; Mahachi, Nyika; Mothibi, Eula; Tukei, Vincent; Chasela, Charles; Lombard, Carl; Fatti, Geoffrey

doi:10.1097/qai.0000000000002797

Cited by 6 publications

(8 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found slightly elevated odds of better MPR and VLS outcomes among older participants. Other studies found retention in adherence clubs and out-of-facility MMD increased with older age among beneficiaries [ 16 , 18 ]. More generally, older age has been associated with better health outcomes than those experienced by younger PLHIV, including ART adherence, retention, and viral suppression, often among clients ≥40 years of age [ 31 – 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several other studies assessing retention and viral suppression between facility and community MMD approaches among clinically stable clients living with HIV have similarly found these outcomes to be non-inferior or better in community settings versus SOC [12,15,17,18,24]. Most studies looked at retention based on 12-month endpoints [12,15,16,18,24,25].…”

Section: Discussionmentioning

confidence: 99%

“…A 2020 systematic review of DSD models for HIV treatment found that only 28% of included studies provided a comparison with either conventional care or another model, making it challenging to draw conclusions on the overall impact of DSD on clinical outcomes [10]. While there is growing evidence that models such as multi-month ART dispensation (MMD), home-based delivery, adherence groups, and community ART groups are at least non-inferior to standard care in SSA [6,[11][12][13][14][15][16][17][18], few studies have focused on community ART distribution models in which non-medical personnel provide both drug dispensation and other related services.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Virological and care outcomes of community ART distribution: Experience with the PODI+ model in Kinshasa, Democratic Republic of the Congo

Gill,

Bakebua,

Ditekemena

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

Introduction Differentiated service delivery models for HIV treatment can minimize unnecessary burdens on health systems and promote efficient delivery of antiretroviral therapy (ART). Under the PODI+ (poste de distribution communautaire) model, ART multi-month dispensation (MMD) was provided by lay workers (peers) in communities. We compared outcomes among clinically stable adults living with HIV receiving MMD via PODI+ or health facility (HF). Methods Clients receiving MMD at nine HFs and two PODI+ sites in Kinshasa were followed prospectively for one year (2018–2020). Medication possession ratio (MPR) was measured as proportion of total days with medication during the study through record abstraction at 3-month intervals. Viral load was assessed at enrollment and 12 months. We compared MPR and viral load suppression by arm and examined associations and potential confounders using unadjusted and adjusted odds ratios (AOR). Likert-style client satisfaction was collected during 12-month interviews and described by arm. Results Odds of maintaining viral load suppression at 12 months for PODI+ participants were two times that for HF participants. In adjusted models, PODI+ participants had 1.89 times the odds of being suppressed at 12 months compared to HF participants (95% CI: 1.10, 3.27). No significant differences in MPR were found between groups (OR: 0.86, 0.38–1.99). Older participants had significantly higher odds of MPR (AOR: 1.02, 95% CI: 1.01, 1.03) and viral suppression (AOR: 1.03, 95% CI: 1.00, 1.07). Satisfaction with services was ≥87% overall, but PODI+ participants rated time spent at site, provider attributes and other care aspects more favorably. Conclusions Participants receiving MMD via peer-run community distribution points had similar MPR, but better virological outcomes and greater satisfaction with care than clinically similar participants receiving MMD through facilities. PODI+ could be a useful model for expansion to serve larger clinic populations from overburdened health facilities, particularly as policy shifts towards more inclusive MMD eligibility requirements.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Virological and care outcomes of community ART distribution: Experience with the PODI+ model in Kinshasa, Democratic Republic of the Congo

Gill,

Bakebua,

Ditekemena

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…20,28,30 Prior studies among adults have demonstrated that providing 3-6 months ART refills to stable patients (virally suppressed and no AIDS-defining illness) did no harm and improved treatment outcomes. 23,24,49 Several studies have described MMD as a feasible model among CWHIV in sub-Saharan Africa with some studies assessing the impact of MMD on viral suppression. 27,50 Overall, previous studies showed that children on MMD had slightly better viral suppression.…”

Section: Discussionmentioning

confidence: 99%

Effect of Dolutegravir and Multimonth Dispensing on Viral Suppression Among Children With HIV

Mugo

Zubayr²,

Ezeokafor³

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

show abstract

“…Whilst human-driven climate change is a global issue that will require global efforts and investment to deal with [1], environmental and HIV interventions could be considered in high HIV burden areas that are likely to experience droughts. Localised interventions in Southern Africa that could mitigate the effects of climate change on HIV outcomes could include the use of newly developed long-lasting antiretrovirals that do not need to be taken daily [36], multi-month dispensing [37], microcredit interventions to reduce reliance on subsistence agriculture [38], reducing the travel costs and time associated with obtaining ART [39,40], and building early warning systems to help health systems anticipate extreme weather conditions [41].…”

Section: Discussionmentioning

confidence: 99%

Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies

Trickey,

Johnson,

Fung

et al. 2023

BMC Infect Dis

Self Cite

View full text Add to dashboard Cite

Background Periods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa. Methods Data were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981–2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre’s latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts < 200 cells/mm3, viral loads > 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre. Results Among 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32–46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07–1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01–1.09]). Levels of rainfall were not strongly associated with CD4 counts < 200 cell/mm3 or > 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66–0.98] per 10 percentile rainfall rank decrease). Conclusions Decreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.

show abstract

Out-of-Facility Multimonth Dispensing of Antiretroviral Treatment: A Pooled Analysis Using Individual Patient Data From Cluster-Randomized Trials in Southern Africa

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 6 publications

References 54 publications

Virological and care outcomes of community ART distribution: Experience with the PODI+ model in Kinshasa, Democratic Republic of the Congo

Virological and care outcomes of community ART distribution: Experience with the PODI+ model in Kinshasa, Democratic Republic of the Congo

Effect of Dolutegravir and Multimonth Dispensing on Viral Suppression Among Children With HIV

Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies

Contact Info

Product

Resources

About