Delivery of Community-based Antiretroviral Therapy to Maintain Viral Suppression and Retention in Care in South Africa

Differentiated Service Delivery Model in Improving HIV Treatment Outcomes Among Female Sex Workers in Gauteng Province of South Africa: A Protocol Paper

South Africa developed the differentiated service delivery (DSD) model to improve access to healthcare for people living with HIV (PLHIV), especially key populations (KPs) including female sex workers (FSWs) who often face barriers in accessing HIV services. The DSD model, aims to reduce the burden on healthcare users, healthcare workers, and the healthcare system, can significantly benefit this group. However, the success of the DSD model in achieving the desired HIV treatment outcomes for FSWs has been barely evaluated. This paper describes the protocol for evaluation of the DSD model in improving HIV treatment outcomes among FSWs in Gauteng Province of South Africa. Both qualitative and quantitative methods will be utilized to address three study objectives: stakeholder analysis, mapping, and in-depth interviews (objective 1); programme evaluation of the DSD model in selected sites (objective 2); and development of a framework for optimizing the DSD model in improving HIV treatment outcomes (objective 3). Quantitative statistical analysis will be performed using STATA version 17 (College Station, TX, USA). Qualitative analysis will be performed using ATLAS.ti. This study will provide new insights into the utilization of the DSD model among FSWs in South Africa. It will also inform new strategies for the DSD model's implementation in the country. This study will contribute towards the development of a framework for strengthening the DSD model in improving HIV treatment outcomes among FSWs in Gauteng Province.

Does type of antiretroviral therapy pick-up point influence 12-month virologic suppression in South Africa?

We assessed the impact of community- versus clinic-based medication pick-up on rates of virologic suppression in an observational cohort of adults on ART enrolled in a decentralized antiretroviral therapy program (CCMDD) in South Africa. Participants either attended clinics where they were given the choice to pick up ART in community venues or traditional clinics, or clinics where this pathway was assigned. Among 1856 participants, 977 (53%) opted for community ART pick-up at enrollment, and 1201 (86%) were virologically suppressed at one year. Because of missing data on virologic suppression, primary results are based on a model incorporating multiple imputation. In addition to age and gender, distance from clinic and year of HIV diagnosis were included in the multivariable model. There was no difference in opting for clinic- vs. community-based pick-up with regard to achieving 12-month virologic suppression (aRR 1.02, 95% CI 0.98-1.05) in clinics offering choice. There was no impact of assigning all participants to an external pick-up point (aRR 1.00, 95% CI 0.95-1.06), but virologic suppression was reduced in the clinic that assigned participants to clinic pick-up (aRR 0.87, 95% CI 0.81-0.92). These results suggest that provision of community-based ART has not reduced continued virologic suppression in the population enrolled in the CCMDD program.

Uptake of community-based differentiated antiretroviral therapy service delivery and associated factors among people living with HIV in Ethiopia: a multicenter cross-sectional study

Background

Achieving the 95-95-95 targets require an efficient and innovative person-centered approach, specifically community-based differentiated service delivery (DSD), to improve access to human immunodeficiency virus (HIV) services and reduce burdens on the health system. Therefore, this study aimed to assess the uptake of community-based DSD models and associated factors among people living with HIV (PLHIV).

Methods

A multicenter cross-sectional study was conducted among PLHIV in public health facilities in South Ethiopia. Data were collected and entered into EpiData version 3.1 before being exported to Stata version 14 for further analysis. In the bivariable logistic regression analysis, variables with a p-value of ≤0.25 were included in the multivariable logistic regression analysis. A p-value of <0.05 was used to identify statistically significant factors.

Results

Among 381 stable PLHIV, 55.91% were women. The median age (interquartile range) was 40 years (27-53). The uptake of community-based DSD models was 19.16%. Residence and disclosure were the two independent factors significantly associated with the uptake of community-based DSD models.

Conclusion

One out of five stable PLHIV on antiretroviral therapy uptake the community-based DSD models. Improvement in uptake is needed in Ethiopia's resource-limited healthcare system to better achieve the 95-95-95 targets.