scholarly journals “Patients are not the same, so we cannot treat them the same” – A qualitative content analysis of provider, patient and implementer perspectives on differentiated service delivery models for HIV treatment in South Africa

2020 ◽  
Vol 23 (6) ◽  
Author(s):  
Sophie J S Pascoe ◽  
Nancy A Scott ◽  
Rachel M Fong ◽  
Joshua Murphy ◽  
Amy N Huber ◽  
...  
Keyword(s):  
South Africa ◽  
Content Analysis ◽  
Service Delivery ◽  
Qualitative Content Analysis ◽  
Hiv Treatment ◽  
Differentiated Service ◽  
Service Delivery Models ◽  
Delivery Models

scholarly journals Similar costs and outcomes for differentiated service delivery models for HIV treatment in Uganda

2021 ◽  
Author(s):  
Teresa Guthrie ◽  
Charlotte Muheki ◽  
Sydney Rosen ◽  
Shiba Kanoowe ◽  
Stephen Lagony ◽  
...  
Keyword(s):  
Service Delivery ◽  
Viral Suppression ◽  
Standard Of Care ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Total Annual Cost ◽  
Differentiated Service ◽  
Community Based ◽  
Service Delivery Models ◽  
Delivery Models

Background: Like many countries in sub-Saharan Africa, Uganda has scaled up differentiated service delivery models (DSDMs) for HIV treatment, but little information is available about the relative costs of the models. We estimated the total annual cost per patient and total cost per patient virally suppressed in five DSDMs, including facility- and community-based models and the standard of care. Methods: We conducted a cost/outcome study from the perspective of the service provider, using retrospective patient record review of a cohort of patients over a two-year period, with bottom-up collection of patient resource utilization data, top-down collection of above-delivery level and delivery-level provider fixed operational costs, and local unit costs. We enrolled adults on ART (>18 years old) enrolled in 47 DSDMs located at facilities or community-based service points in four regions of Uganda with at least 24 months of follow-up data. DSDMs assessed included facility-based groups (FBG); fast-track drug refills (FDR); community client-led ART delivery (CCLAD); community drug distribution points (CDDP); and facility-based individual management (FBIM), which is the standard of care model for new, complex, and virally unsuppressed patients. Viral suppression was defined as <1000 copies/ml. Results: Retention in care was 98% for the sample as a whole [96-100%]. Over viral suppression was 91%, which varied from 86% among patients in FBIM (with the largest share of complex / virally unsuppressed patients) to 93% among CDDP patients. The mean cost to the provider (Ministry of Health or NGO implementers) was $152 per annum per patient treated, ranging from $141 for FBG to $166 for FDR. Differences among the costs of the models were largely due to ARV regimens and proportions of patients on second line regimens. Service delivery costs, excluding ARVs, other medicines and laboratory tests, were modest, ranging from $9.66-16.43 per patient. Conclusions: Differentiated ART service delivery in Uganda achieved excellent treatment outcomes at a cost similar to the standard of care (FBIM). While large budgetary savings might not be immediately realized, the reallocation of saved staff time could improve health system efficiency as facilities and patients gain more experience with DSD models.

scholarly journals Economic evaluation of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients

2021 ◽  
Vol 24 (4) ◽  
Author(s):  
Brooke E Nichols ◽  
Refiloe Cele ◽  
Nkgomeleng Lekodeba ◽  
Betty Tukei ◽  
Nicoletta Ngorima‐Mabhena ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Service Delivery ◽  
Hiv Treatment ◽  
Differentiated Service ◽  
Service Delivery Models ◽  
Delivery Models

scholarly journals Comparing Patients’ Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa

2021 ◽  
pp. 104973232110503
Author(s):  
Ferdinand C. Mukumbang ◽  
Sibusiso Ndlovu ◽  
Brian van Wyk
Keyword(s):  
Service Delivery ◽  
Hiv Treatment ◽  
Self Management ◽  
People Living With Hiv ◽  
Service Delivery Model ◽  
Differentiated Service ◽  
Descriptive Phenomenology ◽  
Service Delivery Models ◽  
Living With Hiv ◽  
Delivery Models

Differentiated service delivery for HIV treatment seeks to enhance medication adherence while respecting the preferences of people living with HIV. Nevertheless, patients’ experiences of using these differentiated service delivery models or approaches have not been qualitatively compared. Underpinned by the tenets of descriptive phenomenology, we explored and compared the experiences of patients in three differentiated service delivery models using the National Health Services’ Patient Experience Framework. Data were collected from 68 purposively selected people living with HIV receiving care in facility adherence clubs, community adherence clubs, and quick pharmacy pick-up. Using the constant comparative thematic analysis approach, we compared themes identified across the different participant groups. Compared to facility adherence clubs and community adherence clubs, patients in the quick pharmacy pick-up model experienced less information sharing; communication and education; and emotional/psychological support. Patients’ positive experience with a differentiated service delivery model is based on how well the model fits into their HIV disease self-management goals.

scholarly journals Tuberculosis treatment within differentiated service delivery models in global HIV/TB programming

2021 ◽  
Vol 24 (S6) ◽  
Author(s):  
Cuc H. Tran ◽  
Brittany K. Moore ◽  
Ishani Pathmanathan ◽  
Patrick Lungu ◽  
N. Sarita Shah ◽  
...  
Keyword(s):  
Service Delivery ◽  
Tuberculosis Treatment ◽  
Differentiated Service ◽  
Service Delivery Models ◽  
Delivery Models

scholarly journals Leaving No Man Behind: How Differentiated Service Delivery Models Increase Men’s Engagement in HIV Care

2020 ◽  
Author(s):  
Ferdinand C. Mukumbang
Keyword(s):  
Service Delivery ◽  
Critical Realism ◽  
Theory Development ◽  
Perceived Usefulness ◽  
Hiv Care ◽  
Potential Contribution ◽  
Differentiated Service ◽  
Hiv Services ◽  
Service Delivery Models ◽  
Delivery Models

Background: Men demonstrate disproportionately poor uptake and engagement in HIV services with strong evidence linking men’s disinclination to engage in HIV services to their masculinity, necessitating adaptive programming to accommodate HIV-positive men. Differentiated service delivery models (DSDMs) – streamlined patient-centred antiretroviral treatment (ART) delivery services – have demonstrated the potential to improve men’s engagement in HIV services. However, it is unclear how and why these models contribute to men’s reframing of ART-friendly masculinities – a set of attributes, behaviours and roles associated with boys and men that favour the uptake and use of ART. We sought to unveil how and why DSDMs support the formation of ART-friendly masculinities to enhance men’s participation in HIV-related services. Methods: A theory-driven qualitative approach underpinned by critical realism was conducted with 30 adult men using 3 types of DSDMs: facility-based adherence clubs (FACs), community-based adherence clubs (CACs) and quick pharmacy pick-ups (QPUPs). Focus group discussions (FGDs) (6) and in-depth interviews (IDIs) (20) were used to elicit information from purposively selected participants based on their potential contribution to the theory development – theoretical sampling. Recordings were transcribed verbatim in isiXhosa, then translated to English and analysed thematically. Theoretical constructs (themes) related to programme context and generative mechanisms were distilled and linked by retroduction and abductive thinking to formulate explanatory theories. Results: Three bundles of mechanisms driving the adoption of ART-friendly masculinities by men using DSDMs were identified. (1) DSDMs instil a sense of cohesion (social support and feeling of connectedness), which enhances their reputational masculinity – having the know-how and being knowledgeable. (2) DSDMs provide a sense of assurance by providing reliable, convenient, stigma-free services, which makes men feel strong and resilient (respectability identity). (3) Through perceived usefulness, the extent to which an individual believes the model enhances their disease management, DSDMs enhance men’s ability to be economically productive and take care of their family (responsibility identity). Conclusion: DSDMs enhance the refashioning of ART-friendly versions of masculinity, thus improving men’s engagement in HIV services. Their effectiveness in refashioning men’s masculinities to ART friendly masculinities can be improved by ensuring conducive conditions for group interactions and including gender-transformative education to their existing modalities.

scholarly journals Differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: A landscape analysis

2020 ◽  
Author(s):  
Amy Huber ◽  
Sophie Pascoe ◽  
Brooke E Nichols ◽  
Lawrence Long ◽  
Salome Kuchukhidze ◽  
...  
Keyword(s):  
South Africa ◽  
Service Delivery ◽  
Health Workers ◽  
Clinical Care ◽  
Hiv Treatment ◽  
Data Systems ◽  
Differentiated Service ◽  
Model Of Care ◽  
Healthcare Facilities ◽  
Organization Models

Introduction: Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods: We interviewed DSD model implementing organizations for descriptive information about each model of care supported by the organization. We described the key characteristics of each model, including population of patients served, location of service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to one organization supporting one model of care as an organization-model. Results: The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility based individual models, 21 out-of-facility based individual models, 14 healthcare worker led groups, and 3 client led groups; jointly, these encompassed 12 service delivery strategies. Over 2/3 (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established healthcare facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from a low of 2 to a high of 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff (doctors, nurses, pharmacists), while group models made greater use of lay personnel (community health workers, counselors). Conclusions: As of 2019, there was a large variety of differentiated service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.

scholarly journals Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe

2021 ◽  
Author(s):  
Mariet Benade ◽  
Brooke E Nichols ◽  
Geoffrey Fatti ◽  
Salome Kuchukhidze ◽  
Kudakwashe Takarinda ◽  
...  
Keyword(s):  
Viral Load ◽  
Service Delivery ◽  
Annual Cost ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Differentiated Service ◽  
Community Based ◽  
Cluster Randomized ◽  
Delivery Models

Background: About 85% of Zimbabwe's >1.4 million people living with HIV are on antiretroviral treatment (ART). Further expansion of its treatment program will require more efficient use of existing resources. Two promising strategies for reducing resource utilization per patient are multi-month medication dispensing and community-based service delivery. We evaluated the costs to providers and patients of community-based, multi-month ART delivery models in Zimbabwe. Methods:We used resource and outcome data from a cluster-randomized non-inferiority trial of three differentiated service delivery (DSD) models targeted to patients stable on ART: 3-month facility-based care (3MF), community ART refill groups (CAGs) with 3-month dispensing (3MC), and CAGs with 6-month dispensing (6MC). Using local unit costs, we estimated the annual cost in 2020 USD of providing HIV treatment per patient from the provider and patient perspectives. Results:In the trial, retention at 12 months was 93.0% in the 3MF, 94.8% in the 3MC, and 95.5% in the 6MC arms. The total average annual cost of HIV treatment per patient was $187 (standard deviation $39), $178 ($30), and $167 ($39) in each of the three arms, respectively. The annual cost/patient was dominated by ART medications (79% in 3MF, 87% in 3MC; 92% in 6MC), followed by facility visits (12%, 5%, 5%, respectively) and viral load (8%, 8%, 2%, respectively). When costs were stratified by district, DSD models cost slightly less, with 6MC the least expensive in all districts. Savings were driven by differences in the number of facility visits made/year, as expected, and low uptake of annual viral load tests in the 6-month arm. The total annual cost to patients to obtain HIV care was $10.03 ($2) in the 3MF arm, $5.12 ($0.41) in the 3MC arm, and $4.40 ($0.39) in the 6MF arm. Conclusions:For stable ART patients in Zimbabwe, 3- and 6-month community-based multi-month dispensing models cost less for both providers and patients than 3-month facility-based care and had non-inferior outcomes.

Sign in / Sign up

Export Citation Format

Share Document