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 Retention in Care and Viral Suppression in Differentiated Service Delivery Models for HIV Treatment in Sub-Saharan Africa: A Rapid Systematic Review

2020 ◽  
Author(s):  
Lawrence Long ◽  
Salome Kuchukhidze ◽  
Sophie Pascoe ◽  
Brooke E. Nichols ◽  
Matthew P. Fox ◽  
...  
Keyword(s):  
Systematic Review ◽  
Service Delivery ◽  
Clinical Outcomes ◽  
Viral Suppression ◽  
Retention In Care ◽  
Conventional Care ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Differentiated Service ◽  
Sub Saharan

Introduction: Differentiated service delivery (DSD) models for antiretroviral treatment (ART) for HIV are being scaled up in the expectation that they will improve the quality and efficiency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes. Even this minimum requirement of equivalent clinical outcomes is poorly documented for most models and settings, however. We reviewed the recent literature on DSD models to describe what is known about clinical outcomes. Methods: We conducted a rapid systematic review of peer-reviewed publications in PubMed, Embase, and the Web of Science and major international conference abstracts that reported outcomes of DSD models for the provision of ART in sub-Saharan Africa from January 1, 2016 to September 12, 2019. Sources reporting standard clinical HIV treatment metrics, primarily retention in care and viral load suppression, were reviewed and categorized by DSD model and source quality assessed. Results and Discussion: Twenty-nine papers and abstracts describing 37 DSD models and reporting 52 discrete outcomes met search inclusion criteria. Of the 37 models, 7 (19%) were facility-based individual models, 12 (32%) out-of-facility based individual models, 5 (14%) client-led groups, and 13 (35%) healthcare worker-led groups. Retention was reported for 73% of the models and viral suppression for 57%. Where a comparison with conventional care was provided, retention in most DSD models was within 5% of that for conventional care; where no comparison was provided, retention generally exceeded 80%. For viral suppression, all those with a comparison to conventional care reported a small increase in suppression in the DSD model; reported suppression exceeded 90% in 11/21 models. Analysis was limited by the extensive heterogeneity of study designs, outcomes, models, and populations. Most sources did not provide comparisons with conventional care, and metrics for assessing outcomes varied widely and were in many cases poorly defined. Conclusion: Existing evidence on the clinical outcomes of DSD models for HIV treatment in sub-Saharan Africa is limited in both quantity and quality but suggests that retention in care and viral suppression are roughly equivalent to those in conventional models of care.

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.

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
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