scholarly journals Correction to: Expansion of a national differentiated service delivery model to support people living with HIV and other chronic conditions in South Africa: a descriptive analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lingrui Liu ◽  
Sarah Christie ◽  
Maggie Munsamy ◽  
Phil Roberts ◽  
Merlin Pillay ◽  
...  
Keyword(s):  
South Africa ◽  
Service Delivery ◽  
Chronic Conditions ◽  
Descriptive Analysis ◽  
People Living With Hiv ◽  
Service Delivery Model ◽  
Differentiated Service ◽  
Delivery Model ◽  
Living With Hiv

scholarly journals Title: Expansion of a national differentiated service delivery model to support people living with HIV and other chronic conditions in South Africa: a descriptive analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lingrui Liu ◽  
Sarah Christie ◽  
Maggie Munsamy ◽  
Phil Roberts ◽  
Merlin Pillay ◽  
...  
Keyword(s):  
South Africa ◽  
Service Delivery ◽  
Chronic Diseases ◽  
Descriptive Analysis ◽  
Noncommunicable Diseases ◽  
People Living With Hiv ◽  
Service Delivery Model ◽  
Differentiated Service ◽  
Delivery Model ◽  
Living With Hiv

Abstract Background South Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel challenge of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) of South Africa launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients who have chronic diseases, including HIV, with alternative access to medications via community-based pick-up points. This study describes the expansion of CCMDD toward national scale. Methods Yale monitors CCMDD expansion as part of its mixed methods evaluation of Project Last Mile, a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication provided [ART only; NCD only; and ART-NCD] and collection sites preferred by patients [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis. Results As of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88 % of South Africa’s districts), and 2,037 external pick-up points had been contracted by the NDoH. A total of 2,069,039 patients were actively serviced through CCMDD, a significant increase since 2018 (p < 0.001), including 76 % collecting ART [64 % ART only, 12 % ART plus NCD/comorbidities] and 479,120 [24 %] collecting medications for chronic diseases only. Further, 734,005 (35 %) of patients were collecting from contracted, external pick-up points, a 73 % increase in patient volume from 2018. Discussion This longitudinal description of CCMDD provides an example of growth of a national differentiated service delivery model that integrates management of HIV and noncommunicable diseases. This study demonstrates the success of the program in engaging patients irrespective of their chronic condition, which bodes well for the potential of the program to address the rising burden of both HIV and NCDs in South Africa. Conclusions The CCMDD program expansion signals the potential for a differentiated service delivery strategy in resource-limited settings that can be agnostic of the patients chronic disease condition.

scholarly journals Expansion of a National Differentiated Service Delivery Model Increases Access to Treatment for HIV and Other Chronic Conditions in South Africa

2021 ◽  
Author(s):  
Lingrui Liu ◽  
Sarah Christie ◽  
Maggie Munsamy ◽  
Phil Roberts ◽  
Merlin Pillay ◽  
...  
Keyword(s):  
South Africa ◽  
Service Delivery ◽  
Noncommunicable Diseases ◽  
People Living With Hiv ◽  
Service Delivery Model ◽  
Differentiated Service ◽  
National Scale ◽  
Access To Treatment ◽  
Delivery Model ◽  
Living With Hiv

Abstract Background: South Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel threat of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients with chronic disease, including HIV, with differentiated access to medications via community-based pick-up points. This study describes the expansion of CCMDD to national scale.Methods: Yale monitors CCMDD enrollment as part of its mixed methods evaluation of Project Last Mile (PLM), a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication collected [ART only; NCD only; and ART-NCD] and of collection site used [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis.Results: As of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88% national coverage), and 2,037 external pick-up points had been established. A total of 2,069,039 patients were active on CCMDD, a significant increase since 2018 (p<0.001), including 76% collecting ART [64% ART only, 12% ART plus NCD/comorbidities] and 479,120 [24%] collecting for chronic diseases only. Further, 734,005 (35%) of patients were collecting from external pick-up points, a 73% increase in patient volume from 2018.Discussion: This longitudinal description of CCMDD provides an example of a path to national scale for a differentiated service delivery model that integrates management of HIV and noncommunicable diseases. This study demonstrates the success of the program in engaging patients who are not living with HIV, which bodes well for the potential of the program to address the rising burden of NCDs in South Africa.Conclusion: The results signal potential for expansion in resource-limited settings, particularly in the context of private sector strategic support.

scholarly journals A Service Delivery Model for Addressing Activity and Social Participation Needs of People Living with HIV

2017 ◽  
Vol 5 (2) ◽  
Author(s):  
Gayle Restall ◽  
Theresa Sullivan ◽  
Tara Carnochan ◽  
Emily Etcheverry ◽  
Kerstin Roger ◽  
...  
Keyword(s):  
Service Delivery ◽  
Social Participation ◽  
People Living With Hiv ◽  
Service Delivery Model ◽  
Delivery Model ◽  
Living With Hiv

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 Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047443
Author(s):  
Jonathan Ross ◽  
Gad Murenzi ◽  
Sarah Hill ◽  
Eric Remera ◽  
Charles Ingabire ◽  
...  
Keyword(s):  
Service Delivery ◽  
Health Centre ◽  
Albert Einstein College ◽  
Secondary Outcome ◽  
Controlled Study ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Differentiated Service ◽  
Viral Loads ◽  
Living With Hiv

IntroductionCurrent HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.Methods and analysesThe present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).Ethics and disseminationThis clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.Trial registration numberNCT04567693.

scholarly journals Acceptability of Community-Based Tuberculosis Preventive Treatment for People Living with HIV in Zimbabwe

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 116
Author(s):  
Martin K. Msukwa ◽  
Munyaradzi P. Mapingure ◽  
Jennifer M. Zech ◽  
Tsitsi B. Masvawure ◽  
Joanne E. Mantell ◽  
...  
Keyword(s):  
Service Delivery ◽  
Preventive Treatment ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Differentiated Service ◽  
Community Based ◽  
Time Motion ◽  
Symptom Screening ◽  
Adherence Monitoring ◽  
Living With Hiv

As Zimbabwe expands tuberculosis preventive treatment (TPT) for people living with HIV (PLHIV), the Ministry of Health and Child Care is considering making TPT more accessible to PLHIV via less-intensive differentiated service delivery models such as Community ART Refill Groups (CARGs). We designed a study to assess the feasibility and acceptability of integrating TPT into CARGs among key stakeholders, including CARG members, in Zimbabwe. We conducted 45 key informant interviews (KII) with policy makers, implementers, and CARG leaders; 16 focus group discussions (FGD) with 136 PLHIV in CARGs; and structured observations of 8 CARG meetings. KII and FGD were conducted in English and Shona. CARG observations were conducted using a structured checklist and time-motion data capture. Ninety six percent of participants supported TPT integration into CARGs and preferred multi-month TPT dispensing aligned with ART dispensing schedules. Participants noted that the existing CARG support systems could be used for TB symptom screening and TPT adherence monitoring/support. Other perceived advantages included convenience for PLHIV and decreased health facility provider workloads. Participants expressed concerns about possible medication stockouts and limited knowledge about TPT among CARG leaders but were confident that CARGs could effectively provide community-based TPT education, adherence monitoring/support, and TB symptom screening provided that CARG leaders received appropriate training and supervision. These results are consistent with findings from pilot projects in other African countries that are scaling up both differentiated service delivery for HIV and TPT and suggest that designing contextually appropriate approaches to integrating TPT into less-intensive HIV treatment models is an effective way to reach people who are established on ART but who may have missed out on access to TPT.

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