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.
An Integrated Service Delivery Model to Identify Persons Living with HIV and to Provide Linkage to HIV Treatment and Care in Prioritized Neighborhoods: A Geotargeted, Program Outcome Study
