scholarly journals Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub‐Saharan Africa: a rapid systematic review

2020 ◽  
Vol 23 (11) ◽  
Author(s):  
Lawrence Long ◽  
Salome Kuchukhidze ◽  
Sophie Pascoe ◽  
Brooke E Nichols ◽  
Matthew P Fox ◽  
...  
Keyword(s):  
Systematic Review ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Differentiated Service ◽  
Treatment Delivery ◽  
Service Delivery Models ◽  
Sub Saharan ◽  
Delivery Models

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 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 Retention in care prior to antiretroviral treatment eligibility in sub-Saharan Africa: a systematic review of the literature

BMJ Open ◽  
2015 ◽  
Vol 5 (6) ◽  
pp. e006927 ◽  
Author(s):  
Mélanie Plazy ◽  
Joanna Orne-Gliemann ◽  
François Dabis ◽  
Rosemary Dray-Spira
Keyword(s):  
Systematic Review ◽  
Antiretroviral Treatment ◽  
Retention In Care ◽  
Sub Saharan Africa ◽  
Review Of The Literature ◽  
Sub Saharan

scholarly journals Effect of female sex work-targeted community-based interventions along the HIV treatment cascade in sub-Saharan Africa: a systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039495
Author(s):  
Lydia Atuhaire ◽  
Olatunji Adetokunboh ◽  
Constance Shumba ◽  
Peter S Nyasulu
Keyword(s):  
Systematic Review ◽  
Sex Work ◽  
Grey Literature ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Community Based Interventions ◽  
Community Based ◽  
Treatment Cascade ◽  
Hiv Treatment Cascade ◽  
Sub Saharan

IntroductionFemale sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic circumstances. Previous systematic reviews have examined the effectiveness of HIV interventions prioritising FSWs and have shown that targeted interventions improve access to HIV prevention and treatment services. Interventions that increase FSWs’ uptake of services are well documented; however, evidence on specific interventions aimed at improving FSWs’ continuity in HIV care along the treatment cascade is lacking. This systematic review aims to document the performance of community-based interventions along the HIV treatment cascade.Methods and analysisWe will use a sensitive search strategy for electronic bibliographic databases, bibliographies of included articles and grey literature sources. In addition, the Joint United Nations Programme on HIV/AIDS and the WHO websites, peer-reviewed conference papers and grey literature sources will be searched for additional reports of sex work programmes. We will include randomised controlled trials, cross-sectional surveys and cohort interventions where community-based HIV services were provided to FSWs and measure the performance of the HIV intervention on one or more cascade stages. We will conduct a systematic review of studies published from 2004 to present within the sub-Saharan Africa region. We will report quantitative study outcomes of HIV testing and diagnosis, linkage to care, initiation on antiretroviral therapy and viral suppression. We will analyse the data using the random-effects meta-analysis method, and funnel plots will be used to assess the publication bias.Ethics and disseminationThis systematic review will not require ethical approval; we will publish data from manuscripts. The results of this study will be disseminated in peer-reviewed journals and conference presentations.PROSPERO registration numberCRD42020157623.

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
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