scholarly journals Distribution of antiretroviral therapy through private pharmacies and postal courier services during COVID‐19 in Botswana: acceptability and reach of two out‐of‐facility individual differentiated service delivery models

2021 ◽  
Vol 24 (S6) ◽  
Author(s):  
Mulamuli Mpofu ◽  
Tackler Moyo ◽  
Masego Gilbert ◽  
Wame Dikobe ◽  
Lirica Nishimoto ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Service Delivery ◽  
Differentiated Service ◽  
Service Delivery Models ◽  
Delivery Models

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 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 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 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 Annual cost of antiretroviral therapy among three service delivery models in Uganda

2016 ◽  
Vol 19 ◽  
pp. 20840 ◽  
Author(s):  
Lung Vu ◽  
Samuel Waliggo ◽  
Brady Zieman ◽  
Nrupa Jani ◽  
Lydia Buzaalirwa ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Service Delivery ◽  
Annual Cost ◽  
Service Delivery Models ◽  
Delivery Models
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