Search

Introduction: Differentiated Service Delivery Models (DSDM), a strategy to promote retention in HIV care and/or ART adherence, is now increasingly recognized as an important and sustainable approach that could contribute significantly toward the UNAIDS 90-90-90 by 2020 and 95-95-95 by 2030 targets and ultimately an AIDS-free generation. This study was conducted to determine the outcomes of DSDM among people living with HIV in Tanzania. Methods: A Cross-sectional analytical design approach employing both quantitative and qualitative data collection methods was adopted in this study that was implemented in 9 regions of Tanzania. We conducted record reviews and in-depth interviews with key informants at national and facility levels where their data was summarized and arranged in sub-themes and then analyzed according to the specific objectives by using Thematic Analysis. We further conducted a bivariate analysis using Chi-Square to assess the association between each outcome and explanatory variable. Unadjusted and adjusted analysis was conducted to determine predictors of unfavourable outcomes using logistics regression models. Results: Data was collected from 50 health facilities comprising 15 (30.0%) hospitals, 22 (44.0%) health centres and 13 (26.0%) dispensaries. Record reviews were for different outcomes as follows; Mis-categorization (13,056 records), Missed appointments (62,222 records), Advanced HIV disease (29,995 records), and Attrition (62,222 records). Among the 320 unstable clients, the rate of miscategorization significantly decreased after the introduction of DSDM, from 63% to 36% (p < 0.001). After the introduction of DSDM, more clients missed their appointments compared to the period before the introduction of DSDM (1.7% vs 0.8% respectively). Missed appointments were associated with an urban setting ( AOR 1.1, 95% CI 1.1-1.2) and older age of 50 years and more (AOR 1.2, 95% CI 1.1-1.4) in comparison to a rural setting and younger age of fewer than 15 years respectively. Furthermore, DSDM led to a decrease (from 56% to 49%) of those with advanced WHO stage among the first-time testers. Attrition among the clients was higher after the introduction of DSDM compared to that before DSDM (ARR 1.1, 95% CI 1.04-1.2). Contributors to attrition were those related to individuals and institutions including beliefs in faith healing, fear of stigma and wrong interpretation of viral load monitoring results. Conclusion: Decentralized Community-based ART model is a promising entry point to improved HIV/AIDS service delivery. Strategies are needed to harmonise the comprehensiveness and quality of services across facilities providing HIV services. [ABSTRACT FROM AUTHOR]

Background: Starting Antiretroviral Treatment (ART) on time and being retained in care reduces the risk of HIV transmission, impoverishment of chronic end-organ effects of untreated viremia, and an overall increase in life expectancy. This study aimed at establishing available strategies for the linkage and retention of HIV clients as well as the costs associated with the strategy. Method: A retrospective cross-sectional design was conducted in eight regions of Tanzania mainland. A total of 60 facilities and affiliated communities providing linkage and ART services were involved. Mixed methods of collecting data were used with comprehensive document review. Information collected was for the period between 1st January to 31st December 2019. Cost evaluation was based on both patient and provider perspectives. Results: In general, 91% of the clients were successfully linked to care and the cost per client linked was $14.0 across regions. The cost of facility linkage strategy was $14.73 with personnel, commodities and supplies and training costs emerging as the cost drivers. The cost for client linkage to care using the community strategy was lower ($11.89) than the facility strategy ($14.73). The overall retention rate was 99% with no difference between retention strategies. The Cost of retention per client in facilities without outreach services was $14.73 while in facilities with outreach, the cost was $11.89. Personnel cost was the primary costs’ driver in both strategies. Of 1,039 participants involved, to establish patient incurred cost for retention to care. Females were 65.4% and 57.8% of participants were from rural settings. Clients incurred annual out-of-pocket payments was $12.06. Conclusion: There is no difference in the yield of the HIV-positive and overall percentage of clients successfully linked to care based on facility and community strategies. However, there is regional variations in terms of per-client cost for HIV linkage and retention services. The overall cost per client linked using the facility strategy was higher than the community strategy and personnel cost was the main cost driver in both linkage and retention costs. [ABSTRACT FROM AUTHOR]