Eligibility for differentiated models of HIV treatment service delivery: an estimate from Malawi and Zambia
AUTHORS
- PMID: 31764076 [PubMed].
ABSTRACT
BACKGROUND: Little is known about the proportion of HIV-positive clients on antiretroviral therapy (ART) who meet stability criteria for differentiated service delivery (DSD) models. We report the proportion of ART clients meeting stability criteria as part of screening for a randomized trial of multi-month dispensing in Malawi and Zambia.
METHODS: For a DSD trial now underway, we screened HIV-positive clients ≥18 years presenting for HIV treatment in 30 adult ART clinics in Malawi and Zambia to determine eligibility for DSD. Stability was defined as on first-line ART (efavirenz/tenofovir/lamivudine) for at least six months, no ART side effects, no toxicity or infectious complications, no non-communicable diseases being treated in ART clinic, no lapses in ART adherence in the prior six months (>30 days without taking ART), and if female, not pregnant or breastfeeding.
RESULTS: A total of 3,465 adult ART clients were approached between May 10, 2017 and April 30, 2018 (Malawi: 1,680; Zambia: 1,785). Of the 2,938 who answered screening questions (Malawi: 1,527; Zambia: 1,411), 2,173 (73.5%) met criteria for DSD eligibility (Malawi: 72.8%; Zambia: 74.3%). The most common reasons for ineligibility were being on ART less than six months (9.6%) and a regimen other than standard first-line (7.9%).
CONCLUSIONS: Approximately three-quarters of all adult clients presenting at ART clinics in Malawi and Zambia were eligible for DSD using a typical definition of stability. High uptake of DSD models by eligible clients would have a major impact on the infrastructure and the allocation of HIV treatment resources.
Tags: alumni publications 2019