TY - JOUR
T1 - Attrition from HIV treatment after enrollment in a differentiated service delivery model
T2 - A cohort analysis of routine care in Zambia
AU - Jo, Youngji
AU - Jamieson, Lise
AU - Phiri, Bevis
AU - Grimsrud, Anna
AU - Mwansa, Muya
AU - Shakwelele, Hilda
AU - Haimbe, Prudence
AU - Mukumbwa-Mwenechanya, Mpande
AU - Mulenga, Priscilla Lumano
AU - Nichols, Brooke E.
AU - Rosen, Sydney
N1 - Funding Information: Funding: Funding for the study was provided by the Bill & Melinda Gates Foundation through OPP1192640 to Boston University. YJ is supported by the Ruth L. Kirschstein National Research Service Award, National Institutes of Health F32 Individual Fellowship Grant (grant number: 1F32MH128120-01). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Publisher Copyright: Copyright: © 2023 Jo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Background Many sub-Saharan Africa countries are scaling up differentiated service delivery (DSD) models for HIV treatment to increase access and remove barriers to care. We assessed factors associated with attrition after DSD model enrollment in Zambia, focusing on patient-level characteristics. Methods We conducted a retrospective record review using electronic medical records (EMR) of adults (≥15 years) initiated on antiretroviral (ART) between 01 January 2018 and 30 November 2021. Attrition was defined as lost to follow-up (LTFU) or died by November 30, 2021. We categorized DSD models into eight groups: fast-track, adherence groups, community pick-up points, home ART delivery, extended facility hours, facility multi-month dispensing (MMD, 4–6-month ART dispensing), frequent refill care (facility 1–2 month dispensing), and conventional care (facility 3 month dispensing, reference group). We used Fine and Gray competing risk regression to assess patient-level factors associated with attrition, stratified by sex and rural/urban setting. Results Of 547,281 eligible patients, 68% (n = 372,409) enrolled in DSD models, most commonly facility MMD (n = 306,430, 82%), frequent refill care (n = 47,142, 13%), and fast track (n = 14,433, 4%), with <2% enrolled in the other DSD groups. Retention was higher in nearly all DSD models for all dispensing intervals, compared to the reference group, except fast track for the ≤2 month dispensing group. Retention benefits were greatest for patients in the extended clinic hours group and least for fast track dispensing. Conclusion Although retention in HIV treatment differed by DSD type, dispensing interval, and patient characteristics, nearly all DSD models out-performed conventional care. Understanding the factors that influence the retention of patients in DSD models could provide an important step towards improving DSD implementation.
AB - Background Many sub-Saharan Africa countries are scaling up differentiated service delivery (DSD) models for HIV treatment to increase access and remove barriers to care. We assessed factors associated with attrition after DSD model enrollment in Zambia, focusing on patient-level characteristics. Methods We conducted a retrospective record review using electronic medical records (EMR) of adults (≥15 years) initiated on antiretroviral (ART) between 01 January 2018 and 30 November 2021. Attrition was defined as lost to follow-up (LTFU) or died by November 30, 2021. We categorized DSD models into eight groups: fast-track, adherence groups, community pick-up points, home ART delivery, extended facility hours, facility multi-month dispensing (MMD, 4–6-month ART dispensing), frequent refill care (facility 1–2 month dispensing), and conventional care (facility 3 month dispensing, reference group). We used Fine and Gray competing risk regression to assess patient-level factors associated with attrition, stratified by sex and rural/urban setting. Results Of 547,281 eligible patients, 68% (n = 372,409) enrolled in DSD models, most commonly facility MMD (n = 306,430, 82%), frequent refill care (n = 47,142, 13%), and fast track (n = 14,433, 4%), with <2% enrolled in the other DSD groups. Retention was higher in nearly all DSD models for all dispensing intervals, compared to the reference group, except fast track for the ≤2 month dispensing group. Retention benefits were greatest for patients in the extended clinic hours group and least for fast track dispensing. Conclusion Although retention in HIV treatment differed by DSD type, dispensing interval, and patient characteristics, nearly all DSD models out-performed conventional care. Understanding the factors that influence the retention of patients in DSD models could provide an important step towards improving DSD implementation.
UR - http://www.scopus.com/inward/record.url?scp=85150311142&partnerID=8YFLogxK
U2 - https://doi.org/10.1371/journal.pone.0280748
DO - https://doi.org/10.1371/journal.pone.0280748
M3 - Article
C2 - 36917568
SN - 1932-6203
VL - 18
JO - PLOS ONE
JF - PLOS ONE
IS - 3 March
M1 - e0280748
ER -