Share

Long appointment spacing: expedited differentiated service delivery in Kenya to mitigate COVID-19 infection among HIV populations

Title
Presenter
Authors
Institutions

BACKGROUND: Differentiated service delivery (DSD) can help mitigate the potential spread of coronavirus disease 2019 (COVID-19) in HIV settings while ensuring sustained access to antiretroviral therapy drugs. At the early phase of the pandemic, Kenya issued policy requiring all facilities to implement DSD through long appointment spacing for all HIV patients regardless of age and clinical stability status. We assessed appointment spacing practices before and after the policy.
METHODS: We used a pre'post study design to compare DSD practices during pre-COVID-19 (1 February 2020 to 15 March 2020) and COVID-19 (1 April 2020 to 15 May 2020) period. We analyzed patient-level data from the Kenya National HIV Data Warehouse, a longitudinal data repository from 1,190 facilities in 45 out of 47 of Kenya's counties. We measured appointment spacing in months as the difference between patient visit date and corresponding next appointment date with long appointment spacing defined as '¥3 months.
RESULTS: We analyzed data from 390,385 patients, with 154,919 (39.7%) visiting facilities during pre-COVID-19 and 235,466 (60.3%) during COVID-19 period. Females were 68.4% (267,065) and median age was 39 years (IQR 30'48). In pre-COVID-19 period, median appointment spacing was 34.5 days (IQR 28.6'84.8) with 25.2% (39,016) having long appointment spacing. During COVID-19 period, median appointment spacing was 84 days (IQR 35'96) and 56.3% (132,646) had long appointment spacing. Compared to males, fewer females in both pre-COVID (24.2% vs 27.4%, p<0.0001) and COVID-19 periods (55.1% vs 59.1%, p<0.0001) had long appointment spacing. Younger patients had long appointment spacing in both pre- and COVID-19 periods (p<0.0001).

Table 1: Appointment spacing by age
Age at last visit
Pre-COVID-19 period (N= 154,919)
COVID-19 period (N= 235,466)
Total

Non-DSD
DSD
Non-DSD
DSD

<15 years
11,320 (96.3%)
433 (3.7%)
11,230 (62.5%)
6,746 (37.5%)
29,729
15-24 years
12,625 (92.5%)
1,022 (7.5%)
12,661 (56.9%)
9,586 (43.1%)
35,894
25-34 years
26,972 (81.1%)
6,282 (18.9%)
25,148 (52.8%)
22,482 (47.2%)
80,884
35-44 years
31,852 (71.9%)
12,445 (28.1%)
27,281 (41.3%)
38,795 (58.7%)
110,373
45-54 years
20,001 (64.3%)
11,094 (35.7%)
16,109 (33.2%)
32,427 (66.8%)
79,631
55+ years
12,968 (62.7%)
7,720 (37.3%)
10,391 (31.5%)
22,610 (68.5%)
53,689
Missing age
165 (89.2%)
20 (10.8%)
0(0%)
0(0%)
185
Total
115,903 (74.8%)
39,016 (25.2%)
102,820 (43.7%)
132,646 (56.3%)
390,385

CONCLUSIONS: Long appointment spacing significantly increased between pre- and COVID-19 periods. Impact of long appointment spacing on patient outcomes should be assessed, especially among unstable patients. DSD implementation enabled continuity of HIV service delivery in Kenya despite the pandemic.