Share

Factors associated with 12-month retention after referral to a differentiated service delivery for HIV treatment model in Zambia

Title
Factors associated with 12-month retention after referral to a differentiated service delivery for HIV treatment model in Zambia
Presenter
Bevis Phiri
Authors
Y. Jo (1), S. Rosen (2,3), B. Phiri * (4), A. Grimsrud (5), M. Mwansa (6), H. Shakwele (4), P. Haimbe (4), M.M Mwenechanya (7), P. Lumano Mulenga (6), B.E Nichols (2,3,8)
Institutions
(1) Boston Medical Center, Section of Infectious Diseases, Department of Medicine, Boston, United States, (2) Boston University School of Public Health, Department of Global Health, Boston, United States, (3) University of the Witwatersrand, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Johannesburg, South Africa, (4) Clinton Health Access Initiative, Lusaka, Zambia, (5) International AIDS Society, Cape Town, South Africa, (6) Ministry of Health, Lusaka, Zambia, (7) The Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, (8) Amsterdam University Medical Center, Department of Medical Microbiology, Lusaka, Zambia

BACKGROUND: Many countries across sub-Saharan Africa are rapidly scaling up differentiated service delivery (DSD) for HIV treatment models to support person-centered care. We assessed the associations between patient and facility characteristics and 12-month retention after referral to DSD across DSD models in Zambia.
METHODS: A retrospective record review using electronic medical records was done including adults ('¥15 years) who started DSD between October 2019 and March 2020. Retention was defined as in ART care on 31 December 2020. We categorized DSD models into six groups: multi-month dispensing (MMD), fast-track, group models, alternative pick-up points, home delivery, and extended facility hours. Relative risk of loss to follow-up (LTFU) was estimated by DSD model adjusted for age, gender, location (urban/rural), and care level stratified by antiretroviral therapy (ART) dispensing interval. Using linear regression, a facility-level analysis assessed the association between mean percentage of patients LTFU per facility with location, care level, number of DSD models and percentage of patients receiving 4-6MMD.
RESULTS: Of 90,829 patients referred to DSD models, the majority (78.3%, n=71,101) received 4-6 MMD. Among those receiving 4-6 MMD, those in fast-track and group models had lower adjusted risk of LTFU after 12 months compared to those receiving only MMD (adjusted risk ratio (aRR) 0.63, 95% confidence interval (CI) 0.59-0.67; aRR 0.72, 95%CI 0.62-0.84, respectively) (Figure 1). Among those receiving 3MMD, there was no difference in LTFU by DSD model. At the facility level, the adjusted risk of LTFU increased with having multiple DSD models available at the facility compared to having just one DSD model (increased LTFU of +2%, 95% CI: 0%-5%).


CONCLUSIONS: Twelve-month retention varied by DSD model, MMD duration, and facility-level characteristics in Zambia. Efforts are needed to support long-term retention in DSD models and understand the interaction between specific models, health facility and patient level characteristics.