'Stable patients' need health services too: HIV-related symptoms are common amongst people eligible for less-intensive differentiated service delivery treatment models in Harare, Zimbabwe


BACKGROUND: Zimbabwe is scaling up HIV differentiated service delivery (DSD) to better meet the needs of people living with HIV (PLHIV) and to improve treatment outcomes and health system efficiencies. National guidelines support five differentiated ART (DART) models for 'stable' PLHIV, defined as adults who have been on their current ART regimen for > six months, have no current opportunistic infections or acute illness, and have a viral load < 1,000 copies/mL and/or a CD4 cell count of > 200 cells/mm3. Decreased health facility (HF) visit frequency is a characteristic of most DART models, which typically assume patients doing well on ART will neither need nor choose to visit the HF more than 1-2 times a year. Although patients in these models have the option to visit HF more frequently, they may not be aware of indications for non-scheduled visits.
METHODS: In the context of a discrete choice experiment to assess DART preferences amongst 'stable patients', we surveyed 500 DART-eligible adults from seven HFs in Harare, Zimbabwe, about their current quality of life, mood, and HIV-related physical symptoms. We used a tablet-based interviewer-assisted survey. Descriptive analyses were conducted using SAS version 9.4.
RESULTS: Participants' median time on ART was 4.1 years (IQR 1.0-7.6); all were virally suppressed and met DART eligibility criteria. 50% were female; median age was 29.5 years (range 24-41). 44% reported HIV-related physical symptoms, 20% rated their quality of life as poor or very poor and 37% reported anhedonia and/or 'feeling down, depressed or hopeless' in the past two weeks. Compared to asymptomatic participants, those reporting HIV-related symptoms were less likely to be interested in the Fast-Track model (OR 0.76; CI 0.60-0.98), an individual, facility-based model in which patients go to the HF 2-4 a year to collect ART.
CONCLUSIONS: As DART models are taken to scale it is important to appreciate the spectrum of care required by 'stable patients' and the varying needs of DART-eligible PLHIV. All less-intensive models should provide comprehensive care and facilitate ad hoc clinical and mental health consultations.