Rayner Tan

This session showcased research on the factors associated with retention for differentiated service delivery models in Zambia, the use of community scorecards for quality improvement of HIV services in Vietnam, and the effect of a multi-component intervention on viral load ordering, results turnaround time and viral suppression in Uganda.

Youngji JO (Boston Medical Center, United States) and Bevis PHIRI (Clinton Health Access Initiative, Zambia) shared data from a retrospective record review assessing the associations between patient and facility characteristics with 12-month retention following referrals to differentiated service delivery models (DSD) across Zambia, and found that there was no single solution for retention. Factors varied by DSD, multi-month dispensing duration and facility-level characteristics, highlighting the need for a better understanding of such interactions. Linh NGUYEN HOAI (Beth Israel Deaconess Medical Center, Vietnam) then shared how the development and implementation of community scorecards, involving participatory mechanisms by patients and health providers to score quality indicators for HIV services in Vietnam, has led to greater community engagement, increased access to HIV services, and promoted friendlier services. Linh highlighted how the process was "about improvement, not blame or scrutiny". Finally, Vivek JAIN (University of California San Francisco, United States) shared results of a pre-post cluster-randomized controlled trial that showed how a multi-component intervention comprising a viral load (VL) ordering flowsheet, rapid near-point-of-care VL testing, and clinician training on VL results counseling, was effective in reducing VL turnaround time (-67.3 days; p<0.0001) and improved 1-year viral suppression for patients (+7% mean viral suppression; p=0.03).

The findings of the late breaker abstracts highlight how clinical outcomes for HIV are dependent on a multitude of factors; including the suitability of differentiated service delivery (DSD) models for varying settings and patient characteristics, robust and rapid community feedback mechanisms that help articulate problems and advocate for solutions, as well as feasible and effective clinical processes. More efforts are needed to understand the mechanisms underlying the effectiveness of varying differentiated service delivery models, and to better understand the links between multi-month dispensing, DSD, and facility-level characteristics. Cost-effectiveness analysis of interventions can also help to justify scale-up of clinic-based interventions.