Patient benefits and costs associated with differentiated models of service delivery for HIV treatment in Sub-Saharan Africa

By Salome Kuchukhidze  Lawrence Long  Sophie Pascoe  Amy Huber  Brooke Nichols  Matthew Fox  Sydney Rosen  |  | 

As of December 2018, 16.4 million people were reported to be receiving antiretroviral therapy (ART) for HIV in sub-Saharan Africa.To achieve global “90-90-90”targets for HIV diagnosis, treatment, and viral suppression, another three million patients must be added to national HIV treatment programs during the coming decade in eastern and southern Africa. At the same time, donor funding for HIV has plateaued, leading to calls for greater efficiency in service delivery. One response to this challenge is the development of “differentiated service delivery models” (DSD models) for HIV treatment. DSD models, which typically reduce clinic visits and/or move services out of the clinic, aim to improve clinical outcomes of treatment, such as retention in care and viral suppression; make treatment more patient-centric by lessening the burden of frequent clinic visits; and reduce costs to both the healthcare system and to patients. Costs and benefits of DSDs to patients themselves (as opposed to costs and benefits to providers and funders) are often omitted from evaluations of specific models of
service delivery and from mathematical modeling of potential impact. As part of a larger rapid review of the published and gray literature on the outcomes of DSDs since 2016, in this report we present and discuss the subset of sources that provide empirical information on
patient costs and benefits and the acceptability of DSDs to patients.

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