A study, published in the Journal of the International AIDS Society, evaluated community-based differentiated service delivery (DSD) models with multi-month dispensing of antiretroviral treatment (ART) against standard, clinical-based ART care for individuals living with HIV in southern Africa.
No significant benefits were observed by implementing DSD with one annual follow-up and either three- or six-month ART refills in community ART groups (CAGs) or centers, relative to standard care provided every three months at a healthcare facility, in patients with HIV.
If effective, DSD models could lessen the burden on patients and healthcare facilities and reduce facility-based exposure. While the present findings were unremarkable, DSD produced results that “were at least non-inferior to standard facility-based care amongst newly stable ART clients aged ≥25 years,” according to Geoffrey Fatti, lead author on the report.
The analysis was performed on individual-level data from 599 participants in two randomized controlled trials. Both trials were designed with the same groups: a control group receiving standard care (SoC), a group receiving ART every three months in CAGs (3MC), and a group receiving ART every six months in CAGs or distribution centers (6MC). The primary outcome was retention in care and the secondary outcomes were viral suppression (VS) and number of unscheduled facility visits within one year of enrollment.
The article reported that 198 (93.4%), 123 (96.1%), and 248 (95.8%) patients were retained in the SoC, 3MC and 6MC groups, respectively, after 12 months. Retention in the 3MC group was superior to the SoC group (adjusted risk difference [aRD] = 4.6%). However, the 6MC groups’ retention was only non-inferior relative to SoC, with a prespecified non-inferiority aRD margin of −3.25% (aRD = 1.7%). VS outcomes were highly similar between arms, with adjusted risk ratios for VS of 0.98 in 3MC versus SoC and 0.98 in 6MC versus SoC. Finally, unscheduled clinic visits were not increased in either intervention arms.
Despite lackluster findings, the researchers maintained the potential value of the patient-centered DSD models of care. They called for further studies with larger sample sizes to determine if their results are generalizable.
