In a report published in the Journal of the International AIDS Society, researchers reviewed observations from the DO ART study to identify the functions of community-based antiretroviral treatment (ART) delivery, which they suggest may improve treatment outcomes in people living with HIV in Uganda and South Africa.
The study advanced “flexibility,” “integration,” “increased efficiency,” and a “slower pace” as four mechanisms of community-delivered ART initiation that reflect the priorities and perspectives of participants.
According to the lead author, Hanna N. Gilbert, all four mechanisms point to areas in treatment organization that could be focused on to improve viral suppression results via reduced treatment lapses and increased medication adherence. “Understanding the mechanisms through which HIV service delivery innovations produce an effect is key to transferability and potential scale-up,” Ms. Gilbert explained.
The study involved open-ended interviews with 150 DO ART participants that covered patients’ experiences of: HIV testing, initiating and refilling ART, and participating in the study. Researchers defined the four previously specified mechanisms as follows:
- Flexibility was ascribed to participants being empowered to easily schedule, re-schedule, and select location of visits via phone contact with clinic staff.
- Integration referred to the melding of various interactions with a healthcare provider into a single clinic visit.
- A “slower pace” was categorized by providers willingness to talk about non-HIV as well as HIV-related concerns at length with participants during visits.
- Increased efficiency was defined by increased time saving and income-generating opportunities for participants in the community that were brought about by the treatment services.
While the authors stated that their sample size was “quite large” for qualitative analyses, they acknowledged that it did not include constituents other than DO ART participants—such as the staff that rendered care to patients.
The authors concluded that the mechanisms of community-based care identified were not exhaustive, but it maintained the significant advantages that community-based treatment services appeared to provide patients with HIV.
