Figures & Tables
Tables
- TABLE 1.
Number of Organization-Modelsa for Differentiated Service Delivery of HIV Treatment Described by Respondents, by Country, Category, and Strategy
Model Category Malawi South Africa Zambia Total Total number of organization-models described 26 43 41 110 Number of organization-models per country and category Facility-based individual model 13 6 13 32 Out-of-facility-based individual model 5 22 16 43 Health care worker-led group 7 15 4 26 Client-led group 1 0 8 9 Numbers of organization-models per country and strategy Adherence clubs 0 11 3 14 Community adherence groups 1 0 8 7 Community outreach 3 3 4 11 External pickup points 2 17 6 26 Extra clinic hours 1 1 2 4 Family models 2 1 1 4 Fast track services 2 1 5 8 Home delivery 0 1 3 4 Multimonth dispensing 3 1 3 7 Nonstable patient models 6 4 1 11 Key population models 1 1 2 4 Youth models 5 2 3 10 ↵a An organization-model is 1 organization supporting 1 model of care.
- TABLE 2.
Twelve Strategies for Differentiated Service Delivery Model for HIV Treatment in Malawi, South Africa, and Zambia, as Reported by Interview Respondents
Adherence clubs Any group model that is led by a health care worker (professional or lay) Community adherence groups Any group model in which a patient picks up medications for other group members (typically abbreviated CAG) Community outreach A variety of models that bring both clinical care and medications into the community, such as nurse-led outreach External pickup points Any model that delivers antiretroviral medications to pickup points outside clinic facilities, such as lockers, community pharmacies, decentralized pickup points, etc. Extra clinic hours Any model that adds additional hours to a facility's operations to facilitate access, such as on evenings or weekends Family models Any model designed to serve multiple and/or specific members of a family at once (e.g., pediatric clinic or family clinic) Fast track services Any model that creates a separate queue, kiosk, or procedure at a facility to speed up service delivery for stable patients Home delivery Any model that delivers antiretroviral medications to patients' homes (e.g., by a community health worker or a bicycle courier) Multimonth dispensing Any model in which the primary goal is to dispense medications for a longer duration than is done under standard care (usually 6 months) Nonstable patient models Models for patients who do not meet definitions of clinical stability, such as high viral load clinics and advanced disease clinics Key population models Models for a key population such as men who have sex with men or female sex worker Youth models Any model specifically for youth/teens/adolescents (e.g., teen clubs in Malawi and the scholar model in Zambia) - TABLE 3.
Populations Served by Current Differentiated Service Delivery Models for HIV Treatment and Criteria for Defining Stability, by Country
Population or Requirements Malawi, No. South Africa, No. Zambia, No. Total, No. Population eligible Number of organization-models 26 43 41 110 All patients (no restrictions by disease status or age) 2 1 0 3 Stable and not stable patients Adults and adolescents/youth 0 2 0 2 Adolescents/youth (age restrictions vary) 5 2 0 7 Children (age restrictions vary) 0 0 1 1 Total stable and not stable patients 5 4 1 10 Stable patients only All ages 0 0 10 10 Adults 10 31 14 55 Adults and adolescents/youth 0 0 9 9 Adolescents/youth (age restrictions vary) 0 0 3 3 Children (age restrictions vary) 0 1 0 1 Total stable patients only 10 32 36 78 Advanced disease/not stable patients only All ages 4 2 1 7 Adults 2 2 0 4 Children (age restrictions vary) 1 0 0 1 Total advanced disease/not stable patients 7 4 1 12 Pregnant/postpartum women only (any disease status) 1 1 0 2 MSM/FSW (any disease status) 1 1 3 5 Requirements to be regarded as stable Number of organization-models 10 32 36 78 ART ≥ 6 months and 1 suppressed viral load 5 4 9 18 ART ≥ 12 months and 1 suppressed viral load 1 0 23 24 ART ≥ 12 months and 2 suppressed viral loads 0 26 0 26 Not specified 4 2 4 10 Abbreviations: ART, antiretroviral therapy; FSW, female sex worker; MSM, men who have sex with men.
- TABLE 4.
Number of Organization-Models for Differentiated Service Delivery of HIV Treatment by Location of Service Delivery and Country
Location of Service Delivery Number of Organization-Models Malawi N=26 South Africa N=43 Zambia N=41 Total N=110 Facility for clinical care with medication pickup at Facility 19 6 16 41 External pickup point 4 18 15 37 Adherence club 0 13 1 14 Home 0 1 3 4 Total (facility location for clinical care) 23 38 35 96 External location for clinical care Clinical care and medications in community 3 3 5 11 Clinical care and medications at adherence club 0 2 0 2 Clinical care and medications at home 0 0 1 1 Total (external location for clinical care) 3 5 6 14 - TABLE 5.
Frequency of Health Care System Interactions per Year, by Country, Model Category, and Viral Suppression Eligibility Criterion for Differentiated Service Delivery Models for HIV Treatment
Frequency of Interactions Required per Year Malawi South Africa Zambia Organization-models, No. Full Clinic Visits,a Median (Range) Other Interactions,b Median (Range) Organization-models, No. Full Clinic Visits,a Median (Range) Other Interactions,b Median (Range) Organization-models, No. Full Clinic Visits,a Median (Range) Other Interactions,b Median (Range) Models explicitly for stable patients Facility-based individual models Every 2 months (6/year) 1 4 0 Every 3 months (4/year) 2 2 (2–2) 2 (2–2) 1 2 4 8 2 (2–4) 2 (0–2) Every 4 months (3/year) 3 2 (2–2) 1 (1–1) Every 6 months (2/year) 3 2 (2–2) 0 (0–0) Out-of-facility-based individual models Every 2 months (6/year) 18 2 (2–2) 4 (4–4) Every 3 months (4/year) 3 1 (0–2) 4 (2–4) 1 0 5 13 2 (0–2) 2 (2–4) Health care worker-led group models Every 2 months (6/year) 10 2 (2–2) 4 (4–4) Every 3 months (4/year) 1 2 2 4 2 (2–4) 2 (0–2) Every 6 months (2/year) 1 0 2 Client-led group models Every 1 month (12/year) 1 2 10 Every 3 months (4/year) 1 2 2 6 2 (2–2) 2 (2–2) Every 6 months (2/year) 1 1 1 Models not requiring stabilityc Facility-based individual models Every 1 month (12/year) 6 0 (0–0) 12 (12–12) 2 0 (0–0) 12 (12–12) 2 0 (0–0) 12 (12–12) Every 2 months (6/year) 2 0 (0-0) 6 (6–6) Every 3 months (4/year) 1 0 4 Visits aligned to PMTCT schedule 1 5 3 Out-of-facility-based individual models Every 2 months (6/year) 3 0 (0–0) 6 (6–6) Every 3 months (4/year) 2 0 (0–0) 4 (4–4) 3 2 (2–2) 2 (2–2) Health care worker-led group models Every 1 month (12/year) 2 0 (0–0) 12 (12–12) 3 0 (0–2) 12 (10–12) Every 2 months (6/year) 2 0 (0–0) 6 (6–6) Visits aligned to child vaccine schedule 1 0 8 Not specified 2 ↵a A full clinic visit is a conventional facility visit that provides the services that were typical of a predifferentiation visit, generally including a consultation with a clinician, counseling, laboratory tests if scheduled, and a medication refill.
↵b Other interactions include any interaction with a provider that has been tailored for the population served, including off-site medication pickups, adherence club participation, or a clinical consultation adjusted for the population in question, including specialist consultations for certain types of patients (i.e., all interactions except conventional, undifferentiated full clinic visits).
↵c Includes models for known unsuppressed patients, high viral load clinics, pediatric clinics, and models that accept both stable and nonstable patients.
- TABLE 6.
Months of Antiretrovirals Dispensed in Differentiated Service Delivery Models for HIV Treatment
Average Months of Antiretrovirals Dispensed in Model Number of Organization-Models Malawi (N=26) South Africa (N=43) Zambia (N=21) Total (N=110) 1 month 7 5 3 15 2 months 2 34 0 36 3 months 7 1 12 20 1 or 3 months (patients typically start with 1 month, then move to 3 months) 2 2 2 6 6 months 3 1 7 11 3 or 6 months (typically previously dispensed 3 months but transitioning to 6 months in line with national policy) 3 0 17 20 Not reported 2 0 0 2 - TABLE 7.
Different Cadres of Clinical Care Providers and Antiretroviral Therapy Dispensers Employed in Differentiated Service Delivery Models for HIV Treatment in Malawi, South Africa, and Zambia
Provider Number of Organizational-Models Facility-based Individual Out-of-facility-based Individual Health Care Worker-led Group Client-led Group Total Clinical care provider Medical doctor/medical officer/clinical officer 9 1 2 2 14 Nurse 7 28 16 0 51 Community health worker 0 1 0 1 2 Non-specified clinician 3 7 3 2 15 Unclear/not reported 13 6 5 4 28 Antiretroviral therapy dispenser Pharmacist/pharmacy assistant 12 7 2 0 21 Nurse/clinician 7 7 3 0 17 Community health worker 0 6 5 0 11 Designated patient 0 2 1 9 12 Lay counselor/trained non-clinical personnel 0 14 9 0 23 Medication locker/remote pharmacist 0 3 0 0 3 Unclear/not reported 13 4 6 0 23
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