Effect of Differentiated Service Delivery Model on Retention to Care among People Living with HIV in Rwanda: A Retrospective Cohort Analysis.

Rwanda journal of medicine and health sciences Pub Date : 2025-03-31 eCollection Date: 2025-03-01 DOI:10.4314/rjmhs.v8i1.1

Jackson Sebeza, Habib Ramadhan, David J Riedel, Peter Memiah, Marie-Claude Lavoie, Deyessa Negussie, Simeon Tuyishime, Gallican Rwibasira Nshogoza, Charles Muiruri, Kristen Stafford

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Abstract

Introduction: The differentiated service delivery (DSD) model, characterized by early antiretroviral therapy (ART) initiation, is supported by peer educators to enhance treatment adherence to improve retention in care among People Living with HIV (PLHIV). The study assessed effect of the DSD model on retention among PLHIV in Kigali City, Rwanda.

Methods: A retrospective cohort study design was used to evaluate the effect of the DSD model on retention by comparing pre- and post-DSD cohorts of 976 ART-naïve PLHIV aged ≥ 17 years who initiated ART between 2014 and 2019. To assess the effect of the DSD model on retention, we used multivariable logistic regression models to estimate the adjusted odds ratio (aOR) and the corresponding 95% confidence intervals (CI). Covariates, namely demographics, body weight, immunological status, and adherence, were included in the multivariable model.

Results: Of 976 participants evaluated, 903 participants (92.5%) were retained in care. While the DSD model did not significantly affect retention in care [aOR = 1.11, (95% CI: 0.67 - 1.85), p = 0.675)], adherence ≥ 90% was strongly associated with higher retention [aOR = 2.20, (95% CI: 1.31-3.68), p = 0.003).

Conclusion: These findings align with the latest literature, showing comparable retention patterns before and after introducing the DSD.

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差异化服务提供模式对卢旺达艾滋病毒感染者保留护理的影响：回顾性队列分析。

导读：差异化服务提供（DSD）模式的特点是早期抗逆转录病毒治疗（ART）的开始，得到同伴教育者的支持，以提高治疗依从性，提高艾滋病毒感染者（PLHIV）的护理保留率。该研究评估了DSD模式对卢旺达基加利市艾滋病毒感染者滞留率的影响。方法：采用回顾性队列研究设计，通过比较2014年至2019年期间接受ART治疗的976名ART-naïve年龄≥17岁的PLHIV患者的DSD前和DSD后队列，评估DSD模型对保留的影响。为了评估DSD模型对留任的影响，我们使用多变量逻辑回归模型来估计调整后的优势比（aOR）和相应的95%置信区间（CI）。协变量，即人口统计学，体重，免疫状态和依从性，包括在多变量模型中。结果：在评估的976名参与者中，903名参与者（92.5%）被保留在护理中。虽然DSD模型对护理中的保留率没有显著影响[aOR = 1.11, (95% CI: 0.67 - 1.85), p = 0.675]，但依从性≥90%与较高的保留率密切相关[aOR = 2.20, (95% CI: 1.31-3.68), p = 0.003]。结论：这些发现与最新文献一致，显示了引入DSD之前和之后的可比保留模式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Rwanda journal of medicine and health sciences

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