Are HIV Treatment Clients Offered a Choice of Differentiated Service Delivery Models? Evidence from Malawi, South Africa, and Zambia.

IF 2 3区医学 Q2 MEDICINE, GENERAL & INTERNAL

Patient preference and adherence Pub Date : 2025-06-25 eCollection Date: 2025-01-01 DOI:10.2147/PPA.S494679

Idah Mokhele, Vinolia Ntjikelane, Nancy A Scott, Jeanette L Kaiser, Allison Juntunen Morgan, Amy Huber, Nomcebo Oratile Mokgethi, Timothy Henry Tchereni, Wyness Phiri, Aniset Kamanga, Prudence Michelo Haimbe, Priscilla Lumano-Mulenga, Rose Kolola Nyirenda, Sophie J S Pascoe, Sydney Rosen

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引用次数: 0

Abstract

Purpose: Differentiated service delivery (DSD) models for antiretroviral therapy (ART) for HIV aim to increase patient-centeredness, a concept that incorporates patient choice of service delivery options. We explored choice in DSD model enrollment at 42 public sector clinics in Malawi, South Africa, and Zambia.

Methods: From 09/2022-05/2023, we surveyed people receiving HIV treatment to ask if they had a choice about DSD model enrollment and healthcare providers about their practices in offering choice. We estimated risk differences for ART clients' self-reported offer of choice and report risk differences. We thematically analyzed open-ended questions and report key themes.

Results: We enrolled 1049 people receiving HIV treatment (Malawi 409, South Africa 362, Zambia 278) and 404 providers (Malawi 110, South Africa 175, Zambia 119). The proportion of study participants indicating that they had been offered a choice ranged from 4% in Malawi to 17% in Zambia to 47% in South Africa. Over 90% of people receiving HIV treatment in all three countries reported that they were happy to be enrolled in their current DSD model. Participants from urban (ARD 0.94 [0.90-0.99]) and medium-volume facilities (2000-4000 ART clients, 0.91 [0.84-0.98]) were slightly less likely to be offered DSD enrollment. Participants in community-based models 1.21 [1.12-1.30] and those satisfied with their current model 1.06 [1.01-1.13] were more likely to be offered a choice. Among providers, 64% in Malawi, 80% in South Africa, and 59% in Zambia said they offered clients the choice to enroll in DSD or remain in conventional care.

Conclusion: As of 2023, relatively few people receiving HIV treatment in Malawi, South Africa, and Zambia reported being offered a choice about enrolling in a DSD model, despite most providers reporting offering such a choice. The value of patient choice in improving clinical outcomes and satisfaction should be explored further.

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艾滋病毒治疗客户是否可以选择不同的服务提供模式？来自马拉维、南非和赞比亚的证据。

目的：艾滋病毒抗逆转录病毒治疗（ART）的差异化服务提供（DSD）模式旨在提高以患者为中心，这是一个纳入患者选择服务提供方案的概念。我们在马拉维、南非和赞比亚的42个公共部门诊所探讨了DSD模型入组的选择。方法：从2022年9月至2023年5月，我们调查了接受艾滋病毒治疗的人，询问他们是否对DSD模型注册有选择，以及医疗保健提供者在提供选择方面的做法。我们估计了ART患者自我报告的选择和报告风险差异的风险差异。我们按主题分析开放式问题并报告关键主题。结果：我们招募了1049名接受艾滋病毒治疗的人（马拉维409人，南非362人，赞比亚278人）和404名提供者（马拉维110人，南非175人，赞比亚119人）。研究参与者表示他们被提供了选择的比例从马拉维的4%到赞比亚的17%到南非的47%不等。在这三个国家中，90%以上接受艾滋病毒治疗的人报告说，他们很高兴参加目前的DSD模式。来自城市（ard0.94[0.90-0.99]）和中等容量设施（2000-4000 ART客户，0.91[0.84-0.98]）的参与者被纳入DSD的可能性略低。基于社区的模型1.21[1.12-1.30]和对当前模型1.06[1.01-1.13]满意的参与者更有可能被提供选择。在医疗服务提供者中，64%的马拉维人、80%的南非人和59%的赞比亚人表示，他们向客户提供参加DSD或继续接受传统护理的选择。结论：截至2023年，在马拉维、南非和赞比亚，接受艾滋病毒治疗的人相对较少，尽管大多数提供者报告提供了这样的选择，但他们可以选择是否加入DSD模式。患者选择在提高临床疗效和满意度方面的价值有待进一步探讨。

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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来源期刊

Patient preference and adherence MEDICINE, GENERAL & INTERNAL-

CiteScore

3.60

自引率

4.50%

发文量

354

审稿时长

6-12 weeks

期刊介绍： Patient Preference and Adherence is an international, peer reviewed, open access journal that focuses on the growing importance of patient preference and adherence throughout the therapeutic continuum. The journal is characterized by the rapid reporting of reviews, original research, modeling and clinical studies across all therapeutic areas. Patient satisfaction, acceptability, quality of life, compliance, persistence and their role in developing new therapeutic modalities and compounds to optimize clinical outcomes for existing disease states are major areas of interest for the journal. As of 1st April 2019, Patient Preference and Adherence will no longer consider meta-analyses for publication.