Effectiveness of differentiated antiretroviral therapy delivery models for stable persons living with HIV in Africa: a systematic review and meta-analysis.

Abstract

Introduction: Fundamental progress has been made in HIV care, and one of the major advances was the implementation of Differentiated Service Delivery (DSD) models. DSD models are important in reducing cost in resource-limited countries. However, evidence on the effectiveness of DSD models on stable Persons Living with HIV (PLWH) in comparison with conventional HIV care is limited. Thus, a systematic review and meta-analysis of randomized controlled trials was conducted to assess whether DSD models are more effective than conventional care in improving viral suppression, retention in care, and adherence among stable PLWH in Africa.

Methods: A comprehensive search was conducted using PubMed, Embase, Scopus, Cochrane, Research4Life, and Google Scholar. In this study, randomized controlled trials conducted on stable PLWH and reporting at least one of the patient's treatment outcomes (viral suppression, failure, attrition, retention in care, and adherence) were included. The quality of studies was assessed using the revised Cochrane risk of bias tool, and the heterogeneity among studies was assessed using forest plot and Cochran's Q test.

Results: This study showed that there was no difference in the viral non-suppression (Risk Ratio (RR) = 0.89, 95% CI: 0.74-1.07, I² = 7.47%, p = 0.37), non-retention in care (RR = 1.03, 95% CI: 0.68-1.57, I² = 90.37%, p < 0.001), and lost to follow-up (RR = 0.80, 95% CI: 0.31-2.06) between PLWH who enrolled in the DSD models and conventional care.

Conclusion: The DSD models have a comparable effect to the conventional care in maintaining sustained viral suppression and care engagement of PLWH.