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

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.