Abstract
Community delivery of Antiretroviral therapy (ART) is a novel innovation to increase sustainable ART coverage for People living with HIV (PLHIV) in resource limited settings. Within a nested cluster-randomised sub-study in two urban communities that participated in the HPTN 071 (PopART) trial in Zambia we investigated individual acceptability and preferences for ART delivery models. Stable PLHIV were enrolled in a cluster-randomized trial of three different models of ART: Facility-based delivery (SoC), Home-based delivery (HBD) and Adherence clubs (AC). Consenting individuals were asked to express their stated preference for ART delivery options. Those assigned to the community models of ART delivery arms could choose (“revealed preference”) between the assigned arm and facility-based delivery. In total 2489 (99.6%) eligible individuals consented to the study and 95.6% chose community models of ART delivery rather than facility-based delivery when offered a choice. When asked to state their preference of model of ART delivery, 67.6% did not state a preference of one model over another, 22.8% stated a preference for HBD, 5.0% and 4.6% stated a preference for AC and SoC, respectively. Offering PLHIV choices of community models of ART delivery is feasible and acceptable with majority expressing HBD as their stated preferred option.
Highlights
By the end of 2016, 36.7 million [30.8–42.9 million] people were living with HIV globally with the vast majority living in low-and middle-income countries [1]
A total of 2499 eligible participants were identified across the two communities between May and December 2017 who were eligible for inclusion in the trial and of these, 2489 (99.6%) consented to participate, 10 (0.4%) declined consent (Fig. 1)
The three study arms were well balanced according to baseline characteristics, there were fewer participants in the stated a preference for facility-based (SoC) arm
Summary
By the end of 2016, 36.7 million [30.8–42.9 million] people were living with HIV globally with the vast majority living in low-and middle-income countries [1]. From the demand point of view, the change in guidelines increased the demand for ART services resulting in overcrowding, long waiting times and overburdening of the already fragile health facility system increasing the workload and burnout for the few existing health care workers [11, 12]. These challenges compromise service delivery and may lead to ART interruption, poor adherence, ongoing transmission and the development of viral drug resistance and increased mortality [9, 10, 13]. Decentralization of ART services into the community through community-based ART delivery models is one of the WHO recommended strategies to maintain the HIV continuum of care in resource limited settings where the existing formal health systems are unable to cope with increasing numbers of PLHIV on treatment [13]
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