Abstract

IntroductionDifferentiated service delivery (DSD) models aim to improve the access of human immunodeficiency virus treatment on clients and reduce requirements for facility visits by extending dispensing intervals. With the advent of the COVID‐19 pandemic, minimising client contact with healthcare facilities and other clients, while maintaining treatment continuity and avoiding loss to care, has become more urgent, resulting in efforts to increase DSD uptake. We assessed the extent to which DSD coverage and antiretroviral treatment (ART) dispensing intervals have changed during the COVID‐19 pandemic in Zambia.MethodsWe used client data from Zambia's electronic medical record system (SmartCare) for 737 health facilities, representing about three‐fourths of all ART clients nationally. We compared the numbers and proportional distributions of clients enrolled in DSD models in the 6 months before and 6 months after the first case of COVID‐19 was diagnosed in Zambia in March 2020. Segmented linear regression was used to determine whether the outbreak of COVID‐19 in Zambia further accelerated the increase in DSD scale‐up.Results and discussionBetween September 2019 and August 2020, 181,317 clients aged 15 or older (81,520 and 99,797 from 1 September 2019 to 1 March 2020 and from 1 March to 31 August 2020, respectively) enrolled in DSD models in Zambia. Overall participation in all DSD models increased over the study period, but uptake varied by model. The rate of acceleration increased in the second period for home ART delivery (152%), ≤2‐month fast‐track (143%) and 3‐month MMD (139%). There was a significant reduction in the enrolment rates for 4‐ to 6‐month fast‐track (−28%) and “other“ models (−19%).ConclusionsParticipation in DSD models for stable ART clients in Zambia increased after the advent of COVID‐19, but dispensing intervals diminished. Eliminating obstacles to longer dispensing intervals, including those related to supply chain management, should be prioritized to achieve the expected benefits of DSD models and minimize COVID‐19 risk.

Highlights

  • Differentiated service delivery (DSD) models aim to improve the access of human immunodeficiency virus treatment on clients and reduce requirements for facility visits by extending dispensing intervals

  • In 2020, an estimated 16.4 million people living with human immunodeficiency virus (PLHIV) and taking antiretroviral treatment (ART) in sub-Saharan Africa risked treatment interruptions because of COVID-19 due to closing or limiting of human immunodeficiency virus (HIV) services, antiretroviral supply chain disruptions, transportation or travel restrictions and/or overwhelmed service providers [1]

  • One potential solution to the disruptions caused by COVID-19 is differentiated service delivery (DSD), a “clientcentered approach that simplifies and adapts HIV services across the cascade to serve the needs of PLHIV better and reduce unnecessary burdens on the health system” [3]

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Summary

Introduction

Differentiated service delivery (DSD) models aim to improve the access of human immunodeficiency virus treatment on clients and reduce requirements for facility visits by extending dispensing intervals. We compared the numbers and proportional distributions of clients enrolled in DSD models in the 6 months before and 6 months after the first case of COVID-19 was diagnosed in Zambia in March 2020. The rate of acceleration increased in the second period for home ART delivery (152%), ≤2-month fast-track (143%) and 3-month MMD (139%). Conclusions: Participation in DSD models for stable ART clients in Zambia increased after the advent of COVID-19, but dispensing intervals diminished. DSD has emerged as a key strategy for HIV programmes in resource-limited settings, as DSD models can lessen the burden of HIV treatment on clients and providers by extending medication dispensing intervals, reducing requirements for Differentiated service delivery model Description. In Zambia, this typically involves a separate and shorter queue for quick dispensing when a clinical visit is not indicated.

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