Abstract
BackgroundSouth Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel challenge of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) of South Africa launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients who have chronic diseases, including HIV, with alternative access to medications via community-based pick-up points. This study describes the expansion of CCMDD toward national scale.MethodsYale monitors CCMDD expansion as part of its mixed methods evaluation of Project Last Mile, a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication provided [ART only; NCD only; and ART-NCD] and collection sites preferred by patients [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis.ResultsAs of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88 % of South Africa’s districts), and 2,037 external pick-up points had been contracted by the NDoH. A total of 2,069,039 patients were actively serviced through CCMDD, a significant increase since 2018 (p < 0.001), including 76 % collecting ART [64 % ART only, 12 % ART plus NCD/comorbidities] and 479,120 [24 %] collecting medications for chronic diseases only. Further, 734,005 (35 %) of patients were collecting from contracted, external pick-up points, a 73 % increase in patient volume from 2018.DiscussionThis longitudinal description of CCMDD provides an example of growth of a national differentiated service delivery model that integrates management of HIV and noncommunicable diseases. This study demonstrates the success of the program in engaging patients irrespective of their chronic condition, which bodes well for the potential of the program to address the rising burden of both HIV and NCDs in South Africa.ConclusionsThe CCMDD program expansion signals the potential for a differentiated service delivery strategy in resource-limited settings that can be agnostic of the patients chronic disease condition.
Highlights
South Africa is home to 7.7 million people living with Human Immunodeficiency Virus (HIV) and supports the largest antiretroviral therapy (ART) program worldwide
While several models of differentiated service delivery (DSD) have been shown to reduce costs and improve the care for people living with HIV (PLHIV) [9,10,11,12,13], descriptive evaluations of DSD programs achieving national scale are lacking [14, 15]
Program description The Central Chronic Medicines Dispensing and Distribution (CCMDD) progamme is positioned within the National Health Insurance (NHI) program and is intended to improve alternative access to medications for patients living with chronic disease including HIV and to address the demand associated with expanded access to ART envisaged under the Universal Test and Treat Guidelines implemented in late 2016 [23]
Summary
South Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. In 2014, the National Department of Health (NDoH) of South Africa launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients who have chronic diseases, including HIV, with alternative access to medications via community-based pick-up points. In 2019, South Africa was home to 7.7 M people living with HIV (one in five adults), and supported the largest antiretroviral therapy (ART) program worldwide, with 4.8 M on ART [1]. While several models of differentiated service delivery (DSD) have been shown to reduce costs and improve the care for people living with HIV (PLHIV) [9,10,11,12,13], descriptive evaluations of DSD programs achieving national scale are lacking [14, 15]. Longitudinal evaluations of the path to scale for such programs would support evidenceinformed global investment in scale-up and sustainabililty for DSD [17,18,19]
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