Reaching the third 95 using community ART delivery models.

Abstract

Differentiated service delivery of HIV care, defined as an approach that simplifies and adapts HIV services to better serve the needs of people with HIV and to optimise the available resources in health systems, 1 WHOUpdated recommendations on service delivery for the treatment and care of people living with HIV. https://www.who.int/publications/i/item/9789240023581Date: 2021 Date accessed: November 24, 2021 Google Scholar is increasingly becoming important to HIV epidemic control. These models aim to provide care that is tailored to the individual and reduce strain on health systems. Various models have been used, including multimonth dispensation, home-based antiretroviral therapy (ART) delivery, and community adherence groups. 2 Huber A Pascoe S Nichols B et al. Differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: a landscape analysis. Glob Health Sci Pract. 2021; 9: 296-307 Crossref PubMed Scopus (1) Google Scholar In The Lancet HIV, Mohammed Limbada and colleagues 3 Limbada M Macleod D Situmbeko V et al. Rates of viral suppression in a cohort of people with stable HIV from two community models of ART delivery versus facility-based HIV care in Lusaka, Zambia: a cluster-randomised, non-inferiority trial nested in the HPTN 071 (PopART) trial. Lancet HIV. 2021; (published online Nov 26.)https://doi.org/10.1016/S2352-3018(21)00242-3 Summary Full Text Full Text PDF PubMed Google Scholar report findings from their cluster-randomised, non-inferiority trial comparing viral load suppression in community models of ART delivery with standard of care. In this trial, which was done in Lusaka, Zambia, participants were assigned to receive ART at a health-care facility (SoC group), home-based delivery (HBD group), or via adherence clubs (AC group). 12 month viral suppression was 99·2% (95% CI 98·4–99·8) in the AC group, 98·7% (97·5–99·6) in the HBD group, and 98·3% (96·6–99·7) in the SoC group. Both differentiated models of ART delivery were found to be non-inferior to the SoC group (p<0·0001). In addition, the authors found that access to viral load measurement and retention in the community models were better compared with facility ART delivery. These findings suggest that scale up of such models of care could be beneficial in reaching viral suppression and improved retention. Rates of viral suppression in a cohort of people with stable HIV from two community models of ART delivery versus facility-based HIV care in Lusaka, Zambia: a cluster-randomised, non-inferiority trial nested in the HPTN 071 (PopART) trialCommunity models of ART delivery were as effective as facility-based care in terms of viral suppression. Full-Text PDF Open Access