Abstract
BackgroundAs countries scale up antiretroviral therapy (ART) for children, innovative strategies to deliver quality services to children are needed. Differentiated ART delivery models have been successful in adults, but no such program has been described in children. We describe the Standardized Pediatric Expedited Encounters for ART Drugs Initiative (SPEEDI).MethodsDescriptive analysis of patients eligible for SPEEDI was done via retrospective review of children, adolescents, and young adults on ART at the Baylor Centre of Excellence (COE) in Mbeya, Tanzania between January 2013 and December 2015. Eligibility for SPEEDI visits included the following: stable children, adolescents, and young adults on ART for approximately 3 months or longer, no medical or social complications, good adherence to ART, and presence of reliable caregiver. During a SPEEDI visit, patients were fast tracked in triage to collect medications directly without physically seeing a clinician. SPEEDI patients came to clinic every two months, and alternated SPEEDI visits with standard visits. Baseline characteristics, mortality, and lost-to-follow up rates of SPEEDI patients were analyzed.ResultsOne thousand one hundred sixty-four patients utilized SPEEDI, totaling 3493 SPEEDI visits. SPEEDI reached 51.3% (1164/2269) of pediatric ART patients, accounting for 7.7% (3493/44489) of total patient encounters. SPEEDI patients were 52% (605/1164) female, median age of 11.7 years (range 1.2–25.5 yr), median time on ART of 21 months (range 4–130 months) and 83.5% (964/1155) categorized as no or mild HIV-associated immunodeficiency. SPEEDI patients had good outcomes (98.8%), low LTFU (0.1%) and low mortality rates (0.61 deaths per 100 patient-years).ConclusionSPEEDI was an effective model for delivering ART to children, adolescents, and young adults in our setting, leading to good clinical outcomes, low mortality, and low LTFU. The SPEEDI program safely and effectively expedited and spaced out ART visits for children, adolescents, and young adults, and can serve as an adaptable ART delivery model for other resource limited settings.
Highlights
As countries scale up antiretroviral therapy (ART) for children, innovative strategies to deliver quality services to children are needed
SPEEDI was an effective model for delivering ART to children, adolescents, and young adults in our setting, leading to good clinical outcomes, low mortality, and low lost-to-follow up (LTFU)
The burden of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) in children remains high as demonstrated by the 150,000 new infections, 110,000 AIDS-related deaths, and low antiretroviral therapy (ART) coverage reported worldwide in 2015 in children under the age of 15 years [1]
Summary
As countries scale up antiretroviral therapy (ART) for children, innovative strategies to deliver quality services to children are needed. As countries scale up availability and provision of ART for children and adolescents, innovative strategies to effectively deliver quality services to substantially more clients without overwhelming already overburdened clinics are needed. Differentiated approaches to HIV care have been promoted as an effective way to put the patient at the centre of service delivery while reducing unnecessary burdens on the health systems [4, 5]. Examples of differentiated care models – such as community ART groups and spacing of clinic visits – have been effective in adults in reducing patient and health system burdens while improving clinical care and outcomes [6,7,8,9,10,11,12]. As increasing numbers of children and adolescents access ART through 90–90-90 efforts, innovative models of care tailored to the unique characteristics and needs of children and adolescents need to be implemented and explored
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