Service Delivery Models Research Articles

Unlocking the Potential of Pediatric Virtual Care: An e-Delphi Study on a Virtual Caregiver Participation Framework in Audiology

Purpose: Virtual service delivery models in audiology have become more accessible due to recent technological advancement and improved system-level uptake following COVID-19. Although current evidence identifies the benefits of virtual care to families with children who are d/Deaf or hard of hearing and supports its use in practice, this delivery model is still underutilized. This research aimed to gain consensus on an evidence-informed virtual caregiver participation framework developed from a scoping review of the communication sciences and disorders literature. Method: A two-round modified e-Delphi study was conducted to survey 26 knowledge users from four different countries with experience in virtual audiology care, including caregivers, audiologists, researchers, and organizational leaders. The study employed Delphi techniques, building from a scoping review to synthesize existing literature informing the knowledge gap, including online surveys and team discussions. Consensus was defined numerically (75% agreement) and by comparing and interpreting text-based responses. Results: The resulting framework grouped nine categories of caregiver participation in virtual care according to three main readiness domains: core readiness (opportunities to participate, perceived value, and willingness to participate), engagement readiness (child capacity, family–provider relationship, and role in the care process), and structural readiness (environment for participation, support, and technology). Conclusion: This work adds novel contributions to the field, through the development of a framework for caregiver participation in virtual audiology care, that can be used to support family involvement and will guide clinical tool development and future research efforts.

First Steps Toward a Participatory Research Program: Early Intervention Perspectives on SLP Services for Children of Diverse Backgrounds.

This research was designed to deepen the understanding of contributing factors to disparities in speech-language pathology (SLP) service delivery to children of diverse backgrounds with language and communication delays, as well as to initiate community connections. We sought to understand the perspectives and experiences of those who provide or oversee SLP services to children with communication disorders in early intervention settings in Washington State. Individual semistructured interviews were completed with six SLPs and three administrators across five organizations. The interviews were designed to understand both individual- and systems-level contributing factors to service delivery challenges. Interviews were analyzed using an iterative coding process with multiple rounds of coding and multiple coders. In addition to synthesizing participants' understandings of, and preparation for, culturally responsive practice, three overarching themes are presented: (1) assets of early intervention as a service delivery model, (2) the distance between families and the practitioners and systems that serve them, and (3) compromised access and quality of services due to a predominantly monolingual-English system. Findings inform the next steps for building community partnerships with early intervention organizations. The long-term goal of this work is to collaboratively develop a participatory research program on equitable service delivery that addresses children's, families', and SLPs' needs.

Utilization of early therapeutic supports by autistic preschoolers in Australia: A cross-sectional study following implementation of the National Disability Insurance Scheme.

There are many types of support for young autistic children and their families, but service use in this population is not well understood. In this study, primary caregivers of autistic preschoolers were surveyed (n = 95) and a selection were then interviewed (n = 19) to understand how early, therapeutic supports were accessed by families in Australia following the establishment of a National Disability Insurance Scheme (NDIS). This article presents the quantitative data from surveys and interviews. Families usually accessed at least two types of support. The most accessed supports were occupational therapy, speech pathology and psychology, with 43% of the sample accessing some other form of support. Multiple linear regression indicated that children's higher level of support need, living in less remote or less socio-economically disadvantaged areas, and high household income were associated with higher numbers of supports accessed. Services tended to follow an individual, clinic-based model and little use of alternative service delivery was reported. The findings indicate that Australian families are accessing a wider range of support types than before the NDIS and children with more substantial autism-related support needs are likely to access a greater number of types of supports. Socio-economic inequities continue to exist and should be addressed.

Physical and occupational therapy service delivery models for populations identified as hard-to-reach: A scoping review.

The delivery of rehabilitation services for hard-to-reach populations (e.g., refugees) is highly complex. There is a need for evidence-based approaches to deliver physiotherapy (PT) or occupational therapy (OT) services to this underserved group. The purpose of this scoping review was to identify PT and OT service delivery models that have been implemented, for populations typically identified as hard-to-reach and their associated health outcomes. Articles were eligible if they described PT and/or OT services for hard-to-reach populations. There were no restrictions on study design. Six electronic databases (AMED, CINAHL, MEDLINE, EMBASE, Healthstar, and PsycINFO) were searched from January 2000 to June 2023. Articles were screened in duplicate by two independent reviewers, and conflicts were resolved by consensus. Twenty-one articles with variable sample sizes (min, max n = 3 to 237) were included and detailed PT and/or OT services for immigrants/migrants, refugees, hard-to-reach veterans, people experiencing homelessness, lower incomes, trauma/torture, and those living in rehabilitation-deficient areas. Common rehabilitation needs (e.g., clinician to client connectivity), barriers (e.g., high transportation costs) and facilitators (e.g., encouragement) were identified among the various populations, mainly due to intersecting identities such as those who are both traumatized and refugees. Unique factors pertaining to the PT and OT services were also identified in some groups, including access to child and family services for people experiencing homelessness. Despite common and individual needs, barriers, and facilitators in hard-to-reach groups in the literature, there is a need for studies with larger sample sizes, rigorous methodology and a conscious effort to publish the results of interventions to generate stronger recommendations for practice.

Estimates of resource use in the public-sector health-care system and the effect of strengthening health-care services in Malawi during 2015-19: a modelling study (Thanzi La Onse).

In all health-care systems, decisions need to be made regarding allocation of available resources. Evidence is needed for these decisions, especially in low-income countries. We aimed to estimate how health-care resources provided by the public sector were used in Malawi during 2015-19 and to estimate the effects of strengthening health-care services. For this modelling study, we used the Thanzi La Onse model, an individual-based simulation model. The scope of the model was health care provided by the public sector in Malawi during 2015-19. Health-care services were delivered during health-care system interaction (HSI) events, which we characterised as occurring at a particular facility level and requiring a particular number of appointments. We developed mechanistic models for the causes of death and disability that were estimated to account for approximately 81% of deaths and approximately 72% of disability-adjusted life-years (DALYs) in Malawi during 2015-19, according to the Global Burden of Disease (GBD) estimates; we computed DALYs incurred in the population as the sum of years of life lost and years lived with disability. The disease models could interact with one another and with the underlying properties of each person. Each person in the Thanzi La Onse model had specific properties (eg, sex, district of residence, wealth percentile, smoking status, and BMI, among others), for which we measured distribution and evolution over time using demographic and health survey data. We also estimated the effect of different types of health-care system improvement. We estimated that the public-sector health-care system in Malawi averted 41·2 million DALYs (95% UI 38·6-43·8) during 2015-19, approximately half of the 84·3 million DALYs (81·5-86·9) that the population would otherwise have incurred. DALYs averted were heavily skewed to children aged 0-4 years due to services averting DALYs that would be caused by acute lower respiratory tract infection, HIV or AIDS, malaria, or neonatal disorders. DALYs averted among adults were mostly attributed to HIV or AIDS and tuberculosis. Under a scenario whereby each appointment took the time expected and health-care workers did not work for longer than contracted, the health-care system in Malawi during 2015-19 would have averted only 19·1 million DALYs (95% UI 17·1-22·4), suggesting that approximately 21·3 million DALYS (20·0-23·6) of total effect were derived through overwork of health-care workers. If people becoming ill immediately accessed care, all referrals were successfully completed, diagnostic accuracy of health-care workers was as good as possible, and consumables (ie, medicines) were always available, 28·2% (95% UI 25·7-30·9) more DALYS (ie, 12·2 million DALYs [95% UI 10·9-13·8]) could be averted. The health-care system in Malawi provides substantial health gains with scarce resources. Strengthening interventions could potentially increase these gains, so should be a priority for investigation and investment. An individual-based simulation model of health-care service delivery is valuable for health-care system planning and strengthening. The Wellcome Trust, UK Research and Innovation, the UK Medical Research Council, and Community Jameel.

What Affects Citizens’ Perception of Public Infrastructure Decision-Making in a Disaster Setting?

This study examines citizens’ views on public-private partnerships (PPPs) and their sector-based preferences between private or nonprofit organizations as partners with government entities in providing public services for local infrastructures. Using survey data collected in Texas, this study finds that risk awareness and trust in institutional actors significantly influence citizens’ perceptions of public service delivery models, while a variety of information sources differently affect their perceptions. This study highlights citizens’ perception of nonprofits’ role in cross-sector collaborative governance, suggesting their involvement in implementing community resilience policies based on citizen preferences. Empirical findings provide insights for policymaking, advocating inclusive approaches in resilience planning and engaging diverse institutional actors, including citizens, in critical infrastructure development.

Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study.

Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients' waiting time by an average of 26.1 (SD 3.8; 95% CI -33.64 to -18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (β=1.13, 95% CI 0.91-1.36). BSSPR implementation for outpatients not only reduced waiting time and improved patients' experience but also augmented the hospital's capacity to provide medical services. This study's findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services.

The Impact of Digital Transformation on Service Models and Employee Skill Requirements in Taiwan's Real Estate Brokerage Industry

This paper investigates how digital transformation impacts service delivery models and employee skill requirements in Taiwan's real estate brokerage industry. Through a multiple-case comparison approach, data was collected from 200 participants across real estate firms to examine organizational adaptation to technological change. The research employed structural equation modeling and hierarchical linear modeling to analyze relationships between compensation satisfaction (β = 0.45, p &lt; 0.001), digital competency levels, and internal case circulation patterns. Results demonstrate that digital technologies significantly reshape brokerage operations, with digitalized companies achieving 32% higher client acquisition rates and 45% reduction in transaction processing time. Analysis reveals that employee digital literacy accounts for 28% of performance variance, while organizational support systems explain 23% of technology adoption rates. The findings extend service innovation literature by establishing empirical links between compensation systems and digital transformation success, providing a practical framework for technology integration in Taiwan's real estate sector. This research offers evidence-based recommendations for firms implementing digitalization strategies and developing employee capabilities in response to industry evolution.

Keeping Clean: A Qualitative Analysis of Water, Sanitation, and Hygiene Among Residents of Recreational Vehicles in Seattle, WA US

The growing number of people living in vehicles in the urban United States in recent years makes their water, sanitation, and hygiene (WASH) an increasingly relevant public health issue. The WASH context of people living in recreational vehicles (RVs) presents unique challenges, especially as it relates to wastewater disposal. This study answers the question: How do RV residents typically manage their wastewater and meet their other WASH needs? We examined the experiences of RV residents in Seattle, Washington participating in Seattle Public Utilities’ mobile pump-out program, which has offered a free, typically monthly, door-to-door RV wastewater disposal service since 2020. We conducted semi-structured interviews with 31 clients and analyzed the data using qualitative content analysis. We found that RV resident water and hygiene experiences were similar to other urban unhoused populations, whereas their sanitation experiences were quite distinct, most notably with regard to open defecation prevalence and the relative risks of shared versus private sanitation. We proposed four WASH service delivery models that consider the possible implications of our findings for cities looking to engage with RV residents. The models included: mobile RV wastewater collection and water delivery, fixed RV dump stations and water resources, public WASH facilities available for all, and safe parking programs.

A modified intensive, comprehensive aphasia program (mICAP) has better reported outcomes than usual care: a randomized controlled trial

ABSTRACT Background Intensive Comprehensive Aphasia Programs (ICAPs) are a new model of service delivery that show promising pre-post outcomes but have yet to be compared with usual care. Aim To compare the clinical effectiveness of a modified Intensive Comprehensive Aphasia Program (mICAP) to usual care in a parallel two arm study utilizing stratified block randomisation. Methods & Procedures Participants were a referred sample with post stroke aphasia from ten local speech pathology departments. Assessments were completed prior to, immediately after, and follow up at 3 months after the mICAP. While 269 participants with aphasia were approached for the study, only 52 were eligible to be randomised with 113 participants approached not meeting selection criteria and 99 of eligible participants declining to participate. Block randomization was based on matched moderate/mild versus severe aphasia pairs. Three of the 26 mICAP participants withdrew. In the experimental arm of the mICAP (the LIFT program), participants with aphasia and their family attended goal directed tailored therapy three times weekly for 8 weeks. Therapy included 14 hours each of impairment therapy, functional communication therapy, and computer therapy and 7 hours of group therapy and a challenge task. The main outcome measures were the self-reported Assessment for Living with Aphasia (ALA) and Content Information Units (#CIU’s) in connected speech. Outcomes & Results Linear Mixed Modelling was completed on the remaining 42 participants’ data and found a significant benefit for the mICAP on the ALA Total score (p= .014; 95% CI= −21.48- −2.57) ALA Aphasia domain (p = .027; 95% CI= −3.23 - −0.203), ALA Environment domain (p = .017; 95% CI= −4.70 - −0.493) immediately post intervention with maintenance of effects for the ALA Aphasia domain in the follow up period (p = .014; 95% CI= −3.64 - −0.438). Family members in the mICAP reported significant reduction in caregiving burden in the follow up period (p= .017; CI= −14.12 - −1.52.). There were no significant differences on the other main outcome measure of Content Information Units (95% CI= −34.94 – 55.15). Conclusions For those suitable and interested, the mICAP was more beneficial than usual care for participants with aphasia and their family members. However, lack of significant differences in discourse and other language functions, suggests that individual elements of mICAPs and their evaluation require review. Based on these results, the LIFT program has been refined to become the Comprehensive High-dose Aphasia Therapy (CHAT) program.

Evolving HIV service delivery: scalability of pharmacist-led care

Abstract Introduction With declining healthcare budgets and numbers of HIV medical trainees1, workforce innovation is crucial to sustain delivery of HIV care. Since local introduction of an advanced pharmacist practitioner (APP) role, we have demonstrated the ability of pharmacists to provide holistic care to people living with HIV, including those with complex medical needs. Scaling up pharmacist-led care may be a potential solution to sustain service delivery2 whilst addressing the needs of an ageing cohort3. Further APP clinics were introduced with consultant support and supervision. Aim We aim to evaluate the impact and outcomes of these APP clinics. Method Prospective data collection of consultations conducted by four pharmacist practitioners (PP) across four HIV clinics between January to December 2023. Surveys were distributed after the appointment to capture service users’ opinions on the pharmacists’ role and care provided. Ethical approval was not required as this does not constitute as research. This was registered as a service evaluation with the research and innovation team at Chelsea and Westminster NHS Foundation Trust. All patient information is anonymised. Results A total of 634 consultations (513 individuals) within 170 clinical sessions were conducted during the 12 month period: 585 (92%) in person; 176 (34%) female; median age 52 (IQR 43-58); 233 (45%) non-white ethnicity; mean number of co-morbidities 2 (0-8); 87 (17%) had more than 5 co-medications (0-21); 87% virologically suppressed [viral load (VL) &amp;lt;50cp/mL]. Of 55 individuals seen with detectable VL, 32 (58%) resuppressed within 6 months. PPs have made 522 interventions and investigations in total, for example 147 referrals to other specialities such as dietitians and mental health services, 112 imaging requested (e.g DEXA and liver ultrasounds) and 99 initiation or switching of antiretroviral therapy (ART). Following investigations, 44 new medical conditions were identified and managed by the PPs which included namely 18 cases of micronutrient deficiencies, 8 cases of skin conditions and 6 cases of metabolic disorders. From the survey, 55% (30/55) of service users were aware that pharmacists could review their overall health. All (100%) respondents felt that the quality of care received met or exceeded expectations and 54 (98%) would attend a pharmacist-led appointment in future. Discussion/Conclusion We have previously successfully demonstrated implementation of pharmacist practitioner clinics as a novel way of utilising and developing the pharmacist workforce. We demonstrate scalability of this service delivery model in our large, urban multi-site centre by successfully increasing the number of pharmacist practitioner clinics from three clinics to six clinics week. The positive feedback from service users indicates high acceptability of this model. HIV services may consider investment into mobilising senior pharmacists to facilitate expansion of this advanced practitioner role in order to address increasing levels of co-morbidities, polypharmacy and complex medical needs observed in our ageing population. The knowledge base of HIV pharmacists means they are ideally placed to facilitate communication across sectors, specialties and disciplines. Future development plans include expanding to other specialist areas such as HIV pre-exposure prophylaxis, contraception, gender health and research delivery and enhanced skills such as phlebotomy, injectable ART administration.

Availability and readiness of public health facilities to provide differentiated service delivery models for HIV treatment in Zambia: implications for better treatment outcomes

BackgroundThere is persistent pressure on countries with a high burden of HIV infection to reach desired targets for HIV treatment outcomes. This has led to moving from the “one-size-fits-all” model to differentiated service delivery (DSD) models, which are meant to be more patient-centered and efficient but without compromising on the quality of patient care. However, for DSD models to be efficient, facilities should have indicators of HIV services available and ready to provide the DSD models. We aimed to assess the availability of HIV service indicators and the readiness of facilities to provide DSD models for HIV treatment in selected public health facilities in Zambia.MethodsWe conducted a nationwide cross-sectional survey among public health facilities in Zambia that provide antiretroviral therapy (ART) services. We used an interviewer-administered questionnaire based on a World Health Organization (WHO) Service Availability Readiness Assessment (SARA) tool to assess the availability of HIV service indicators and the readiness of facilities to implement DSD models for HIV treatment. Availability and readiness were considered latent constructs, and therefore, we used structural equation modeling (SEM) to determine the correlations between them and their respective indicators.ResultsOf 60 public health ART facilities, the overall availability of HIV service indicators was 80.0% (48/60), and readiness to provide the DSD models was 81.7% (48/60). However, only 48 and 39% of the facilities had all indicators of availability and readiness, respectively. Retention in care for HIV multidisciplinary teams was more likely to occur in urban areas than in rural areas. SEM showed that the standardized estimate between availability and readiness was significantly and positively correlated (r = 0.73, p &amp;lt; 0.0001). In addition, both availability and readiness were significantly and positively correlated with most of their respective indicators.ConclusionAlthough most facilities had available HIV service indicators and were ready to provide DSD models, most facilities did not have all indicators of availability and readiness. In addition, there were differences between rural and urban facilities in some indicators. There is a need for persistent and heightened efforts meant to implement DSD in HIV treatment, especially in rural areas to accelerate reaching the desired HIV treatment outcomes.

Service-Delivery Models to Increase the Uptake of Non-Communicable Disease Screening in South-Central Ethiopia: A Difference-In-Differences Analysis

Background: Screening for non-communicable diseases (NCDs) is a critical step for early detection and the prevention of consequent morbidity and mortality. To facilitate NCD screening, the Ethiopian Ministry of Health has developed screening guidelines. However, like other low- and middle-income countries, interventions to increase the uptake of NCD-screening services in Ethiopia remain ineffective. Thus, this study aimed to determine the effectiveness of service delivery models to increase NCD-screening service uptake in south-central Ethiopia. Method: A health-facility-based quasi-experimental study design was employed to determine the effectiveness of providing a multiple-NCD-screening service in addition to social- and behavioral-change communication (SBCC) intervention to increase the uptake of NCD-screening services. The interviewer-administered structured questionnaire was adapted from previously published research and used to collect data during the baseline and end-line survey periods. A difference-in-differences analysis was used to determine the effectiveness of the intervention. Results: Compared with routine care, the availability of a multiple-NCD-screening service, together with SBCC intervention, was found to significantly increase the uptake of cervical cancer screening, clinical breast examination, blood pressure measurement, and blood glucose-measurement services, by 18, 9, 44 and 23 percent points, respectively. However, the availability of a multiple-NCD-screening service without SBCC intervention increased clinical breast-examination service uptake by 9% point and blood glucose-measurement service uptake by 18% point without increasing the uptake of cervical cancer-screening or blood pressure-measurement services. Conclusion: The integration of multiple-NCD-screening services accompanied by SBCC intervention that promotes them is an important approach for improving the uptake of NCD-screening services.

AI-Driven Service Transformation : Revolutionizing Operational Excellence

Service industries are undergoing rapid transformation through the integration of artificial intelligence (AI) and automation. This article presents an AI-powered service delivery model that autonomously optimizes operations, improves customer satisfaction, and drives business growth. The article leverages AI algorithms to automate incident management, predict operational disruptions, and enhance customer experiences. Real-world implementations within retail, healthcare, and technology sectors demonstrate significant improvements in service efficiency, with operational costs reduced by 30% and customer satisfaction scores increasing by 30%. This article proposes AI-driven service enhancements as a game-changer in the delivery of complex, scalable, and reliable services.

Feasibility Testing of Digitise Home Visit Service(DHVS) Core Model

The COVID-19 pandemic precipitated a global surge in homeschooling (Ray et al., 2020). While support networks for homeschooling parents have expanded, access to in-home educational professionals, particularly in rural areas, remains a significant challenge (Bullock &amp; Davis, 2018). This study introduces a novel "Digitized Home Visit Education Services (DHVS) (Sathya D H, 2024)" model to address this gap. Building on two years of experience delivering one- to-one home visit special education, our model integrates online monitoring with in-home support from a local trained resource person. The model's feasibility was assessed through a comprehensive evaluation, encompassing subject selection, learning profile analysis, teacher training, and online monitoring during home visits. Semi-structured interviews with the parent, the teacher, the trained resource person, and the passive observer provide qualitative data to refine the model. This paper delves into the Digitised Home Visit Service (DHVS) Core Model, evaluating its feasibility and acceptability. Findings will contribute to the development of DHVS as an alternative special education and therapy service delivery model (Sathya D H, 2024), informing rehabilitation and special education professionals about an innovative method leveraging technology to reach needy students. Parents of students with disabilities will appreciate the digitised home visit model when it becomes available for their children to receive education at home.

Differentiated Service Delivery Model in Improving HIV Treatment Outcomes Among Female Sex Workers in Gauteng Province of South Africa: A Protocol Paper

Differentiated Service Delivery Model in Improving HIV Treatment Outcomes Among Female Sex Workers in Gauteng Province of South Africa: A Protocol Paper

Association between differentiated HIV care delivery model and low-level viremia among people living with HIV in Rwanda

BackgroundLow-level viremia (LLV) (HIV-RNA 51–999 copies/mL) is associated with increased risk of non viral load suppression (HIV-RNA ≥ 1000 copies/mL). We assessed the association between differentiated service delivery model (DSDM) and LLV among people living with HIV (PLHIV) in Rwanda.MethodsWe conducted a retrospective cohort analysis using routinely collected data of adults living with HIV from 28-healthcare facilities in Rwanda before and after the introduction of DSDM. Under DSDM, PLHIV initiated treatment within seven days of HIV diagnosis and medication pick-up up to six months for those with sustained viral load suppression suppression. Proportions of LLV at 6,12 and 18 months were quantified. Multivariable log binomial regression models were used to assess the effect of DSDM on LLV. To handle missing data, multiple imputations was performed.ResultsOf 976 people living with HIV, 645(66.0%) were female and 463(47.4%) initiated treatment during DSDM. The median age was 37 (interquartile range: 32–43) years. LLV was 7.4%, 6.6% and 5.4%, at 6,12 and 18 months, respectively. Compared to those who initiated treatment before DSDM, starting treatment during DSDM increased six-month LLV [adjusted risk ratio (aRR) = 2.8: 95%CI (1.15–6.91)] but not at 12 [aRR = 2.3: 95%CI (0.93–5.75)] and 18 months [aRR = 0.3: 95%CI (0.09–1.20)]. Using imputed datasets, the association between DSDM and LLV persisted.ConclusionsDSDM was associated with increased risk of LLV at 6-months. possibly due to the minimal amount of time PLHIV had in pondering and accepting the HIV diagnosis. Continued support is needed among people receiving early antiretroviral therapy initiation to prevent development of LLV.

A Systematic Review of Alternative Service Delivery in Africa for Taming Wicked Risks

This research considers the role that alternative service delivery can play in addressing wicked problems. The aim of this research is, firstly, to determine which evidence and knowledge are available on alternative service delivery arrangements relevant to African countries to inform decisions about addressing wicked problems on the continent. Second, this research determines suitable mechanisms for an alternative service delivery model for mitigating wicked risks in Africa. This research is based on a systematic literature review. This systematic literature review reveals that most work on alternative service delivery has been done in developed countries, with developing African countries being left behind in research on alternative service delivery. Furthermore, most of the alternative service delivery efforts have not focused on addressing wicked problems. A large number of articles on alternative service delivery models show that alternative delivery is not a preferred approach in Africa. This research recommends an alternative service delivery model that is based on digital governance, service delivery innovation and partnerships. Robust governance responses are needed to mitigate these wicked risks, and alternative service delivery presents robust features to mitigate these risks given that it is more flexible, agile, adaptable, and decentralized in nature than simply relying on traditional government responses. Lastly, risk-informed decision-making should be placed at the center of the reform agenda for a smart and sustainable society.

Applying theories, models, and frameworks to help genetic counselors and students achieve clinical and professional goals.

Some genetic counselors (GCs) may find theories, models, and frameworks (TMFs) useful in clinical skills selection and when reflecting on or evaluating genetic counseling practice. This paper aims to demonstrate how TMFs can be used to postulate how different skills may impact patients'/clients' decisions, behaviors, and outcomes and consider how multiple TMFs can inform the use of various skills or strategies to achieve different goals. Additionally, we provide examples of TMFs that may help GCs in nonclinical aspects of their work, such as implementing and evaluating new interventions or service delivery models. To guide the selection of appropriate TMFs, we provide a set of questions to consider and include examples of skills and approaches that align with different TMFs. While TMFs provide a structured approach and valuable guidance that may help advance genetic counseling practice, they have certain limitations. Additional research is necessary to determine the effectiveness of using TMFs to guide clinical practice and improve patient/client outcomes.

Promoting equality in utilization of basic public health services in China: the role of the family doctor contract service

Background The Family Doctor Contract Service (FDCS) system is a service model for primary care reform launched in 2016 to offer families and individuals active and continuous health care by a team of family doctors within primary care institutions in China. Objectives This study aimed to estimate socioeconomic-related inequalities in the utilization of basic public health services, and to identify the contribution of FDCS to promoting equality. Methods Data for the study were collected from a 2023 cross-sectional household health survey in western China, involving 39,456 participants. The concentration index (C) was employed for analyzing the extent of socioeconomic-related inequalities in the utilization of basic public health services and the coarsened exact matching technique was employed for sensitivity analysis in order to reduce selection bias. Results Our results indicated pro-poor inequalities in the utilization of health records (C = −0.046), free health check-ups (C = −0.009), and follow-ups for hypertension (C = −0.051). Additionally, a more equitable distribution across the economic spectrum was observed within the FDCS group (people who voluntarily contracted for services) compared to the non-FDCS group. The FDCS demonstrated more favorable positive impacts among individuals with higher (quintiles 60–80%) and the highest (top 20%) socioeconomic status. The FDCS contributed 83.94%, 59.24%, and 36.92% to pro-poor inequalities in the utilization of three basic public health services. These contributions reflected the positive impact of the FDCS on utilization. Conclusions Government policy and service delivery models require a paradigm shift to promote a stronger primary healthcare approach to practice, as evidenced by the effectiveness of the FDCS in promoting equality.