Factors associated with enrollment into differentiated service delivery model among adults with HIV in Kenya

Details

• Alternative Title:
  AIDS
• Personal Author:
  Lavoie, Marie-Claude C. ; Koech, Emily ; Blanco, Natalia ; Wangusi, Rebecca ; Jumbe, Marline ; Kimonye, Francis ; Ndaga, Angela ; Ndichu, Geofrey ; Makokha, Violet ; Awuor, Patrick ; Momanyi, Emmah ; Oyuga, Roseline ; Nzyoka, Sarah ; Mutisya, Immaculate ; Joseph, Rachel ; Miruka, Fredrick ; Musingila, Paul ; Stafford, Kristen A. ; Lascko, Taylor ; Ngunu, Carol ; Owino, Elizabeth ; Kiplangat, Anthony ; Kepha, Abuya ; Ng’eno, Caroline
• Description:
  Introduction:
  
  Differentiated service delivery (DSD) such as multimonth dispensing (MMD) aims to provide client-centered HIV services, while reducing the workload within health facilities. We assessed individual and facility factors associated with receiving more than three MMD and switching from ≥3MMD back to <3MMD in Kenya.
  
  Methods:
  
  We conducted a retrospective cohort study of clients eligible for DSD between July 2017 and December 2019. A random sample of clients eligible for DSD was selected from 32 randomly selected facilities located in Nairobi, Kisii, and Migori counties. We used a multilevel Poisson regression model to assess the factors associated with receiving ≥3MMD, and with switching from ≥3MMD back to <3MMD.
  
  Results:
  
  A total of 3501 clients eligible for ≥3MMD were included in our analysis: 1808 (51.6%) were receiving care in Nairobi County and the remaining 1693 (48.4%) in Kisii and Migori counties. Overall, 65% of clients were enrolled in ≥3MMD at the time of entry into the cohort. In the multivariable model, younger age (20–24; 25–29; 30–34 vs. 50 or more years) and switching ART regimen was significantly associated with a lower likelihood of ≥3MMD uptake. Factors associated with a higher likelihood of enrollment in ≥3MMD included receiving DTG vs. EFV-based ART regimen (aRR: 1.10; 95% confidence interval: 1.05–1.15).
  
  Conclusion:
  
  Client-level characteristics are associated with being on ≥3MMD and the likelihood of switching from ≥3MMD to <3MMD. Monitoring DSD enrollment across different populations is critical to successfully implementing these models continually.
  
  
• Subjects:
  Adult Anti-HIV Agents Health Facilities HIV Infections Humans Kenya Middle Aged Research Design Retrospective Studies Young Adult
• Keywords:
  Differentiated Service Delivery Model HIV Multimonth Prescription
• Source:
  AIDS. 37(15):2409-2417
• Pubmed ID:
  37707787
• Pubmed Central ID:
  PMC11317986
• Document Type:
  Journal Article
• Funding:
  NU2GGH001949/GH/CGH CDC HHSUnited States/ ; NU2GGH001949/ImCDC/Intramural CDC HHSUnited States/ ; NU2GGH001962/GH/CGH CDC HHSUnited States/ ; NU2GGH001962/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  37
• Issue:
  15
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:2338018358d996609dc7f56b590b7d19918adff01f16c110c4fab4ff5d95071be3d5addf1b72634d879a214b5219b77234ff345aea8dfa4611763fbf50df236b
• Download URL:
  https://stacks.cdc.gov/view/cdc/159819/cdc_159819_DS1.pdf
• File Type:
  [PDF - 162.48 KB ]