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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Differentiated Services Delivery Model and its associated outcomes among people living with HIV in Tanzania: A cross-sectional study
Tanzania Journal of Health Research, Volume 24, No. 3, Year 2023
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Description
Introduction: Differentiated Service Delivery Models (DSDM), a strategy to promote retention in HIV care and/or ART adherence, is now increasingly recognized as an important and sustainable approach that could contribute significantly toward the UNAIDS 90-90-90 by 2020 and 95-95-95 by 2030 targets and ultimately an AIDS-free generation. This study was conducted to determine the outcomes of DSDM among people living with HIV in Tanzania. Methods: A Cross-sectional analytical design approach employing both quantitative and qualitative data collection methods was adopted in this study that was implemented in 9 regions of Tanzania. We conducted record reviews and in-depth interviews with key informants at national and facility levels where their data was summarized and arranged in sub-themes and then analyzed according to the specific objectives by using Thematic Analysis. We further conducted a bivariate analysis using Chi-Square to assess the association between each outcome and explanatory variable. Unadjusted and adjusted analysis was conducted to determine predictors of unfavourable outcomes using logistics regression models. Results: Data was collected from 50 health facilities comprising 15 (30.0%) hospitals, 22 (44.0%) health centres and 13 (26.0%) dispensaries. Record reviews were for different outcomes as follows; Mis-categorization (13,056 records), Missed appointments (62,222 records), Advanced HIV disease (29,995 records), and Attrition (62,222 records). Among the 320 unstable clients, the rate of miscategorization significantly decreased after the introduction of DSDM, from 63% to 36% (p < 0.001). After the introduction of DSDM, more clients missed their appointments compared to the period before the introduction of DSDM (1.7% vs 0.8% respectively). Missed appointments were associated with an urban setting (AOR 1.1, 95% CI 1.1-1.2) and older age of 50 years and more (AOR 1.2, 95% CI 1.1-1.4) in comparison to a rural setting and younger age of fewer than 15 years respectively. Furthermore, DSDM led to a decrease (from 56% to 49%) of those with advanced WHO stage among the first-time testers. Attrition among the clients was higher after the introduction of DSDM compared to that before DSDM (ARR 1.1, 95% CI 1.04-1.2). Contributors to attrition were those related to individuals and institutions including beliefs in faith healing, fear of stigma and wrong interpretation of viral load monitoring results. Conclusion: Decentralized Community-based ART model is a promising entry point to improved HIV/AIDS service delivery. Strategies are needed to harmonise the comprehensiveness and quality of services across facilities providing HIV services. © 2023, National Institute for Medical Research. All rights reserved.
Authors & Co-Authors
Burengelo, Dorica
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Kitinya, Caritas
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Kagaruki, Gibson Benard
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Philbert, Doreen
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Soka, Grace
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Donard, Francis N.
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Rwebembera, Anath Ab Bakari
Tanzania, Dar es Salaam
National Aids Control Program
Maokola, Werner M.
Tanzania, Dar es Salaam
National Aids Control Program
Njau, Prosper Faustine
Tanzania, Dar es Salaam
National Aids Control Program
Silvan, Boniface
Tanzania, Dar es Salaam
National Aids Control Program
Rutaihwa, Mastidia
Tanzania, Dar es Salaam
National Aids Control Program
Mutalemwa, Prince Pius P.
Tanzania, Tanga
National Institute for Medical Research Tanga
Minja, Victor
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Mahende, Coline
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Mfinanga, Sayoki Godfrey Mrinde
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Ngadaya, Esther Stanslaus
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Kimaro, Godfather Dickson
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Kahwa, Amos M.
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Senkoro, Mbazi
Tanzania, Dar es Salaam
National Institute for Medical Research Muhimbili Research Centre
Statistics
Authors: 19
Affiliations: 3
Identifiers
Doi:
10.4314/thrb.v24i3.3
ISSN:
18216404
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Grounded Theory
Study Approach
Qualitative
Quantitative
Study Locations
Tanzania