Differentiated HIV Service Delivery vs Conventional Care: Tuberculosis Preventive Therapy Outcomes for People Living With HIV in Sub-Saharan Africa.

Abstract

IntroductionDifferentiated service delivery (DSD) models, which reduce provider visits and offer varied ART delivery methods for people with HIV, are expanding across sub-Saharan Africa. However, their impact on services beyond ART, including the uptake and completion of tuberculosis preventive therapy (TPT), remains unclear.MethodsUsing the RE-AIM framework, we analyzed data from Opt4TPT, a longitudinal cohort study examining TPT delivery in South Africa and Zimbabwe. We constructed multivariate logistic regression models to evaluate the association of receiving ART from a DSD model with TPT initiation and completion, as measured by electronic medication boxes. We constructed a Cox proportional hazards model to assess time to TPT initiation.ResultsAmong 1193 participants, 276 received ART through a DSD model, while 917 used the conventional model. Overall, 1035 (87%) initiated TPT, including 242 (88%) in DSD models and 793 (86%) in conventional models. Receiving ART from a DSD model was not significantly associated (OR 1.11, 95% CI: 0.74 to 1.67, P = 0.61) with TPT initiation. DSD models had a significantly longer mean time to initiation (6.5 vs. 2.7 days, P = 0.01). Among 731 (71%) with MERM box data, 356 (49%) completed TPT. Bivariate analysis showed higher odds of completing TPT among those in DSD models (OR 1.53, 95% CI: 1.06 to 2.21, P = 0.024), but this was not significant after adjusting for demographic and clinical factors (OR 0.89, 95% CI: 0.58 to 1.36, P = 0.58).ConclusionsHigh TPT uptake in DSD and conventional models indicate TPT delivery in DSD models is feasible. TPT completion was low in both models of care, showing a need to focus on improving TPT completion overall.