HIV
Conditions
Keywords
HIV, Differentiated service delivery, South Africa
Brief summary
Many countries in sub-Saharan Africa are rapidly scaling up differentiated service delivery (DSD) models for HIV treatment to improve the quality of care, increase access, reduce costs, and support the continued expansion and sustainability of antiretroviral therapy (ART) programs. Although there is some published evidence about the health outcomes of patients in DSD models, little is known about their impacts on healthcare providers' job satisfaction, patients' quality of life, costs to providers or patients, or how DSD models affect resource allocation at the facility level. SENTINEL is a multi-year observational study that will collect detailed data about DSD models for ART delivery and related services from 12 healthcare facilities in Malawi, 24 in South Africa, and 12 in Zambia. The first round of SENTINEL included a patient survey, provider survey, provider time-and-motion observations, and facility resource use inventory. A survey of clients testing for HIV and a supplement to the facility resource use component to describe service delivery integration will be added for the second round. The patient survey will ask up to 10 patients enrolled in each DSD model at each study site about their experiences in HIV care and in DSD models, costs incurred seeking treatment, and preferences for HIV service delivery. The provider survey will ask up to 10 providers per site about the impact of DSD models on their positions and clinics. The time-and-motion component will directly observe the time use of a sample of providers implementing DSD models. Finally, the resource utilization component will collect facility-level data about DSD model availability and enrollment and the human and other resources needed to implement them. SENTINEL is planned to include at least four approximately annual rounds of data collection between 2021 and 2025. As national DSD programs for HIV treatment mature, it is important to understand how individual healthcare facilities are interpreting and implementing national guidelines and how healthcare workers and clients are adapting to new models of service delivery. SENTINEL will help policy makers and program managers understand the benefits and costs of differentiated service delivery and improve resource allocation going forward.
Interventions
OTHERNo intervention
Observational data collection only.
Sponsors
Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand
Clinton Health Access Initiative, Nigeria
Boston University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
15 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria for the time and motion study are: * Patient-facing or patient-supporting service provider at the study site (patient-supporting providers include data clerks, pharmacists, etc.) * Directly or indirectly involved in the site's implementation of ART and DSD models * Employed in current role at the study site for at least six months * Provides written informed consent to participate Inclusion criteria for provider interviews are: * Direct or indirect service provider at the study site (indirect providers include supervisors, technical advisors, etc.) * Directly or indirectly involved in the site's implementation of ART and DSD models * Employed in current role at the study site for at least six months * Provides written informed consent to participate. Inclusion criteria for the patient survey are: * Living with HIV and on ART for at least six months at the study site * ≥ 18 years old (18 and older considered adult for research purposes in South Africa) * Enrolled in a specified model of care (including conventional care) up to the target number of participants for that model and have received at least one medication refill under this model * Provide written informed consent to participate. Inclusion criteria for the testing survey are: * Undergoing HIV testing at the study site or other testing site within the catchment area * ≥ 18 years old (18 and older considered adult for research purposes in South Africa) * Provide written informed consent to participate.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patient survey participants with HIV viral suppression ≤400 copies/ml at most recent test | 12 months after enrollment | Viral suppression among ART patients enrolled and not enrolled in differentiated service delivery models |
Countries
South Africa
Outcome results
None listed