What are the 12-month retention and viral suppression outcomes for South African ART clients enrolled in DSD models compared to conventional care?


BACKGROUND: South Africa has implemented several differentiated service delivery (DSD) models for HIV treatment. Few comparisons of treatment outcomes between the country's DSD models and conventional care are available. We analyzed routine data to determine one-year retention and viral suppression of clients enrolled in DSD models.
METHODS: We analyzed individual data from South Africa's electronic patient record (TIER.Net) for 24 clinics across 4 districts. We followed clients alive and in care on 01/02/2019 and estimated outcomes of retained at 12 months after follow-up start and virally suppressed(<400 copies/ml3) '¥3-18 months. We classified clients as eligible for DSD models if they were '¥18 years old, on ART '¥12 months and had two suppressed viral load (VL) measurements, per national guidelines at the time. We compared outcomes for those enrolled in a DSD model to those eligible but not enrolled and for those ineligible, compared outcomes by reason ineligible for DSD.
RESULTS: Among 12,120 clients enrolled in DSD and 22,551 ART clients eligible but not enrolled in DSD, retention was 95% and 93%, respectively (risk ratio [95% confidence interval] 1.02[1.02-1.03])(Table). Viral suppression for those with a VL measure was 95% for both groups, but 29% of those in DSD models and 16% in conventional care had no VL measurement recorded. Of the 3,298 recently enrolled into a DSD model ('¤6 months), 35% (n=1,153) did not meet the eligibility criteria (0.5% <18yrs, 3% on ART <12 months, 99% missing two suppressed VLs). Retention and VL suppression were higher for those with a known suppressed VL prior to DSD enrollment (93%, n=498) than for those with a known unsuppressed VL prior to DSD enrolment (87%, n=46).
CONCLUSIONS: DSD model enrolment conferred a minor benefit to retention and equivalent viral suppression over one year of follow-up compared to conventional care for clients eligible for DSD enrolment.

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