Uptake of community- versus clinic-based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa.

Autor: Bassett IV; Massachusetts General Hospital, Division of Infectious Diseases, Boston, Massachusetts, USA.; Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, USA.; Center for AIDS Research (CFAR), Harvard University, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Yan J; Massachusetts General Hospital, Biostatistics Center, Boston, Massachusetts, USA., Govere S; AIDS Healthcare Foundation, Durban, South Africa., Khumalo A; AIDS Healthcare Foundation, Durban, South Africa., Ngobese N; AIDS Healthcare Foundation, Durban, South Africa., Shazi Z; AIDS Healthcare Foundation, Durban, South Africa., Nzuza M; AIDS Healthcare Foundation, Durban, South Africa., Bunda BA; Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, USA., Wara NJ; Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, USA., Stuckwisch A; Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, USA., Zionts D; Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, USA., Dube N; AIDS Healthcare Foundation, Durban, South Africa., Tshabalala S; South Africa Department of Health, Province of KwaZulu-Natal, South Africa., Bogart LM; RAND Corporation, Santa Monica, California, USA., Parker RA; Center for AIDS Research (CFAR), Harvard University, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Massachusetts General Hospital, Biostatistics Center, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2022 Jan; Vol. 25 (1), pp. e25877.
DOI: 10.1002/jia2.25877
Abstrakt: Introduction: South Africa's government-led Central Chronic Medication Dispensing and Distribution (CCMDD) program offers people living with HIV the option to collect antiretroviral therapy at their choice of community- or clinic-based pick-up points intended to increase convenience and decongest clinics. To understand CCMDD pick-up point use among people living with HIV, we evaluated factors associated with uptake of a community- versus clinic-based pick-up point at CCMDD enrolment.
Methods: We collected baseline data from October 2018 to March 2020 on adults (≥18 years) who met CCMDD clinical eligibility criteria (non-pregnant, on antiretroviral therapy for ≥1 year and virologically suppressed) as part of an observational cohort in seven public clinics in KwaZulu-Natal. We identified factors associated with community-based pick-up point uptake and fit a multivariable logistic regression model, including age, gender, employment status, self-perceived barriers to care, self-efficacy, HIV-related discrimination, and perceived benefits and challenges of CCMDD.
Results and Discussion: Among 1521 participants, 67% were females, with median age 36 years (IQR 30-44). Uptake of a community-based pick-up point was associated with younger age (aOR 1.18 per 10-year decrease, 95% CI 1.05-1.33), being employed ≥40 hours per week (aOR 1.42, 95% CI 1.10-1.83) versus being unemployed, no self-perceived barriers to care (aOR 1.42, 95% CI 1.09-1.86) and scoring between 36 and 39 (aOR 1.44, 95% CI 1.03-2.01) or 40 (aOR 1.91, 95% CI 1.39-2.63) versus 10-35 on the self-efficacy scale, where higher scores indicate greater self-efficacy. Additional factors included more convenient pick-up point location (aOR 2.32, 95% CI 1.77-3.04) or hours (aOR 5.09, 95% CI 3.71-6.98) as perceived benefits of CCMDD, and lack of in-clinic follow-up after a missed collection date as a perceived challenge of CCMDD (aOR 4.37, 95% CI 2.30-8.31).
Conclusions: Uptake of community-based pick-up was associated with younger age, full-time employment, and systemic and structural factors of living with HIV (no self-perceived barriers to care and high self-efficacy), as well as perceptions of CCMDD (convenient pick-up point location and hours, lack of in-clinic follow-up). Strategies to facilitate community-based pick-up point uptake should be tailored to patients' age, employment, self-perceived barriers to care and self-efficacy to maximize the impact of CCMDD in decongesting clinics.
(© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
Databáze: MEDLINE
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