Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol
Autor: | Kiesha Prem, Pheak Chhoun, Alvin Kuo Jing Teo, Mengieng Ung, Sovannary Tuot, Siyan Yi, Masamine Jimba, Penh Sun Ly, Chamroen Pall |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Time Factors Service delivery framework Anti-HIV Agents Stigma (botany) HIV Infections Infectious and parasitic diseases RC109-216 Community Social support Study Protocol Quality of life (healthcare) Intervention (counseling) medicine Humans business.industry HIV Mental health Service delivery Antiretroviral therapy Infectious Diseases Community mobilization Family medicine Quality of Life Implementation science business Cambodia Viral load |
Zdroj: | BMC Infectious Diseases BMC Infectious Diseases, Vol 21, Iss 1, Pp 1-9 (2021) |
ISSN: | 1471-2334 |
Popis: | Background Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities’ burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model’s effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia. Methods We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers’ work burden, the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective. Discussion This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response. Trial registration ClinicalTrials.gov, NCT04766710. Registered 23 February 2021, Version 1. |
Databáze: | OpenAIRE |
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