Assessing the Efficacy of Various Differentiated Service Delivery (DSD) Models in Chosen Healthcare Centers within Masaiti District.
DOI:
https://doi.org/10.47941/ijhs.2043Keywords:
DSD Models, HIV/AIDS, USAID, Art, PolicyAbstract
Purpose: This study delves into the assessment of Differentiated Service Delivery (DSD) models within the healthcare framework of Masaiti District, focusing on their effectiveness, components, and implementation challenges.
Methodology: Using a mixed method approach with explanatory embedded design, the study objectives encompass a multi-faceted exploration. These include an analysis of the specific components integrated into each DSD model adopted in Masaiti, an investigation into the interplay between facility level and individual stage participation in differentiated care, and an identification of the implementation difficulties faced in public health facilities.
Findings: The study reveals a statistically significant connection (p < 0.05) between facility stage participation and individual stage engagement in differentiated care, with a Cramer's V coefficient of 0.131 indicating a small effect size. This suggests a feasible relationship between the degree of individual participation in differentiated care and the facility's capacity to encourage and facilitate such participation.
Unique contribution to theory, practice, and policy (recommendations):
This research provides valuable insights for healthcare policymakers, practitioners, and stakeholders involved in the design, implementation, and improvement of DSD models. It highlights the distinctive features and methodologies of each DSD model in Masaiti District, the influence of healthcare facility hierarchies on DSD model effectiveness, and the challenges encountered during implementation. By addressing these aspects, the study offers recommendations to enhance the efficacy and sustainability of DSD initiatives within the Masaiti healthcare context.
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Amy H., Sophie P., Brooke N., L. Long, S. Kuchukhidze, B. Phiri, T. Tchereni, and S. Rosena (2021). A Landscape Analysis of Differentiated Service Delivery Models for HIV Treatment in Malawi, South Africa, and Zambia.
Belay, Y.A., Taye, F.A., Yitayal, M., and Atnafu, A. (2022). Scoping review of the obstacles and enablers to the adoption and expansion of diversified service delivery methods for HIV treatment in Africa. P. 1431 in BMC Health Services Research, 22(1).
Brennan AT, Long L, Maskew M, et al. Outcomes of stable HIV-positive patients down-referred from a doctor-managed antiretroviral therapy clinic to a nurse-managed primary health clinic for monitoring and treatment. AIDS. 2011; 25(16):2027-2036.
Buckle and colleagues (2020). A systematic review and meta-analysis of telemedicine interventions among patients with diabetes mellitus were conducted to determine the clinical effectiveness of telemedicine in treating the condition. Innovations, Quality & Outcomes: Proceedings of the Mayo Clinic, 4(1), 47–63.
Chimbwandira F, Kalua T, et al. (2018) Patientand health worker experiences of differentiated models of care for stable HIV patients in Malawi: A qualitative study. PLoS ONE 13(7): e0196498.
Coens, T., & Jenkins, M. (2000) abolishing performance appraisal: why they backfire and what to do instead.
Davies NEC, Homfray M, Venables EC, et al. Where next for differentiated antiretroviral therapy delivery? OPINION. Current Opinion in HIV and AIDS. 2018; 13(5):405-411.
De Boni, R.B., Shepherd, B.E., Grinsztejn, B. et al. (2019). Effectiveness and safety of the fast-track cities treatment and care cascade for HIV-infected persons. AIDS, 33(11), 1773-1781.
Eshun-Wilson I, Mukumbwa-Mwenechanya M, Kim HY, Zannolini A, Mwamba CP, Dowdy D, Kalunkumya E, Lumpa M, Beres LK, Roy M, Sharma A, Topp SM, Glidden DV, Padian N, Ehrenkranz P, Sikazwe I, Holmes CB, Bolton-Moore C, Geng E. H. (2019). Differentiated Care Preferences of Stable Patients on Antiretroviral Therapy in Zambia: A Discrete Choice Experiment.
El-Sadr WM, Rabkin M, DeCock KM. Population health and individualized care in the global AIDS response: synergy or conflict? AIDS 2016; 30:2145–2148.
Ford, N., Swan, T., Baggaley, R., & Ehrenkranz, P. (2020). HIV differentiated service delivery: an evidence-based and patient-centered approach to achieving universal health coverage. Journal of the International AIDS Society, 23(Suppl 5), e25540. Acquir Immune Defic Syndr. 2019 Aug 15;81(5):540-546. doi: 10.1097/QAI.0000000000002070. PMID: 31021988; PMCID: PMC6625870.
Grimsrud A, Barnabas RV, Ehrenkranz P, Ford N (2017). Evidence for scale up: the differentiated care research agenda. J Int AIDS Soc. 2017; 20(Suppl 4):22024.
Grangeiro, A., Pepitone, A., lannes, L. et al. (2020). HIV differentiated service delivery models implemented by Brazil, South Africa, and Mozambique: A comparison of outcomes. Journal of Acquired Immune Deficiency Syndromes, 83(1), S92-S98.
ICAP (2020). Evaluating Effectiveness of Differentiated Service Delivery (DSD) Projects in Public Hospitals: A Study of Selected Health Facilities in Lusaka District. CFP/2378/2021.
Lecher, S. et al. (2017). Achieving the First 90 for Key Populations in Sub-Saharan Africa Through Innovative and Differentiated Approaches. Journal of the International AIDS Society, 20(Suppl 4), 21759.
Levi, J., Schroeder, M., Thompson, D. et al. (2020). Adherence support workers: Addressing social barriers to antiretroviral therapy adherence in high-income countries. AIDS, 34(14), 2079-2086.
Lujintanon, S., Amatavete, S., Sungsing, T., Seekaew, P., Peelay, J., Mingkwanrungruang, P., Chinbunchorn, T., Teeratakulpisarn, S., Methajittiphan, P., Leenasirima, P. and Norchaiwong, A., (2021). Client and provider preferences for HIV care: Implications for implementing differentiated service delivery in Thailand. Journal of the International AIDS Society, 24(4), p.e25693.
Long L, Kuchukhidze S, Pascoe S, Nichols BE, Fox MP, Cele R, Govathson C, Huber AN, Flynn D, Rosen S. Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub-Saharan Africa: a rapid systematic review. J Int AIDS Soc. 2020 Nov;23(11): e25640. doi: 10.1002/jia2.25640. PMID: 33247517; PMCID: PMC7696000.
May, C. et al. (2014). Implementing and Evaluating Complex Interventions: The Virtual Ward Programme in the UK National Health Service. Journal of Health Services Research & Policy, 19(3), 40–48.
McClashen W. (2005) the strength approach. St luke’s innovative resources.
Murphy, E., Shwe, Y.Y., Bhatia, R., Bakkali, T. and Vannakit, R., (2021). What will it take to end AIDS in Asia and the Pacific region by 2030? Sexual health, 18(1), pp.41-49.
Kalua T, Chimbwandira F, and others (2018) experiences of patients and healthcare professionals with various forms of care for HIV patients in stable.
Mody, A., Pauly, M., Grow, A., Ford, N., McKinney, O., Alistar, S. S., & Yotebieng, K. (2018). The role of differentiated ART delivery strategies in accelerating progression to viral suppression among HIV-positive pregnant women in Kenya, South Africa, and Haiti: a systematic review protocol. Systematic Reviews, 7(1), 32.
Roy, M., Bolton Moore, C., Sikazwe, I. and Holmes, C.B., (2019). A review of differentiated service delivery for HIV treatment: effectiveness, mechanisms, targeting, and scale. Current HIV/AIDS Reports, 16, pp.324-334.
Sanwo O, Persaud NE, Nwaokoro P, Idemudia A, Akpan U, Toyo O, Imohi P, Badru T, Obiora-Okafo C, Uzochukwu CE, Aliu O, Olatunbosun K, Pandey SR, Khamofu H, Chiegil R, James E, Iyortim I, Oqua D, Bateganya M. (2022). Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID-19 pandemic: descriptive analysis of programmatic data. J Int AIDS Soc. 2021 Oct;24 Suppl 6(Suppl 6): e25820. doi: 10.1002/jia2.25820. PMID: 34713591; PMCID: PMC8554211.
Swaziland Ministry of Health. Standard operating procedures for implementing community-centred models of ART service delivery (CommART) in Swaziland. June 2016. Swaziland: Ministry of Health; 2016.
UNAIDS, Review of data from People Living with HIV Stigma Index surveys conducted in more than 65 countries, 2016.
UNAIDS, Review of data from People Living with HIV Stigma Index surveys conducted in more than 30 countries, 2020.
Van Der Kwaak, A. et al. (2012). Evaluating Nurse-Led Innovations in Health Care: Identifying and Addressing Complexity. Milbank Quarterly, 90(2), 237–249.
World Health Organization (2015). Consolidated strategic information guidelines for.
Ware NC, Wyatt MA, Geng EH, et al (2020). Toward an understanding of disengagement from HIV treatment and care in sub-Saharan Africa: a qualitative study. PLoS Med. 2016; 13(1):e1001954.
Zambia Ministry of Health (2017). Zambia National Health Strategic Plan 2017-2021. Lusaka: Government of the Republic of Zambia; 2017.
Zambia Ministry of Health. Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection. Lusaka: Government of the Republic of Zambia; 2020.
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