HIV Care Models and Tuberculosis Prevention in Africa
Publication Title: Differentiated HIV Service Delivery vs Conventional Care: Tuberculosis Preventive Therapy Outcomes for People Living With HIV in Sub-Saharan Africa
Summary
- Question
- This study examined the impact of differentiated service delivery (DSD) models versus conventional care on tuberculosis preventive therapy (TPT) outcomes among people living with HIV (PLHIV) in sub-Saharan Africa. The researchers aimed to determine whether DSD models affected TPT initiation and completion rates compared to traditional care.
- Why it Matters
Tuberculosis is a leading cause of death among PLHIV, and TPT is a critical, proven intervention to prevent TB in this population. Differentiated service delivery (DSD) models, which simplify and personalize HIV care by reducing clinic visits for stable patients, are expanding across sub-Saharan Africa. Understanding whether DSD models can effectively integrate TPT is essential for improving HIV care and reducing TB-related deaths, particularly in resource-limited settings.
- Methods
The researchers conducted a secondary analysis of data from the Opt4TPT study, a longitudinal cohort study in South Africa and Zimbabwe. They analyzed 1,193 PLHIV who were eligible for TPT, comparing outcomes between those receiving antiretroviral therapy (ART) through DSD models (n=276) and conventional care (n=917). TPT initiation, time to initiation, and TPT completion were assessed over a 24-month follow-up period using electronic medication monitoring for a subset of participants.
- Key Findings
- Among the participants, 87% initiated TPT, with similar initiation rates in DSD (88%) and conventional care (86%). However, DSD participants had a longer average time to initiation (6.5 days vs. 2.7 days). TPT completion rates were low overall (49%), with slightly higher completion in DSD models (57%) compared to conventional care (47%). After adjusting for factors like age, sex, and treatment regimen, there was no significant difference in TPT initiation or completion between DSD and conventional models.
- Implications
The findings suggest that DSD models are as effective as conventional care in initiating and delivering TPT to PLHIV. However, the low completion rates in both models highlight the need for targeted adherence interventions, such as enhanced patient education, reminders, and better alignment of TPT with existing HIV care schedules. These results support the feasibility of integrating TPT into DSD models as they continue to scale up.
- Next Steps
Future research should explore strategies to improve TPT completion rates, particularly in DSD models, and evaluate the effectiveness of supportive measures like multi-month medication dispensing, telephone reminders, and patient education. Studies should also investigate integrating other preventive and non-communicable disease treatments into DSD models to enhance comprehensive HIV care.
- Funding Information
This research was supported by the National Institutes of Health through awards TL1 TR001864, T32 GM136651, and D43 TW010540 (Global Health Emerging Scholars Program). Additional support was provided by the Bill and Melinda Gates Foundation (Investment number INV-006096).
Full Citation
Authors
Ann Johnson, BS, PhD
First AuthorClinical Fellow
Violet Chihota
Last Author
Additional Yale School of Medicine Authors
Other Authors
Research Themes
Concepts
- differentiated service delivery models;
- differentiated service delivery;
- tuberculosis preventive therapy;
- service delivery;
- RE-AIM framework;
- models of care;
- HIV service delivery;
- sub-Saharan Africa;
- longitudinal cohort study;
- multivariate logistic regression model;
- Cox proportional hazards models;
- logistic regression models;
- RE-AIM;
- provider visits;
- proportional hazards model;
- conventional care;
- higher odds;
- cohort study;
- bivariate analysis;
- hazards model;
- regression models;
- preventive therapy;
- clinical factors;
- care;
- HIV