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Impact of offering differentiated HIV care on treatment retention and health facility workload: Results from Kenya health zone in the Democratic Republic of Congo
Abstract Content:
Background: Implementation of
test-and-treat in the Democratic Republic of Congo (DRC) has resulted in more
people living with HIV (PLHIV) accessing treatment services at health
facilities, overwhelming facility workforce and increasing wait times for
PLHIV, leading to weaker retention of PLHIV in treatment. PATH, through the
USAID-funded Integrated HIV/AIDS Project in the DRC, piloted three differentiated
models of care (DMC). We conducted an analysis to evaluate the impact of DMC on
antiretroviral treatment (ART) retention and health facility workload.
Methods: Beginning October 2016, three DMC were implemented to decongest the Kenya General Reference Hospital (HGR):
1. ART distribution during monthly meetings at six PLHIV support groups
2. Community-based point of ART distribution (PoDi+)
3. Fast-track ART refill circuit at Kenya HGR
Stable PLHIV (older than 18 years; no opportunistic infections; not pregnant; undetectable viral load for at least six months) enrolled in a DMC of their choice and received a three-month ART supply. We used descriptive statistics to analyze patient medical records data.
Results: From October 2016 to December 2017, 938 PLHIV from Kenya HGR enrolled in a DMC: 576 in a PoDi+; 313 in the fast-track circuit; and 49 in support groups. The six-month retention rate observed at each DMC was 96% at the PoDi+, 96% at the fast-track circuit, and 94% among support groups, compared to 60% at Kenya HGR for the same period. The only model with 12 months of data (see table), the PoDi+, achieved a 12-month retention rate of 98%, as 22 of the 28 dropped from the PoDi+ were transferred back to Kenya HGR for treatment services due to pregnancy or opportunistic infections. There was a 47% reduction in provider workload at Kenya HGR, from 404 PLHIV/provider before DMC to 217 PLHIV/provider after DMC, and a decrease in wait time at Kenya HGR from two hours to 45 minutes.
Conclusions: Our analysis demonstrated that DMC were successful strategies for improving retention in treatment and reducing provider workload and wait times at Kenya HGR. Results suggest DMC are critical to increasing PLHIV retention in ART to contribute to epidemic control in the DRC.
[12-month retention of patients enrolled at Kenya PoDi+ from October 2016 to January 2017.]
Methods: Beginning October 2016, three DMC were implemented to decongest the Kenya General Reference Hospital (HGR):
1. ART distribution during monthly meetings at six PLHIV support groups
2. Community-based point of ART distribution (PoDi+)
3. Fast-track ART refill circuit at Kenya HGR
Stable PLHIV (older than 18 years; no opportunistic infections; not pregnant; undetectable viral load for at least six months) enrolled in a DMC of their choice and received a three-month ART supply. We used descriptive statistics to analyze patient medical records data.
Results: From October 2016 to December 2017, 938 PLHIV from Kenya HGR enrolled in a DMC: 576 in a PoDi+; 313 in the fast-track circuit; and 49 in support groups. The six-month retention rate observed at each DMC was 96% at the PoDi+, 96% at the fast-track circuit, and 94% among support groups, compared to 60% at Kenya HGR for the same period. The only model with 12 months of data (see table), the PoDi+, achieved a 12-month retention rate of 98%, as 22 of the 28 dropped from the PoDi+ were transferred back to Kenya HGR for treatment services due to pregnancy or opportunistic infections. There was a 47% reduction in provider workload at Kenya HGR, from 404 PLHIV/provider before DMC to 217 PLHIV/provider after DMC, and a decrease in wait time at Kenya HGR from two hours to 45 minutes.
Conclusions: Our analysis demonstrated that DMC were successful strategies for improving retention in treatment and reducing provider workload and wait times at Kenya HGR. Results suggest DMC are critical to increasing PLHIV retention in ART to contribute to epidemic control in the DRC.
| Month of enrollment | Patients newly enrolled at PoDi+ | Number retained after six months | Retention rate at six months (%) | Number retained after twelve months | Retention rate at twelve months (%) |
| October 2016 | 125 | 115 | 92% | 110 | 88% |
| November 2016 | 87 | 86 | 99% | 81 | 93% |
| December 2016 | 74 | 73 | 99% | 68 | 92% |
| January 2017 | 38 | 36 | 95% | 37 | 97% |
| 324 | 310 | 96% | 296 | 91% |