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A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi

INTRODUCTION: Multimonth dispensing (MMD) of antiretroviral therapy (ART) is a differentiated model of care that can help overcome health system challenges and reduce the burden of HIV care on clients. Although 3-month dispensing has been the standard of care, interest has increased in extending ref...

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Autores principales: Hubbard, Julie, Phiri, Khumbo, Moucheraud, Corrina, McBride, Kaitlyn, Bardon, Ashley, Balakasi, Kelvin, Lungu, Eric, Dovel, Kathryn, Kakwesa, Gift, Hoffman, Risa M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Global Health: Science and Practice 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108939/
https://www.ncbi.nlm.nih.gov/pubmed/32015007
http://dx.doi.org/10.9745/GHSP-D-19-00286
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author Hubbard, Julie
Phiri, Khumbo
Moucheraud, Corrina
McBride, Kaitlyn
Bardon, Ashley
Balakasi, Kelvin
Lungu, Eric
Dovel, Kathryn
Kakwesa, Gift
Hoffman, Risa M.
author_facet Hubbard, Julie
Phiri, Khumbo
Moucheraud, Corrina
McBride, Kaitlyn
Bardon, Ashley
Balakasi, Kelvin
Lungu, Eric
Dovel, Kathryn
Kakwesa, Gift
Hoffman, Risa M.
author_sort Hubbard, Julie
collection PubMed
description INTRODUCTION: Multimonth dispensing (MMD) of antiretroviral therapy (ART) is a differentiated model of care that can help overcome health system challenges and reduce the burden of HIV care on clients. Although 3-month dispensing has been the standard of care, interest has increased in extending refill intervals to 6 months. We explored client and provider experiences with MMD in Malawi as part of a cluster randomized trial evaluating 3- versus 6-month ART dispensing. METHODS: Semi-structured in-depth interviews were conducted with 17 ART providers and 62 stable, adult clients with HIV on ART. Clients and providers were evenly divided by arm and were eligible for an interview if they had been participating in the study for 1 year (clients) or 6 months (providers). Questions focused on perceived challenges and benefits of the 3- or 6-month amount of ART dispensing. Interviews were transcribed, and data were coded and analyzed using constant comparison. RESULTS: Both clients and providers reported that the larger medication supply had benefits. Clients reported decreased costs due to less frequent travel to the clinic and increased time for income-generating activities. Clients in the 6-month dispensing arm reported a greater sense of personal freedom and normalcy. Providers felt that the 6-month dispensing interval reduced their workload. They also expressed concerned about clients' challenges with ART storage at home, but clients reported no storage problems. Although providers mentioned the potential risk of clients sharing the larger medication supply with family or friends, clients emphasized the value of ART and reported only rare, short-term sharing, mostly with their spouses. Providers mentioned clients' lack of motivation to seek care for illnesses that might occur between refill appointments. CONCLUSIONS: The 6-month ART dispensing arm was particularly beneficial to clients for decreased costs, increased time for income generation, and a greater sense of normalcy. Providers' concerns about storage, sharing, and return visits to the facility did not emerge in client interviews. Further data are needed on the feasibility of implementing a large-scale program with 6-month dispensing.
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spelling pubmed-71089392020-04-03 A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi Hubbard, Julie Phiri, Khumbo Moucheraud, Corrina McBride, Kaitlyn Bardon, Ashley Balakasi, Kelvin Lungu, Eric Dovel, Kathryn Kakwesa, Gift Hoffman, Risa M. Glob Health Sci Pract Original Articles INTRODUCTION: Multimonth dispensing (MMD) of antiretroviral therapy (ART) is a differentiated model of care that can help overcome health system challenges and reduce the burden of HIV care on clients. Although 3-month dispensing has been the standard of care, interest has increased in extending refill intervals to 6 months. We explored client and provider experiences with MMD in Malawi as part of a cluster randomized trial evaluating 3- versus 6-month ART dispensing. METHODS: Semi-structured in-depth interviews were conducted with 17 ART providers and 62 stable, adult clients with HIV on ART. Clients and providers were evenly divided by arm and were eligible for an interview if they had been participating in the study for 1 year (clients) or 6 months (providers). Questions focused on perceived challenges and benefits of the 3- or 6-month amount of ART dispensing. Interviews were transcribed, and data were coded and analyzed using constant comparison. RESULTS: Both clients and providers reported that the larger medication supply had benefits. Clients reported decreased costs due to less frequent travel to the clinic and increased time for income-generating activities. Clients in the 6-month dispensing arm reported a greater sense of personal freedom and normalcy. Providers felt that the 6-month dispensing interval reduced their workload. They also expressed concerned about clients' challenges with ART storage at home, but clients reported no storage problems. Although providers mentioned the potential risk of clients sharing the larger medication supply with family or friends, clients emphasized the value of ART and reported only rare, short-term sharing, mostly with their spouses. Providers mentioned clients' lack of motivation to seek care for illnesses that might occur between refill appointments. CONCLUSIONS: The 6-month ART dispensing arm was particularly beneficial to clients for decreased costs, increased time for income generation, and a greater sense of normalcy. Providers' concerns about storage, sharing, and return visits to the facility did not emerge in client interviews. Further data are needed on the feasibility of implementing a large-scale program with 6-month dispensing. Global Health: Science and Practice 2020-03-30 /pmc/articles/PMC7108939/ /pubmed/32015007 http://dx.doi.org/10.9745/GHSP-D-19-00286 Text en © Hubbard et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-19-00286
spellingShingle Original Articles
Hubbard, Julie
Phiri, Khumbo
Moucheraud, Corrina
McBride, Kaitlyn
Bardon, Ashley
Balakasi, Kelvin
Lungu, Eric
Dovel, Kathryn
Kakwesa, Gift
Hoffman, Risa M.
A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi
title A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi
title_full A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi
title_fullStr A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi
title_full_unstemmed A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi
title_short A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi
title_sort qualitative assessment of provider and client experiences with 3- and 6-month dispensing intervals of antiretroviral therapy in malawi
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108939/
https://www.ncbi.nlm.nih.gov/pubmed/32015007
http://dx.doi.org/10.9745/GHSP-D-19-00286
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