Delivery of Community-based Antiretroviral Therapy to Maintain Viral Suppression and Retention in Care in South Africa

BACKGROUND: To determine whether the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program in South Africa’s differentiated ART delivery model impacts clinical outcomes, we assessed viral load (VL) suppression and retention in care between patients participating in the program compared to the clinic-based standard of care. METHODS: Clinically stable people living with HIV (PLHIV) eligible for differentiated care were referred to the national CCMDD program and followed for up to six months. In this secondary analysis of trial cohort data, we estimated the association between routine patient participation in the CCMDD program and their clinical outcomes of viral suppression (<200 copies/mL) and retention in care. RESULTS: Among 390 PLHIV, 236 (61%) were assessed for CCMDD eligibility, 144 (37%) were eligible, and 116 (30%) participated in CCMDD. Participants obtained their ART in a timely manner at 93% (265/286) of CCMDD visits. VL suppression and retention in care was very similar among CCMDD-eligible patients who participated in the program compared to patients who did not participate in the program (aRR: 1.03; 95% CI 0.94–1.12). VL suppression alone (aRR: 1.02; 95% CI 0.97–1.08) and retention in care alone (aRR: 1.03; 95% CI 0.95–1.12) were also similar between CCMDD-eligible PLHIV who participated in the program and those who did not. CONCLUSION: The CCMDD program successfully facilitated differentiated care among clinically stable participants. PLHIV participating in the CCMDD program maintained a high proportion of viral suppression and retention in care, indicating that community-based ART delivery model did not negatively impact their HIV care outcomes.