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Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini

INTRODUCTION: Universal access to antiretroviral therapy (ART) is a cornerstone of Eswatini’s national HIV strategy, and the number of people on ART in the country more than tripled between 2010 and 2019. Building on these achievements, the Ministry of Health (MOH) is scaling up differentiated servi...

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Autores principales: Reidy, William, Kambale, Hervé Nzereka, Hughey, Allison B., Nhlengethwa, Tengetile Tezzy, Tailor, Janki, Lukhele, Nomthandazo, Mthethwa, Simangele, Hettema, Anita, Preko, Peter, Rabkin, Miriam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132331/
https://www.ncbi.nlm.nih.gov/pubmed/35613146
http://dx.doi.org/10.1371/journal.pone.0269020
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author Reidy, William
Kambale, Hervé Nzereka
Hughey, Allison B.
Nhlengethwa, Tengetile Tezzy
Tailor, Janki
Lukhele, Nomthandazo
Mthethwa, Simangele
Hettema, Anita
Preko, Peter
Rabkin, Miriam
author_facet Reidy, William
Kambale, Hervé Nzereka
Hughey, Allison B.
Nhlengethwa, Tengetile Tezzy
Tailor, Janki
Lukhele, Nomthandazo
Mthethwa, Simangele
Hettema, Anita
Preko, Peter
Rabkin, Miriam
author_sort Reidy, William
collection PubMed
description INTRODUCTION: Universal access to antiretroviral therapy (ART) is a cornerstone of Eswatini’s national HIV strategy, and the number of people on ART in the country more than tripled between 2010 and 2019. Building on these achievements, the Ministry of Health (MOH) is scaling up differentiated service delivery, including less-intensive differentiated ART (DART) models for people doing well on treatment. We conducted a mixed-methods study to explore client and health care worker (HCW) perceptions of DART in Eswatini. METHODS: The study included structured site assessments at 39 purposively selected health facilities (HF), key informant interviews with 20 HCW, a provider satisfaction survey with 172 HCW and a client satisfaction survey with 270 adults. RESULTS: All clients had been on ART for more than a year; 69% were on ART for ≥ 5 years. The most common DART models were Fast-Track (44%), Outreach (26%) and Community ART Groups (20%). HCW and clients appreciated DART, noting that the models often decrease provider workload and client wait time. Clients also reported that DART models helped them to adhere to ART, 96% said they were “very satisfied” with their current model, and 90% said they would recommend their model to others, highlighting convenience, efficiency and cost savings. The majority of HCW (52%) noted that implementation of DART reduced their workload, although some models, such as Outreach, were more labor-intensive. Each model had advantages and disadvantages; for example, clients concerned about stigma and inadvertent disclosure of HIV status were less interested in group models. CONCLUSIONS: Clients in DART models were very satisfied with their care. HCW were also supportive of the new approach to HIV treatment delivery, noting its advantages to HF, HCW and to clients. Given the heterogeneous needs of people living with HIV, no single DART model will suit every client; a diverse portfolio of DART models is likely the best strategy.
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spelling pubmed-91323312022-05-26 Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini Reidy, William Kambale, Hervé Nzereka Hughey, Allison B. Nhlengethwa, Tengetile Tezzy Tailor, Janki Lukhele, Nomthandazo Mthethwa, Simangele Hettema, Anita Preko, Peter Rabkin, Miriam PLoS One Research Article INTRODUCTION: Universal access to antiretroviral therapy (ART) is a cornerstone of Eswatini’s national HIV strategy, and the number of people on ART in the country more than tripled between 2010 and 2019. Building on these achievements, the Ministry of Health (MOH) is scaling up differentiated service delivery, including less-intensive differentiated ART (DART) models for people doing well on treatment. We conducted a mixed-methods study to explore client and health care worker (HCW) perceptions of DART in Eswatini. METHODS: The study included structured site assessments at 39 purposively selected health facilities (HF), key informant interviews with 20 HCW, a provider satisfaction survey with 172 HCW and a client satisfaction survey with 270 adults. RESULTS: All clients had been on ART for more than a year; 69% were on ART for ≥ 5 years. The most common DART models were Fast-Track (44%), Outreach (26%) and Community ART Groups (20%). HCW and clients appreciated DART, noting that the models often decrease provider workload and client wait time. Clients also reported that DART models helped them to adhere to ART, 96% said they were “very satisfied” with their current model, and 90% said they would recommend their model to others, highlighting convenience, efficiency and cost savings. The majority of HCW (52%) noted that implementation of DART reduced their workload, although some models, such as Outreach, were more labor-intensive. Each model had advantages and disadvantages; for example, clients concerned about stigma and inadvertent disclosure of HIV status were less interested in group models. CONCLUSIONS: Clients in DART models were very satisfied with their care. HCW were also supportive of the new approach to HIV treatment delivery, noting its advantages to HF, HCW and to clients. Given the heterogeneous needs of people living with HIV, no single DART model will suit every client; a diverse portfolio of DART models is likely the best strategy. Public Library of Science 2022-05-25 /pmc/articles/PMC9132331/ /pubmed/35613146 http://dx.doi.org/10.1371/journal.pone.0269020 Text en © 2022 Reidy et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Reidy, William
Kambale, Hervé Nzereka
Hughey, Allison B.
Nhlengethwa, Tengetile Tezzy
Tailor, Janki
Lukhele, Nomthandazo
Mthethwa, Simangele
Hettema, Anita
Preko, Peter
Rabkin, Miriam
Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini
title Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini
title_full Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini
title_fullStr Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini
title_full_unstemmed Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini
title_short Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini
title_sort client and healthcare worker experiences with differentiated hiv treatment models in eswatini
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132331/
https://www.ncbi.nlm.nih.gov/pubmed/35613146
http://dx.doi.org/10.1371/journal.pone.0269020
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