Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, South Africa.
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Glob Health Sci Pract. 2021 Jun 30;9(2):296-307. doi: 10.9745/GHSP-D-20-00532.
INTRODUCTION: Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. METHODS: We interviewed DSD model implementing organizations for descriptive information about each of the organization's models of care. We described the key characteristics of each model, including population of patients served, location of service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an "organization-model." RESULTS: The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel. CONCLUSIONS: As of 2019, there was a large variety of differentiated service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
简介:许多非洲国家正在扩大针对艾滋病毒治疗的差异化服务提供(DSD)模式,但大多数现有数据系统并未描述正在使用的模式。我们调查了 2019 年在马拉维、南非和赞比亚支持 DSD 模式的组织,以描述当时正在实施的 DSD 模式的多样性。
方法:我们采访了 DSD 模式实施组织,以获取有关每个组织护理模式的描述性信息。我们描述了每个模型的关键特征,包括服务的患者人群、服务提供地点、与患者互动的频率、配药时长以及涉及的提供者(医疗保健人员)。为了便于分析,我们将一个组织支持的一种护理模式称为“组织-模式”。
结果:34 名受访者(马拉维 8 名、南非 16 名、赞比亚 10 名)共描述了 110 个组织-模式,其中包括 19 个基于机构的个体模式、21 个非机构的个体模式、14 个由卫生保健工作者领导的小组和 3 个由患者领导的小组;这些共同涵盖了 12 种特定的服务提供策略,如多个月的配药、服药依从俱乐部、上门配送和医疗机构工作时间的改变。超过三分之二(n=78)的组织-模式仅适用于临床稳定的患者。几乎所有的组织-模式(n=96)都继续在既定的卫生保健设施中提供临床护理;药物取药在设施、外部取药点和服药依从俱乐部进行。每年所需的提供者互动次数差异很大,从 2 次到 12 次不等。配药间隔在马拉维和赞比亚通常为 3 或 6 个月,在南非为 2 个月。个体模式更多地依赖临床人员,而小组模式则更多地利用非专业人员。
结论:截至 2019 年,马拉维、南非和赞比亚提供的艾滋病毒治疗差异化服务模式种类繁多,服务对象包括不同的患者群体。
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