Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia.
Department of Public Health Emergency Management, South Ethiopia Region Public Health Institute, Jinka, Ethiopia.
PLoS One. 2024 Sep 12;19(9):e0310400. doi: 10.1371/journal.pone.0310400. eCollection 2024.
Differentiated service delivery models have been developed to accommodate the rising number of stable antiretroviral therapy clients and to maintain improvements in health outcomes and care retention. Ethiopia adopted the appointment spacing model and has had notable successes in implementing it. However, with the implementation of the six multi-month scripting/appointment spacing model in Ethiopia, little is known about the uptake and its associated factors. Therefore, this study aimed to assess the uptake and associated factors of the six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia.
A hospital-based cross-sectional study was conducted among 419 stable clients on antiretroviral therapy in southern Ethiopia from June 22 to September 29, 2023. A systematic sampling technique was used to select the study participants. Using a structured questionnaire, socio-demographic, health service delivery, behavioral, and clinical-related data were collected. The collected data were entered into Epi Data version 3.1 and analyzed using Stata version 14. Variables with a P-value <0.05 in the multivariable logistic analysis were considered statistically significant. Multicollinearity and model fitness were checked using the variance inflation factor and the Hosmer and Lemeshow goodness of fit tests, respectively.
The uptake of the six multi-month scripting/appointment spacing differentiated service delivery model of care was 63.25% (95% confidence interval (CI): 58.61%, 67.88%). Missed appointment (Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.13, 3.25)), distance to antiretroviral therapy facility (AOR: 2.90 (95% CI: 1.67, 5.04)), duration on antiretroviral therapy (AOR: 2.21 (95% CI: 1.34, 3.64)), and intermediate social support (AOR: 2.02 (95% CI: 1.29, 3.17)) and strong social support (AOR: 2.71 (95% CI: 1.23, 5.97)) were factors significantly associated with the uptake.
The uptake of six multi-month scripting/appointment spacing differentiated service delivery models of care was six out of ten clients on antiretroviral therapy. To further improve the uptake, a precise intervention on the identified associated factor is required.
为了满足越来越多稳定接受抗逆转录病毒治疗的患者的需求，并保持健康结果和护理保留率的改善，已经开发了差异化服务交付模式。埃塞俄比亚采用了预约间隔模式，并在实施方面取得了显著成功。然而，随着埃塞俄比亚实施六个月多脚本/预约间隔差异化服务交付模式，对于该模式的采用情况及其相关因素知之甚少。因此，本研究旨在评估南部埃塞俄比亚稳定接受抗逆转录病毒治疗的患者对六个月多脚本/预约间隔差异化服务交付模式的采用情况及其相关因素。
这是一项在 2023 年 6 月 22 日至 9 月 29 日期间在埃塞俄比亚南部的 419 名稳定接受抗逆转录病毒治疗的患者中进行的基于医院的横断面研究。采用系统抽样技术选择研究参与者。使用结构化问卷收集社会人口统计学、卫生服务提供、行为和临床相关数据。收集的数据输入 EpiData 版本 3.1，并使用 Stata 版本 14 进行分析。多变量逻辑分析中 P 值<0.05 的变量被认为具有统计学意义。使用方差膨胀因子和 Hosmer 和 Lemeshow 拟合优度检验分别检查多重共线性和模型拟合情况。
六个月多脚本/预约间隔差异化服务交付模式的采用率为 63.25%（95%置信区间（CI）：58.61%，67.88%）。错过预约（调整后的优势比（AOR）：1.91（95%CI：1.13，3.25））、抗逆转录病毒治疗机构的距离（AOR：2.90（95%CI：1.67，5.04））、抗逆转录病毒治疗持续时间（AOR：2.21（95%CI：1.34，3.64））和中等社会支持（AOR：2.02（95%CI：1.29，3.17））和强社会支持（AOR：2.71（95%CI：1.23，5.97））是与采用率显著相关的因素。
在接受抗逆转录病毒治疗的患者中，有十分之六采用了六个月多脚本/预约间隔差异化服务交付模式。为了进一步提高采用率，需要针对已确定的相关因素进行精确干预。
