Johnson Ann, Chimoyi Lucy, Charalambous Salome, Kawaza Nicole, Hoffmann Chris J, Davis J Lucian, Chihota Violet
Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA.
Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA.
medRxiv. 2025 Jan 15:2025.01.15.25320590. doi: 10.1101/2025.01.15.25320590.
Differentiated service delivery (DSD) models, which are mechanisms of HIV care that reduce provider visits and offer varied ART delivery methods, are scaling up across sub-Saharan Africa. It is unknown how the movement of patients to DSD models impacts services beyond ART, including the uptake and completion of tuberculosis preventive therapy (TPT).
Using the RE-AIM framework, we analyzed data from Opt4TPT, a longitudinal cohort study examining TPT delivery in South Africa and Zimbabwe. We constructed multivariate logistic regression models to evaluate the association of receiving ART from a DSD model with the proportion of participants who initiated and completed TPT, as measured by electronic medication boxes. We constructed a Cox proportional hazards model to assess the association between DSD models and time to TPT initiation.
Among 1193 participants, 276 received ART through a DSD model, while 917 used the conventional model. Overall, 1035 (87%) initiated TPT, including 242 (88%) in DSD models and 793 (86%) in conventional models. Receiving ART from a DSD model was not significantly associated (OR 1.11, 95% CI 0.74-1.67, p = 0.61) with TPT initiation. DSD models had a significantly longer mean time to initiation (6.5 vs. 2.7 days, p = 0.01). Of the 731 (71%) participants with MERM box data, 356 (49%) completed TPT. Bivariate analysis showed significantly higher odds of completing TPT among those in DSD models (OR 1.53, 95% CI 1.06-2.21, p=0.024). This association was not significant in multivariate analysis after adjusting for demographic and clinical factors (OR 0.89, 95% CI 0.58-1.36, p=0.58).
We found high TPT uptake in DSD and conventional models of care, indicating that TPT delivery in DSD models is feasible. We found low TPT completion in both models of care, showing a need to focus on improving TPT completion overall.
差异化服务提供（DSD）模式是一种艾滋病护理机制，可减少患者就诊次数并提供多种抗逆转录病毒治疗（ART）给药方式，目前正在撒哈拉以南非洲地区推广。尚不清楚患者转向DSD模式对ART以外的服务有何影响，包括结核病预防性治疗（TPT）的接受和完成情况。
我们使用RE-AIM框架，分析了Opt4TPT研究的数据，这是一项在南非和津巴布韦进行的关于TPT实施情况的纵向队列研究。我们构建了多变量逻辑回归模型，以评估从DSD模式接受ART与开始并完成TPT的参与者比例之间的关联，通过电子药盒进行测量。我们构建了Cox比例风险模型，以评估DSD模式与开始TPT的时间之间的关联。
在1193名参与者中，276人通过DSD模式接受ART，而917人使用传统模式。总体而言，1035人（87%）开始接受TPT，其中DSD模式中有242人（88%），传统模式中有793人（86%）。从DSD模式接受ART与开始TPT之间无显著关联（比值比1.11，95%置信区间0.74 - 1.67，p = 0.61）。DSD模式的平均开始时间显著更长（6.5天对2.7天，p = 0.01）。在有电子药盒数据的731名（71%）参与者中，356人（49%）完成了TPT。双变量分析显示，DSD模式下完成TPT的几率显著更高（比值比1.53，95%置信区间1.06 - 2.21，p = 0.024）。在调整人口统计学和临床因素后，多变量分析中这种关联不显著（比值比0.89，95%置信区间0.58 - 1.36，p = 0.58）。
我们发现DSD模式和传统护理模式中TPT的接受率都很高，这表明在DSD模式中实施TPT是可行的。我们发现两种护理模式下TPT的完成率都很低，这表明需要总体上专注于提高TPT的完成率。
