Eluwa George Ikechi Emmanuel, Geibel Scott, Callens Steven, Vu Lung, Iyortim Isa
Health Research and Policy, Diadem Consults Initiative, No.4, Ikole St, Area 11, Garki, Abuja, Nigeria.
Population Council, HIV/AIDS, Washington, D.C., USA.
BMC Public Health. 2025 Mar 19;25(1):1066. doi: 10.1186/s12889-025-21630-w.
Differentiated Service Delivery models (DSD) that cater to the needs of key populations (KP) have shown promise in providing KP-sensitive and KP-tailored care and treatment services. We evaluated the effect of two DSD models on linkage to and retention in treatment in Nigeria.
Between December 2017 and June 2018, newly-diagnosed men who have sex with men (MSM) and female sex workers (FSWs) were enrolled into treatment through two DSD models and followed prospectively for one year. Model 1 was a fully integrated one-stop-shop (OSS) while model 2 was a hybrid HIV prevention and treatment site (DIC). Retention was estimated from drug pick-up records and was defined as being on treatment within 90 days one-year post ART initiation. Cox regression was used to identify the independent effect of the DSD models on retention while probability of being retained in treatment at 1-year was estimated with Kaplan-Meier product limit.
A total of 605 newly-diagnosed clients were enrolled into the study (340 in OSS and 265 in DIC; 342 were FSWs, while 263 were MSM). Median age was 26 years for MSM and 30 years for FSWs. Among those linked to treatment, retention was higher in the OSS than in DIC (63% vs. 48%; p = 0.002). Among those not retained, mean days to be lost-to-follow up (LFTU) was 60 days. Controlling for educational level, population type and age, clients who received treatment in M2 were 6 times more likely not to be retained in treatment at the end of 1 year (Hazard ratio 5.89; 95% CI: 1.04-33.16). The Kaplan Meier estimates of the probability of being retained in 6 months, 9 months and 12 months was 0.97, 0.92, 0.80 for the DIC and 1.00, 0.96, 0.91 for the OSS.
Linkage to treatment was suboptimal across both models with less than 90% of newly-diagnosed positives initiated on treatment and suggests that facilitated linkage is required to achieve at least 95%. Though retention was higher in the OSS model, both models had an alarmingly short time frame for LTFU and thus intensive monitoring during this phase of treatment is recommended irrespective of the type of DSD. Addressing these gaps will improve service delivery by one stop shops for HIV care and treatment.
针对关键人群需求的差异化服务提供模式（DSD）在提供针对关键人群且量身定制的护理和治疗服务方面已展现出前景。我们评估了两种DSD模式对尼日利亚治疗衔接和留存率的影响。
在2017年12月至2018年6月期间，通过两种DSD模式将新诊断的男男性行为者（MSM）和女性性工作者（FSW）纳入治疗，并进行为期一年的前瞻性随访。模式1是完全整合的一站式服务（OSS），而模式2是艾滋病预防与治疗混合站点（DIC）。根据药物领取记录估算留存率，定义为在启动抗逆转录病毒治疗（ART）后一年内90天内接受治疗。使用Cox回归确定DSD模式对留存率的独立影响，同时用Kaplan-Meier乘积限估计1年时继续接受治疗的概率。
共有605名新诊断的患者纳入研究（OSS组340名，DIC组265名；FSW有342名，MSM有263名）。MSM的中位年龄为26岁，FSW为30岁。在那些与治疗衔接的患者中，OSS组的留存率高于DIC组（63%对48%；p = 0.002）。在未留存的患者中，失访（LFTU）的平均天数为60天。在控制教育水平、人群类型和年龄后，在模式2接受治疗的患者在1年末继续接受治疗的可能性低6倍（风险比5.89；95%置信区间：1.04 - 33.16）。DIC组在6个月、9个月和12个月时继续接受治疗概率的Kaplan Meier估计值分别为0.97、0.92、0.80，OSS组分别为1.00、0.96、0.91。
两种模式下的治疗衔接均未达到最佳状态，新诊断的阳性患者中不到90%开始接受治疗，这表明需要提供便利的衔接措施以实现至少95%的衔接率。尽管OSS模式的留存率更高，但两种模式的失访时间框架都短得惊人，因此无论DSD类型如何，在此治疗阶段都建议进行强化监测。解决这些差距将改善一站式艾滋病护理和治疗服务的提供。
