Mokhele Idah, Ntjikelane Vinolia, Scott Nancy A, Kaiser Jeanette L, Morgan Allison Juntunen, Huber Amy, Mokgethi Nomcebo Oratile, Tchereni Timothy Henry, Phiri Wyness, Kamanga Aniset, Haimbe Prudence Michelo, Lumano-Mulenga Priscilla, Nyirenda Rose Kolola, Pascoe Sophie J S, Rosen Sydney
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Boston University School of Public Health, Boston, MA, USA.
Patient Prefer Adherence. 2025 Jun 25;19:1825-1841. doi: 10.2147/PPA.S494679. eCollection 2025.
Differentiated service delivery (DSD) models for antiretroviral therapy (ART) for HIV aim to increase patient-centeredness, a concept that incorporates patient choice of service delivery options. We explored choice in DSD model enrollment at 42 public sector clinics in Malawi, South Africa, and Zambia.
From 09/2022-05/2023, we surveyed people receiving HIV treatment to ask if they had a choice about DSD model enrollment and healthcare providers about their practices in offering choice. We estimated risk differences for ART clients' self-reported offer of choice and report risk differences. We thematically analyzed open-ended questions and report key themes.
We enrolled 1049 people receiving HIV treatment (Malawi 409, South Africa 362, Zambia 278) and 404 providers (Malawi 110, South Africa 175, Zambia 119). The proportion of study participants indicating that they had been offered a choice ranged from 4% in Malawi to 17% in Zambia to 47% in South Africa. Over 90% of people receiving HIV treatment in all three countries reported that they were happy to be enrolled in their current DSD model. Participants from urban (ARD 0.94 [0.90-0.99]) and medium-volume facilities (2000-4000 ART clients, 0.91 [0.84-0.98]) were slightly less likely to be offered DSD enrollment. Participants in community-based models 1.21 [1.12-1.30] and those satisfied with their current model 1.06 [1.01-1.13] were more likely to be offered a choice. Among providers, 64% in Malawi, 80% in South Africa, and 59% in Zambia said they offered clients the choice to enroll in DSD or remain in conventional care.
As of 2023, relatively few people receiving HIV treatment in Malawi, South Africa, and Zambia reported being offered a choice about enrolling in a DSD model, despite most providers reporting offering such a choice. The value of patient choice in improving clinical outcomes and satisfaction should be explored further.
用于治疗人类免疫缺陷病毒（HIV）的抗逆转录病毒疗法（ART）的差异化服务提供（DSD）模式旨在提高以患者为中心的程度，这一概念包含患者对服务提供选项的选择。我们在马拉维、南非和赞比亚的42家公共部门诊所探讨了DSD模式登记中的选择情况。
从2022年9月至2023年5月，我们对接受HIV治疗的人群进行了调查，询问他们在DSD模式登记方面是否有选择，同时也对医疗服务提供者提供选择的做法进行了调查。我们估计了ART患者自我报告的选择提供情况的风险差异，并报告了风险差异。我们对开放式问题进行了主题分析，并报告了关键主题。
我们纳入了1049名接受HIV治疗的患者（马拉维409名、南非362名、赞比亚278名）和404名医疗服务提供者（马拉维110名、南非175名、赞比亚119名）。表示自己有选择机会的研究参与者比例在马拉维为4%，在赞比亚为17%，在南非为47%。在这三个国家，超过90%接受HIV治疗的人报告说他们很高兴加入目前的DSD模式。来自城市地区（风险差异0.94 [0.90 - 0.99]）和中等规模设施（2000 - 4000名ART患者，0.91 [0.84 - 0.98]）的参与者被提供DSD登记的可能性略低。参与社区模式的参与者（1.21 [1.12 - 1.30]）以及对当前模式满意的参与者（1.06 [1.01 - 1.13]）更有可能被提供选择机会。在医疗服务提供者中，马拉维有64%、南非有80%、赞比亚有59%表示他们为患者提供了选择加入DSD或继续接受传统护理的机会。
截至2023年，在马拉维、南非和赞比亚，尽管大多数医疗服务提供者报告提供了这种选择，但报告称在DSD模式登记方面有选择机会的接受HIV治疗的人相对较少。应进一步探讨患者选择在改善临床结局和满意度方面的价值。
