Exploring sustainability in the era of differentiated HIV service delivery in Sub-Saharan Africa: a systematic review
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Introduction:
The World Health Organization recommends differentiated service delivery (DSD) to support resource-limited health systems in providing patient-centered HIV care. DSD offers alternative care models to clinic-based care for people living with HIV (PLHIV) who are stable on antiretroviral therapy (ART). Despite good patient-related outcomes, there is limited evidence of their sustainability. Our review evaluated the reporting of sustainability indicators of DSD interventions conducted in sub-Saharan Africa (SSA).
Methods:
We searched PubMed and EMBASE for studies conducted between 2000-2019 assessing DSD interventions targeting HIV-positive individuals who are established in ART in SSA. We evaluated them through a comprehensive sustainability framework of constructs categorized into six domains (intervention design, process, external environment, resources, organizational setting, and people involvement). We scored each construct 1, 2, or 3 for no, partial, or sufficient level of evidence, respectively. Interventions with a calculated sustainability score (overall and domain-specific) of >90% or domain-specific median score >2.7 were considered likely to be sustainable.
Results:
Overall scores ranged from 69% to 98%. Top scoring intervention types included adherence clubs (98%) and community ART groups (95%) which comprised more than half of interventions. The highest scoring domains were design (2.9) and organizational setting (2.8). The domains of resources (2.4) and people involvement (2.3) scored lowest revealing potential areas for improvement to support DSD sustainability.
Conclusions:
With the right investment in stakeholder involvement and domestic funding, DSD models generally show potential for sustainability. Our results could guide informed decisions on which DSD intervention is likely to be sustainable per setting and highlight areas that could motivate further research.
PROSPERO Number:
CRD42019120891
The World Health Organization recommends differentiated service delivery (DSD) to support resource-limited health systems in providing patient-centered HIV care. DSD offers alternative care models to clinic-based care for people living with HIV (PLHIV) who are stable on antiretroviral therapy (ART). Despite good patient-related outcomes, there is limited evidence of their sustainability. Our review evaluated the reporting of sustainability indicators of DSD interventions conducted in sub-Saharan Africa (SSA).
Methods:
We searched PubMed and EMBASE for studies conducted between 2000-2019 assessing DSD interventions targeting HIV-positive individuals who are established in ART in SSA. We evaluated them through a comprehensive sustainability framework of constructs categorized into six domains (intervention design, process, external environment, resources, organizational setting, and people involvement). We scored each construct 1, 2, or 3 for no, partial, or sufficient level of evidence, respectively. Interventions with a calculated sustainability score (overall and domain-specific) of >90% or domain-specific median score >2.7 were considered likely to be sustainable.
Results:
Overall scores ranged from 69% to 98%. Top scoring intervention types included adherence clubs (98%) and community ART groups (95%) which comprised more than half of interventions. The highest scoring domains were design (2.9) and organizational setting (2.8). The domains of resources (2.4) and people involvement (2.3) scored lowest revealing potential areas for improvement to support DSD sustainability.
Conclusions:
With the right investment in stakeholder involvement and domestic funding, DSD models generally show potential for sustainability. Our results could guide informed decisions on which DSD intervention is likely to be sustainable per setting and highlight areas that could motivate further research.
PROSPERO Number:
CRD42019120891
Date Issued
2021-08-01
Date Acceptance
2021-03-01
Citation
JAIDS: Journal of Acquired Immune Deficiency Syndromes, 2021, 87 (4), pp.1055-1071
ISSN
1525-4135
Publisher
Lippincott, Williams & Wilkins
Start Page
1055
End Page
1071
Journal / Book Title
JAIDS: Journal of Acquired Immune Deficiency Syndromes
Volume
87
Issue
4
Copyright Statement
© 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0
(CCBY-NC-ND), where it is permissible to download and share the
work provided it is properly cited. The work cannot be changed in any
way or used commercially without permission from the journal.
This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0
(CCBY-NC-ND), where it is permissible to download and share the
work provided it is properly cited. The work cannot be changed in any
way or used commercially without permission from the journal.
Identifier
https://journals.lww.com/jaids/Abstract/9000/Exploring_sustainability_in_the_era_of.95903.aspx
Subjects
Virology
1103 Clinical Sciences
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2021-03-23