Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery models in South Africa
Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery models in South Africa
复制标题
DOI：
10.1371/journal.pmed.1002874
复制
发表时间：
2019-07-01
期刊：
影响因子：
15.8
通讯作者：
Fraser-Hurt, Nicole
中科院分区：
文献类型：
--
作者：
Fox, Matthew P.;Pascoe, Sophie;Fraser-Hurt, Nicole
背景不同的抗逆转录病毒疗法（ART）提供模式，其中向患者提供与其当前状态相关的护理（例如，新开始、治疗稳定或治疗不稳定）已经成为以患者为中心的卫生系统的重要组成部分。2015年，南非政府实施了慢性病依从性指南（AGL），其中涉及五项干预措施：针对新启动患者的快速启动咨询，针对病毒载量未受抑制的患者的增强依从性咨询，错过访视的患者的早期追踪，以及针对稳定患者的依从性俱乐部（AC）和分散式药物交付（DMD）。我们评估了这些干预措施中的两个在24个南非设施：AC，在这种情况下，患者在通常的诊所程序之外的群体中见面，并接受药物治疗;和DMD，在这种情况下，患者在通常的药房队列之外领取药物。方法和findingsWe比较了那些参与AC或接受DMD在干预网站的那些有资格为AC或DMD在控制网站。结果是保留和持续的病毒抑制（
BackgroundDifferentiated antiretroviral therapy (ART) delivery models, in which patients are provided with care relevant to their current status (e.g., newly initiating, stable on treatment, or unstable on treatment) has become an essential part of patient-centered health systems. In 2015, the South African government implemented Chronic Disease Adherence Guidelines (AGLs), which involved five interventions: Fast Track Initiation Counseling for newly initiating patients, Enhanced Adherence Counseling for patients with an unsuppressed viral load, Early Tracing of patients who miss visits, and Adherence Clubs (ACs) and Decentralized Medication Delivery (DMD) for stable patients. We evaluated two of these interventions in 24 South African facilities: ACs, in which patients meet in groups outside usual clinic procedures and receive medication; and DMD, in which patients pick up their medication outside usual pharmacy queues.Methods and findingsWe compared those participating in ACs or receiving DMD at intervention sites to those eligible for ACs or DMD at control sites. Outcomes were retention and sustained viral suppression (