South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact

南非新的中央慢性药物配发和分配计划：评估诊所、患者和社区的影响

• 批准号: 10413904
• 负责人: Ingrid Valerie Bassett
• 金额: $ 64.35万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-26 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10413904
• 关键词: Adherence; Administrator; Adopted; Adoption; Africa South of the Sahara; African; Behavioral Sciences; Biometry; Caring; Characteristics; Chronic; Chronic Care; Church; Client; Clinic; Clinical; Cohort Studies; Communities; Congestive; Continuity of Patient Care; Country; Data; Drops; Effectiveness; Electronic Health Record; Enrollment; Epidemiology; Face; Goals; Government; HIV; HIV antiretroviral; Health; Health Expenditures; Health Personnel; Health care facility; Health system; Human immunodeficiency virus test; Improve Access; Individual; Interdisciplinary Study; Intervention; Life; Life Expectancy; Medicine; Methods; Modeling; Municipalities; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacy Schools; Play; Policies; Policy Maker; Population; Population Programs; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Prevalence; Privatization; Public Health; Public Sector; Qualitative Methods; Quality of Care; Recommendation; Research; Resource-limited setting; Role; Service delivery model; Services; Site; South Africa; South African; System; Testing; Time; Travel; Uninsured; Wait Time; antenatal; antiretroviral therapy; base; clinical practice; cohort; community based service; cost; density; design; expectation; flexibility; follow-up; home based service; implementation science; improved; innovation; interest; intervention delivery; prevent; programs; prospective; randomized trial; scale up; service delivery; service providers; transmission process; uptake

Project Summary Achieving the UNAIDS 90-90-90 target by 2020 in sub-Saharan Africa will require innovative solutions to meet the increasing demands placed on public health care facilities. With ART coverage in sub-Saharan Africa hovering around 50%, health systems face the dual challenge of increasing HIV testing and ART enrollment for those not yet in care and continuing to provide treatment to the millions of people already on ART. Community- based ART delivery is a potential strategy for maintaining long-term virologic suppression and retention in HIV care. South Africa’s new Central Chronic Medicine Dispensing and Distribution (CCMDD) program allows clinically stable patients to choose from a list of community pick-up points (e.g., private pharmacies, schools, churches) to access ART and therefore has the potential to offer more convenient services to patients and to decompress health facilities. The current proposal leverages this national policy change to assess the impact of this large scale service delivery intervention at the patient-, clinic-, and community-level over time in the high-density settlement of Umlazi in Durban, South Africa. Using a mixed-methods approach that incorporates the Practical, Robust Implementation and Sustainability Model (PRISM), we will comprehensively evaluate the impact of CCMDD at all 10 public sector clinics in Umlazi through the following specific aims: 1) To prospectively assess patient uptake of CCMDD and patient factors associated with favorable early clinical outcomes for CCMDD enrollees and to compare outcomes with non-enrollees; 2) To evaluate facilitators of and barriers to adoption of CCMDD by patients, clinic staff, and administrators using qualitative methods, and 3) To evaluate virologic suppression over time across all 10 public sector clinics in Umlazi using programmatic electronic health record data. This proposal is motivated by PA-17-182 to better understand system-level interventions using implementation science, which may increase the number of people consistently engaged in HIV care. We have played a major role for over a decade implementing and evaluating interventions along the HIV care continuum in South Africa and are well-positioned to evaluate the impact of this important policy change. Our results will inform clinical leaders and policymakers in high HIV prevalence settings developing community ART delivery systems that will enable life-long therapy for millions of people living with HIV. This research has the potential to change clinical practice throughout sub-Saharan Africa, where innovative and efficient approaches to long-term community-based HIV treatment delivery are urgently needed.

项目总结

项目成果

Uptake of community- versus clinic-based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa.

• DOI: 10.1002/jia2.25877
• 发表时间: 2022-01
• 期刊: Journal of the International AIDS Society
• 影响因子: 6
• 作者: Bassett IV;Yan J;Govere S;Khumalo A;Ngobese N;Shazi Z;Nzuza M;Bunda BA;Wara NJ;Stuckwisch A;Zionts D;Dube N;Tshabalala S;Bogart LM;Parker RA
• 通讯作者: Parker RA