Location, dates, summary (Source)	Scope/scale; rural/urban	Optimisation component	Stratification metric	ARV distribution frequency, location, and provider	Monitoring and clinical care	Clinical metric: intervention vs. SOC for similar population * denotes significant at P < 0.05	Costs	System costs	Necessary supports
Centralised models
Kampala, Uganda 29. June 2006–July 2007 Monthly pickup of medication at pharmacy, where routine screening is completed. SOC is monthly visit to clinic with physician	578 in the intervention group. Urban	Health Service Provider	CD4 ≥ 200; ≥12 months of ART; self-reported adherence ≥95%; adherence to scheduled clinic visits for last 6 months; disclosed status to spouse; not pregnant; no substantial clinical event in last 6 months	Monthly in the pharmacy by a pharmacy-based nurse	Pharmacy-based nurse asked screening questions; Physician visit every 6 months	Favourable immune response after 1 year (CD4 ≥ 500): 18.9% vs. 19.6%; comparison group was a matched sample before PRP who were followed for at least 1 year after initiating ART		$496 per year vs. $610 per year Costs include: ART, other drugs, radiology, labs, health personnel, and overhead and capital
Decentralised models
Free State, South Africa 21 January 2008–June 2010 In one cohort (top row) ART initiation and management was completed in nurse-led primary care clinic. In the other cohort (bottom row) ART management provided in nurse-led primary care clinic. SOC is initiation and management at physician-led HIV clinic	Initiation and management 5390 Rural and Urban	Health Service Provider, Location	CD4 between 51 and 200; no Stage IV infection; no previous ART ≥1 month; no drugs other than cotrimoxazole or vitamins, not bed-or wheelchair bound; Weight>40 kg; BMI<28	Monthly in the primary care clinic by a nurse	Routine, not discussed in article; care provided in health centre by nurse	Mortality per 100 person years: 1.34 vs. 1.44 Programme retention: 63% vs. 58%* Random assignment by primary care clinic	Shorter commute to community clinic, not quantified in study		Significant training for nurses and nurse managers (4 sessions), plus 2.5 day train the trainer session
Management 3029 Rural and Urban	Health Service Provider, Location	Undetectable VL; no severe side effects; no new opportunistic infections	Monthly in a primary care clinic by a nurse	Routine, not discussed in article; care provided in health centre by nurse	Suppressed VL: 71% vs. 70% Programme retention: 90% vs. 91% Random assignment by primary care clinic	Shorter commute to community clinic, not quantified in study			Significant training for nurses and nurse managers (4 sessions), plus 2.5 day train the trainer session
South Africa (3), Malawi (1), Swaziland (1), Thailand (1)14 Study data range from 2004 through 2009 Partial decentralisation – treatment initiation in a hospital with follow-up care provided by a health centre	23 217 individuals decentralised; 15 980 in control; three studies focused only on adults, two on children, one on both Rural, peri-urban, and urban	Health Service Provider, Location	Varies, one study included only treatment naïve patients, three on stable patients with minimum time on ARV between 4 weeks and 11 months, and one with limited requirements	Studies did not vary frequency of care/ART distribution. Initiation was at the hospital by a doctor or clinical officer, while follow-up care provided at health centres by a nurse	Varies, but generally by nurse at health centre	Lost to care per 100 patient years: 7.4 vs. 13.4* Mortality per 100 patient years: 2.8 vs. 8.4* Note: these amounts are for 12-month follow-up of four of six studies. Account for nearly all participants. Two excluded studies are small and excluded b/c they do not provide 12-month time point
South Africa (1), Malawi (2), Ethiopia (2), Kenya, Mozambique, Rwanda, Tanzania, Lesotho 14 Study data range from 2004 through 2010 Full decentralisation – treatment initiation and management provided by health centre	20 448 individuals fully decentralised; 48 096 control; four studies focused only on adults, one only on children, and one on both All studies include rural patients, two include urban patients as well	Task shifting, location	Varies, most studies do not note exclusion criteria, one study required individuals to be on treatment for <6 months, another required treatment naïve patients	Studies did not vary frequency of care/ART distribution. Initiation and follow-up were performed at a primary health centre. All studies used nurses, two also used physicians, three used medical officers, and two used medical assistants	Varies, but generally by nurse at health centre	Lost to care per 100 patient years: 8.1 vs. 27.0* Mortality per 100 patient years: 10.6 vs. 9.7 Note: these amounts are for 12-month follow-up of four of six studies. Account for nearly all participants. Two excluded studies are small and excluded b/c they do not provide 12-month time point
Chiradzulu District, Malawi 18 January 2008–June 2013 Intervention group could pick up medication at health centre every 3 months. Clinic visits every 6 months. Care at health centre provided by CHW. SOC is clinic visit every 1–2 months	5 869 received intervention, which was 21% of active ART cohort; 2722 (33% of original enrollees) returned to standard clinical follow-up status. Rural	Health Service Provider, Frequency, Location	Stable adult patients - ≥15 on first-line ART for ≥12 months; CD4 ≥ 300; no OI or side effects; no pregnancy or breastfeeding	Clinic every 6 months vs. 1–2 months; 3-month ART refills at health centres by a community health worker	Monitored via standardised assessment tool at each visit; Clinic visits every 6 months	36-month Retention: 94% vs. 83% Lost to follow-up (1, 2, 5 years):– 1.3%, 2.98% and 7.8%; Mortality (1, 2 and 5 years) –. 4%,. 9% and 2.8%. Comparison with those eligible for but not enrolled in intervention			Paid community health workers; supply chain that can accommodate 3-month prescriptions
Lubombo, Swaziland 30 January 2007 –November 2007 Intervention group received care in primary care health clinic by nurse. SOC is monthly visit to central HIV clinic and receiving care from clinical officer	317 were included in the study of the 425 invited from the intervention clinic Rural	Health Service Provider, Location	≥14; on ART for ≥4 weeks; CD4 ≥ 100; clinically suitable	Monthly at primary care clinic by a counsellor and nurse evolving to primary care nurse and staff	Blood test, clinical questionnaire; care provided at health centre by nurses	No missed appointments - 89.6% vs. 72%* Loss to follow-up: 2.8% vs. 1.3% Mortality: 0 vs. 2.5%* Comparison population were individuals who would have been eligible for the study, but receive care from a different clinical area	Average cost of round trip transportation was halved ($.74 vs. $1.5); 53% of intervention group said transportation cost was lowered. Other benefits reported include being nearer to home, shorter waits, better treatment by staff, better care		Initial training of primary care team
South Africa 19,20 February 2008 through January 2009 (Study timeline, initiation intervention began in 2007) Care and medication distribution provided at nurse-led primary care clinic every 2 months. SOC is bi-monthly visits to HIV clinic with physician	693 in study, approximately 2000 in total down-referred. Urban	Health Service Provider, Location	ART≥11 months; no opportunistic infections; CD4 > 200; stable weight as reflected by <5% weight loss between the last three visits; VL undetectable	Every 2 months at the primary care clinic by a primary care nurse	Weight loss; symptoms other visit to medical facility; blood test every 6 months; care provided at primary care health centre by nurse	Mortality per 100 patient years:. 3 vs. 1.6*; Lost to follow-up: 1.4% vs. 4.2%* Matched cohort using propensity scores based on gender, age, months on ART, ARV regimen, BMI, CD4 count		Costs reduced by 11% – $492 pppy vs. 551. Cost-effectiveness increased: $509 to $602 per person in care and responding to treatment Costs included: ARVs, other drugs, labs, outpatient visits, fixed costs	EHR system that enables communication between clinic and initiation site; 6-week ART-specific training for primary care health nurses
Community and home-based models
Khayelitsha, South Africa 18,26 11/2007 – 6/2013 Medications distributed via community health worker-led 30 person support groups bi-monthly. SOC is monthly visits with medical staff	776 clubs have formed as of publication. 18 719 receiving care through the intervention, which is 19% of active ART cohort Urban	Health Service Provider, Location	Adult on 1st line for ≥18 months; two undetectable VL; CD4 > 200; Criteria for return to clinic care: Missed club visit (5 day grace) or clinically unstable including high VL	Every two months at meetings which take place either at clinic or community location, provided by community health workers	Bi-monthly weight, symptom based general assessments; attendance; nurse review twice per year (1 clinical, 1 blood test). Nurse attends meetings only during these sessions	Lost to care (including death, per 100 person years: 2.98 vs. 11.69* Virological rebound per 100 person years: 3.18 vs. 9.04* Comparison population had been on ARVs for a similar period of time	Shorter waiting times; higher acceptability of services; fewer missed appointments	$58 per year vs. $109 in SOC (unclear what is included, citation to a conference abstract)	Pharmacy staff to pre-package drugs for groups, well-trained lay-workers and support for lay-workers, registries
Kinshasa, Democratic Republic of the Congo 18 12/2010 – 5/2013 Medications distributed at community distribution points by peers every 3 months. SOC is visits to clinic (timing of SOC is not described.)	2161 referred to community ART distribution sites, which is 43% of active ART cohort Urban	Health Service Provider, Frequency (?), Location	On 1st line ART for ≥6 months; CD4 ≥ 350; no OI or side effects	Every 3 months at community ART distribution points by peers	Basic health indicators monitored by peer distributor; annual clinical consultation and blood test (CD4) at clinic	Retention at 12 months, 24 months: 89.3%, 82.4%; reported retention of 75–85% reported elsewhere Lost to follow-up at 24 months: 7.6%	Reduction from 85 to 14 min to refill prescription; Transportation costs cut to 1/3	HR costs lower, not quantified	Trained PLWH, supply chain that can support 3-month med delivery
Tete Province, Mozambique 18,25 2/2008 – 12/2012 PLWH form groups of six who share responsibility of picking up medications and distributing them to group monthly. SOC is monthly clinic visits by all	8181 receiving medication through CAGs in study, which is 50% of active ART cohort within demonstration programme; Overall, 17 272 receiving care this way countrywide, including 276 children. Rural	Frequency, Location	On 1st line ART for ≥6 months; CD4 ≥ 200; no OI or side effects	Monthly, in the community for 5 of 6 members, while one member attends clinic to pick up meds for the group	Clinic visit every 6 months, which includes clinical consultation and blood test (CD4); group card record keeping	Retention at 12, 24, 36, 48 months: 97.7%, 96%, 93.4%, 91.8%; Mortality per 100 person years: 2.1 LTFU per 100 person years: 1.0	Reduced costs and time burden on patients; 28% of members shared transportation costs	49.6% reduction in clinic visits, 62% reduction of ART refill visits	Lay Health Service Providers to ensure links between community groups and health facilities
Kosirai, Western Kenya 24 March 2006 – March 2007 CHWs deliver medications, screen, and provide adherence support monthly at home. SOC is monthly clinic visits served by full medical staff	100, 5% of active ART cohort in clinic that was studied. Rural	Health Service Provider, Location	≥18 years old; clinically stable on ART for ≥3 months; no adherence issues; household members aware of patients’ HIV status; no WHO stage 3 or 4 condition; no pregnancy; no hospitalisations	Monthly, in the home by community health workers with secondary education, training and PDA with decision support tools	CCC assessed patient symptoms (using PDA) vital signs, adherence to ART, and opportunistic infection prophylaxis. Clinical consultation every 3 months with nurse, physician, and pharmacist. Blood test every 6 months	LTFU: 5.2% vs. 4.5% No significant difference of results as compared to SOC. Comparison population was based on random sample	6.4 clinic visits vs. 12.6	Half the clinic visits	CCCs with secondary education and mobile, computer-based decision support tools
Karabole, Uganda 22 March 2006-May 2009 Weekly, home-based monitoring and adherence counselling and monthly ARV delivery by unpaid volunteers with 6-monthly appointments at the clinic vs. monthly hospital visits in the standard of care	185 enrolled in trial arm Rural	Health Service Provider, Frequency, Location	Eligible for treatment and willing to accept daily treatment support from a family member and weekly visits by a trained community volunteer	Monthly at home by trained community volunteers	Weekly monitoring by trained volunteers looking for adverse reactions, adherence (pill counts), and clinical problems. Six-monthly visits to clinic for blood work and clinical review. Health centre is staffed by two clinical officers, two nurses, and on midwife	Mortality: 17% vs. 12% VL suppression (ITT): 64.9% vs. 62.0% In multivariate analysis, the only factor significantly related to viral suppression was enrolment in home-based cohort. Odds ratio: 2.47 (1.02–6.04)			Clinic staff was trained on ART as part of the project; training for volunteers; boots, raincoats, bicycles for volunteers. Report forms for volunteers
Jinja, Uganda 23 February 2005 through January 2009 Home-based, monthly follow-up by trained field officers, with six-monthly clinic visits (after visits during months 2 and 6). SOC is 3-monthly visits with monthly ARV pickup	859 enrolled in trial arm Rural and semi-urban	Health Service Provider, Location	Anyone eligible for treatment within 100 km from the clinic	Monthly at home by trained field officers	Monthly monitoring at home, plus clinic visits at months 2, 6, and every 6 months thereafter	Virological failure, LTFU, or withdrew: 24% vs. 27% Mortality (24 months): 14% vs. 14%	First Year: 29 vs. 60 Second Year: 18 vs. 54 This includes transportation, lunch, childcare costs, and lost work time	$793 vs. $838 This includes staff, transport, drugs, labs, sensitisation, training, utilities, supervision and overheads, and capital. Main cause of higher costs of facility-based model is increased contacts with staff. Home-based patients had 75% fewer clinic visits	4 weeks of training for field officers over and above a college degree; motorcycles for field staff