Table 2. Description of models and sample included in each study.
| Model name | Description of model | Number
of model participants in study |
%
retained at 12 months |
Location | Refill duration | Approach | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Facility | Community | 1-2 mos | 3 mos | 6 mos | Individual | Group | ||||
| Lesotho | ||||||||||
| Facility enhanced
conventional care †† |
Standard facility-based care with 4 visits/year
and 3-month refills |
1,898 | 97.1% | ✓ | ✓ | ✓ | ||||
| Community ART groups
with 3-month refills (CAGs) |
Group of 6-12 patients in same geographic
area; groups meet 4 times/year in community, with 1 member collecting medications for all members from clinic once/quarter and 3-month refills |
1,558 | 96.5% | ✓ | ✓ | ✓ | ||||
| Community distribution
points with 6-month refills |
6-month dispensing alternating between
clinic and community pickup point; 1 clinic visit + 1 pickup point visit/year |
1,880 | 94.7% | ✓ | ✓ | ✓ | ||||
| Malawi | ||||||||||
| Facility conventional care | Standard of care; dispensing intervals varied
with provider’s discretion, availability of stock, etc. from 1-3 months, with 4-12 clinic visits/year. |
1,532 | 89.7% | ✓ | ||||||
| Facility dispensing with
3-month refills |
Patients consistently received 3-month
supplies of ARVs, with 4 clinic visits/year. No other changes to model of care. |
1,430 | 90.2% | ✓ | ✓ | ✓ | ||||
| Facility dispensing with
6-month refills |
Patients consistently received 6-month
supplies of ARVs, with 2 clinic visits/year. No other changes to model of care. |
1,588 | 93.2% | ✓ | ✓ | ✓ | ||||
| Uganda * | ||||||||||
| Facility conventional care | Standard of care referred to as “Facility-
based individual model”; generally required 4 clinic visits/year with varying dispensing intervals. Note: This was considered a differentiated model for new and complicated patients but continued to function as conventional care for patients not in other models |
128 | 97%
(88% *) |
✓ | ✓ | ✓ | ||||
| Facility-based groups | Groups of patients requiring additional care
or adherence support, with varying numbers of visits and dispensing intervals. ** |
129 | 96%
(94%) |
✓ | ✓ | ✓ | ||||
| Fast-track drug refills | Accelerated medication pickup at facilities
for stable first- and second-line patients; varying dispensing intervals. |
133 | 99%
(90%) |
✓ | ✓ | ✓ | ✓ | |||
| Client-led ART delivery
(CAGs) |
Groups of stable patients meet in the
community, with 1 member collecting medications from the clinic for all members; varying frequency of meetings and dispensing intervals. |
131 | 98%
(90%) |
✓ | ✓ | ✓ | ✓ | |||
| Community drug
distribution points |
Stable patients pick up medications from
a community location, including private pharmacies; dispensing intervals varied but most patients had 1 clinic visit and 6 medication pickup interactions per year. |
132 | 100%
(92%) |
✓ | ✓ | ✓ | ||||
| Zambia 1 (observational) | ||||||||||
| Facility conventional care | Standard of care; generally requires 4 full
clinic visits/year with 1-3 month dispensing intervals. For study, selected a matched sample of DSD model-eligible patients not enrolled in DSD models. |
1,174 | 80.7% | ✓ | ✓ | ✓ | ||||
| Community adherence
groups (CAGs) |
Group of approximately 6 patients meet
monthly in the community; 1 member collects medications for all members. 2 full clinic visits/year. |
754 | 83.2% | ✓ | ✓ | ✓ | ||||
| Urban adherence groups | Group of 20-30 patients meet as a group at
clinic to receive services every 2-3 months. Urban areas only. |
193 | 94.8% | ✓ | ✓ | ✓ | ||||
| Home ART delivery | Community health workers visit patients’
homes to deliver medications and monitor treatment. 2 full clinic visits/year. Rural areas only. |
169 | 79.3% | ✓ | ✓ | ✓ | ||||
| Mobile ART services † | Clinical team from district hospital visits
rural health posts every 2 weeks to provide services. Requires 6 patient interactions/ year. |
216 | 68.5% | ✓ | ✓ | ✓ | ||||
| Zambia 2 | ||||||||||
| Facility conventional care | Standard of care; dispensing intervals vary
with provider’s discretion, availability of stock, etc. from 1-3 months, with 4-12 clinic visits/year. |
1,480 | 74.6% | ✓ | ✓ | ✓ | ||||
| Facility dispensing with
3-month refills |
Patients consistently receive 3-month
supplies of ARVs, with 4 clinic visits/year. No other changes to model of care. |
1,296 | 82.3% | ✓ | ✓ | ✓ | ||||
| Facility dispensing with
6-month refills |
Patients consistently receive 6-month
supplies of ARVs, with 2 clinic visits/year. No other changes to model of care. |
1,393 | 89.7% | ✓ | ✓ | ✓ | ||||
| Zimbabwe | ||||||||||
| Facility enhanced
conventional care †† |
Standard facility-based care with 4 clinic
visits/year and 3-month refills |
1,919 | 93.0% | ✓ | ✓ | ✓ | ||||
| Community ART groups
with 3-month refills |
Group of 6–12 patients in same geographic
area; groups met 4 times/year in community, with 1 member collecting medications for all members from clinic once/quarter and 3- month refills; 1 annual clinical consultation/ year on same day for entire group. |
1,335 | 94.8% | ✓ | ✓ | ✓ | ||||
| Community ART groups
with 6-month refills |
Group of 6–12 patients in same geographic
area; groups met 4 times/year in community, with 1 member collecting medications for all members from clinic once/quarter and 6- month refills; 1 annual clinical consultation/ year on same day for entire group. |
1,546 | 95.5% | ✓ | ✓ | ✓ | ||||
*Uganda results reported were from the second 12-month observation period (months 13–24 reported in published paper). Outcome in parentheses is viral suppression.
** Facility groups included in study were for pregnant and post-partum women only.
†Model includes newly-initiated patients; outcomes reflect high early attrition during period when patients are not eligible for all other DSD models.
††Conventional models in Lesotho and Zimbabwe were an enhanced version of standard of care in which providers were asked to dispense 3-month supplies of ARVs, rather than whatever duration they otherwise would have and patients received 4 clinical consultations per year, rather than 1.