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

Introduction South Africa's government‐led Central Chronic Medication Dispensing and Distribution (CCMDD) program offers people living with HIV the option to collect antiretroviral therapy at their choice of community‐ or clinic‐based pick‐up points intended to increase convenience and deconges...

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Bibliographic Details
Published in:Journal of the International AIDS Society 2022-01, Vol.25 (1), p.e25877-n/a
Main Authors: Bassett, Ingrid V., Yan, Joyce, Govere, Sabina, Khumalo, Anele, Ngobese, Nompumelelo, Shazi, Zinhle, Nzuza, Mpilonhle, Bunda, Bridget A., Wara, Nafisa J., Stuckwisch, Ashley, Zionts, Dani, Dube, Nduduzo, Tshabalala, Sandile, Bogart, Laura M., Parker, Robert A.
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
Africa
AIDS
Ambulatory Care Facilities
Antiretroviral agents
Antiretroviral drugs
ARV
Chronic illnesses
Clinics
Cohort analysis
Cohort Studies
community
Cost control
differentiated care
Drug therapy
Female
Health care policy
HIV
HIV care continuum
HIV Infections - drug therapy
Human immunodeficiency virus
Humans
Male
Mental health
Patients
Public sector
Short Report
Social support
South Africa
Stigma
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Summary:Introduction South Africa's government‐led Central Chronic Medication Dispensing and Distribution (CCMDD) program offers people living with HIV the option to collect antiretroviral therapy at their choice of community‐ or clinic‐based pick‐up points intended to increase convenience and decongest clinics. To understand CCMDD pick‐up point use among people living with HIV, we evaluated factors associated with uptake of a community‐ versus clinic‐based pick‐up point at CCMDD enrolment. Methods We collected baseline data from October 2018 to March 2020 on adults (≥18 years) who met CCMDD clinical eligibility criteria (non‐pregnant, on antiretroviral therapy for ≥1 year and virologically suppressed) as part of an observational cohort in seven public clinics in KwaZulu‐Natal. We identified factors associated with community‐based pick‐up point uptake and fit a multivariable logistic regression model, including age, gender, employment status, self‐perceived barriers to care, self‐efficacy, HIV‐related discrimination, and perceived benefits and challenges of CCMDD. Results and Discussion Among 1521 participants, 67% were females, with median age 36 years (IQR 30–44). Uptake of a community‐based pick‐up point was associated with younger age (aOR 1.18 per 10‐year decrease, 95% CI 1.05–1.33), being employed ≥40 hours per week (aOR 1.42, 95% CI 1.10–1.83) versus being unemployed, no self‐perceived barriers to care (aOR 1.42, 95% CI 1.09–1.86) and scoring between 36 and 39 (aOR 1.44, 95% CI 1.03–2.01) or 40 (aOR 1.91, 95% CI 1.39–2.63) versus 10–35 on the self‐efficacy scale, where higher scores indicate greater self‐efficacy. Additional factors included more convenient pick‐up point location (aOR 2.32, 95% CI 1.77–3.04) or hours (aOR 5.09, 95% CI 3.71–6.98) as perceived benefits of CCMDD, and lack of in‐clinic follow‐up after a missed collection date as a perceived challenge of CCMDD (aOR 4.37, 95% CI 2.30–8.31). Conclusions Uptake of community‐based pick‐up was associated with younger age, full‐time employment, and systemic and structural factors of living with HIV (no self‐perceived barriers to care and high self‐efficacy), as well as perceptions of CCMDD (convenient pick‐up point location and hours, lack of in‐clinic follow‐up). Strategies to facilitate community‐based pick‐up point uptake should be tailored to patients’ age, employment, self‐perceived barriers to care and self‐efficacy to maximize the impact of CCMDD in decongesting clinics.
ISSN:1758-2652
1758-2652
DOI:10.1002/jia2.25877