![]() The standard of care in Zambia at the time of study initiation included a mean one-month ART refill schedule, (though 3-month refills had been recommended for stable patients in alignment with World Health Organization standards since 2014), HIV was dispensed on a first-come first-served schedule through a single, common queue service point with patient volume often in excess of clinic design and staffing. For patients already on treatment, negative experiences accessing care, including unacceptable waiting times, emerged as a critical factor in undermining the sustainability of treatment. By 2017, patient volumes had grown so rapidly that waiting times for clinical services reached 3–4 hours (or longer) per visit in Zambia. Although scale up of supply chains, task shifting, and universal training to create human resources for health have improved the HIV care landscape, the front lines where the health system interfaces with the public, remain highly burdened. ![]() To reach HIV epidemic control, countries must offer reliable, high-quality, long-term antiretroviral therapy (ART) to persons on treatment while continuing to absorb new patients accessing care and treatment services. The funders had no role in study design, data collection and analysis, or decision to publish.Ĭompeting interests: The authors have declared that no competing interests exist. ![]() This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: The data used to prepare these analyses are not public and are part of the Zambian national electronic HIV medical record data, and as such, are only potentially available on request and with permission from the Zambian Ministry of Health (suggested contact: Access to data is subject to restrictions including, but not limited to de-identification and suppression of small cell sizes.įunding: This study was funded by the Bill & Melinda Gates Foundation (OPP1115306 to CBH) and National Institutes of Health (K24 AI134413 to EHG). Received: JAccepted: JPublished: August 3, 2022Ĭopyright: © 2022 Bolton Moore et al. PLOS Glob Public Health 2(8):Įditor: Joel Msafiri Francis, University of the Witwatersrand, SOUTH AFRICA (2022) A controlled study to assess the effects of a Fast Track (FT) service delivery model among stable HIV patients in Lusaka Zambia. Ĭitation: Bolton Moore C, Pry JM, Mukumbwa-Mwenechanya M, Eshun-Wilson I, Topp S, Mwamba C, et al. The apparent synergistic relationship between refill time and other elements of the FT suggest that FT may enhance the effects of extending visit spacing/multi-month scripting alone. FT models significantly improved timely ART pick up among study participants. This trend held for >28 days late for ART pick-up appointments, at 23% (95% CI: 18%-28%) among intervention participants and 54% (95% CI: 47%-61%) among control participants. During the one-year follow-up period FT participants had a significantly reduced cumulative incidence of being >7 days late for ART pick-up (0.36, 95% confidence interval : 0.31–0.41) compared to control participants (0.66 95% CI: 0.57–0.65). A total of 905 participants were enrolled with a median age of 40 years (interquartile range : 34–46 years), 67.1% were female, median CD4 count was 499 cells/mm 3 (IQR: 354–691), and median time on ART was 5 years (IQR: 3–7). ![]() We used a variety of methods including Kaplan Meier (KM) stratified by FT, to compare time to first late pick up, exploring late thresholds at >7, >14 and >28 days, Cox proportional hazards to describe associations between FT and late pick up, and linear mixed effects regression to assess the association of FT with medication possession ratio. Within each clinic, we selected a systematic sample of patients meeting FT eligibility to follow prospectively for retention using both electronic medical records as well as targeted chart review. We examine effects of a Fast Track model (FT) in a real-world clinical HIV treatment program on retention to care comparing two clinics initiating FT care to five similar (in size and health care level), standard of care clinics in Zambia. Fast Track models-in which patients coming to facility to pick up medications minimize waiting times through foregoing clinical review and collecting pre-packaged medications-present a potential strategy to reduce the burden of treatment. ![]()
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