MOPED544
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Title
Optimizing treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study
Presenter
Jennifer Zech
Authors
M. Strauss1, G. George1, M. Mapingure2, J. Mantell3,4, M. Lamb5, G. Musuka2, J. Zech5, I. Chingombe2, M. Msukwa2, R. Boccanera6, C. Gwanzura7, T. Apollo7, M. Rabkin5
Institutions
1University of KwaZulu-Natal, Health Economics and HIV and AIDS Research Division, Durban, South Africa, 2ICAP at Columbia University, Harare, Zimbabwe, 3New York State Psychiatric Institute, HIV Center for Clinical & Behavioral Studies, New York, United States, 4Columbia University, New York, United States, 5ICAP at Columbia University, New York, United States, 6U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, United States, 7Ministry of Health and Child Care Zimbabwe, AIDS and TB Unit, Harare, Zimbabwe

Background: Zimbabwe is scaling up differentiated HIV service delivery to improve patient and healthcare worker (HCW) satisfaction, HIV treatment outcomes, and program efficiencies. The Ministry of Health and Child Care and its partners support five differentiated antiretroviral treatment models (DARTs) for stable HIV-positive adults, but program data suggest that urban and rural patients prefer different models. We designed a mixed-methods study to explore the treatment preferences of urban people living with HIV (PLHIV).
Methods: The study took place at 7 health facilities (HF) in Harare and included 35 key informant interviews (KII) with HCWs; 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for HF vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration (including wait time), and cost to patient (including transportation); and a survey with the 500 DCE participants exploring DART knowledge and preferences.
Results: Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred HF-based services, individual DART models, respectful and understanding HCWs, and services costing < $3/visit. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF (Figure 1). These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. In KII, HCWs characterized the fast track/visit spacing model (a facility-based individual model) as the one most favoured by patients; HCW also preferred this model, which they felt decompressed HF and decreased HCW workload.
Conclusions: DARTs-eligible PLHIV in Harare preferred attributes associated with two of Zimbabwe''s five DART models. Prioritizing these models for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.


Key findings from qualitative and quantitative study components
[Key findings from qualitative and quantitative study components]

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