Background: Non-facility based models of antiretroviral therapy (ART) delivery may retain patients in care and facilitate task-shifting. Within the HPTN 071 (PopART) trial, two models, home-based delivery (HBD) or adherence clubs (AC), were offered and compared to clinic-based standard of care (SoC) for stable patients. We estimate patient retention in non-facility based ART delivery models and compare HBD and AC.
Methods: A three-arm cluster randomized non-inferiority trial, nested in two urban HPTN 071 trial communities in Lusaka Zambia, randomly allocated 104 zones to SoC, HBD or AC arms. In both HBD and AC arms, patients were offered the choice between SoC or non-facility based ART model. All patients received ARVs and support every 3 months at home (HBD), out-of-clinic adherence club (AC) or at the clinic (SoC). In both intervention arms, patients were referred back to SoC if they relocated to an area not offering the intervention, developed a co-morbidity, had a viral rebound, missed > 2 visits or opted out. We assessed the proportion of patients referred back to routine care (SoC) during the first 18 months of the programme.
Results: Between May and December 2017, 2,493 patients were enrolled of which 774(31%) were randomized to SoC, 869 (35%) to HBD and 850 (34%) to AC arms [Fig 1]. After 18 months, 743 (93.6%) patients were retained in the AC arm versus 715 (84.9%) in the HBD arm. The most common reason for not being retained was shifting out of a study zone which did not offer the intervention.
Conclusions: Overall patient retention in non-facility based ART delivery models was high (85%) and this was higher in adherence clubs as patients who shifted from study zones could continue going for their club meetings to receive care.



[Flow Chart of Study Participants]

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