Background: Differentiated care is a client-centered approach accommodating preferences of people living with HIV (PLHIV) while reducing burdens like long distance travel and waiting times that might negatively affect retention in care. The Integrated HIV/AIDS Project in Haut Katanga and Lualaba (IHAP-HK/L) introduced three differentiated care models (DCM) in 2016. We conducted a review of programmatic data to compare retention outcomes between patients who opted to enroll in a DCM and those who continued with the traditional facility-based care model.
Methods: Three DCMs were implemented to decongest Kenya General Reference Hospital (HGR):
· Community-based treatment support groups
· Community-based points of treatment distribution (PODI+)
· Facility-based fast-track refill circuits
Stable PLHIV?patients older than 18 years of age, with no opportunistic infections and an undetectable viral load for at least six months?enrolled in treatment at Kenya HGR were offered to transfer to a DMC of their preference or remain in the traditional model (and provided with multi-month stocks of antiretroviral medication). From October 2016 to December 2018, 920 PLHIV from Kenya HGR were eligible and selected for the evaluation. Using a multivariate analysis, we compared 12-month retention outcomes for PLHIV enrolled in DCMs versus those who remained in the traditional model.
Results: 70% of participants were female. 57% of participants opted for a DCM (46% PODI+; 9% fast-track circuit; 2% treatment groups). 98% of PLHIV in DCM were still in care after 12 months compared to 89% who remained in the traditional model. PLHIV enrolled in a DCM were 5.7 times more likely to remain in care 12 months following enrollment (OR = 5.69-95% CI = 2.9-11) compared to those who opted to stay with the traditional model after controlling for sex (Female: OR = 3.1-95% CI = 1.7-5.3) and age at treatment initiation (OR = .9-95% CI= .9-1).
Conclusions: PLHIV who transferred to a DCM had better retention in care than those who did not. DCM and sex were independent predictors of retention among PLHIV treated at Kenya HGR. As DRC moves towards achievement of epidemic control, expansion of DCMs to retain PLHIV in treatment is critical.