Speaker
Description
Background: HIV remains a global public health issue, and people from sub-Saharan Africa are highly affected by the disease. Fundamental achievements were made in HIV care, and one of the major advances was the implementation of the Differentiated Service Delivery Models (DSDM) along with the universal test and treat strategy. DSDM has been recommended since 2016 to accommodate the growing number of people living with HIV (PLHIV), and several countries in Sub-Saharan Africa have implemented DSDM as part of their national policy. However, there is no conclusive evidence about the level of uptake and the preferences of PLHIV towards DSDM.
Objective: To estimate the pooled uptake of DSDM by PLHIV and to synthesis their DSDM preferences in Sub-Saharan Africa.
Methods: A comprehensive search was conducted using PubMed, Scopus, Embase, Hinari, and Google Scholar. In this study, cross-sectional, cohort, case-control, discrete choice experiments, and qualitative studies were included. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist. STATA V.17 was used to estimate the pooled uptake of the DSDM. Heterogeneity across the studies was assessed using forest plot, I2 and Cochran’s Q test.
Results: In this review, 57 studies were included, and about 69% of the studies were published recently, since 2022. Among the studies, 12 studies were reported from South Africa, and 20 were retrospective cohort studies. In this study, the pooled uptake of DSDM among stable PLHIV was 46% (proportion=0.46, 95% CI: 0.36-0.55). Moreover, the facility-based individual models were identified as the most preferred model by stable PLHIV in sub-Saharan Africa.
**Conclusion and recommendations: ** Our study showed that the uptake of DSDM among stable PLHIV was moderate in sub-Saharan Africa. The facility-based models, particularly the multi-month drug refill and the less-frequent clinical consultation models, were the most preferred models. Thus, countries in sub-Saharan Africa shall strengthen their policies to scale up the implementation of DSDM. Increasing the availability of facility-based individual models in particular is important in SSA. Moreover, health workers shall identify the gaps and enhance the awareness of patients towards the DSDM.
