The SENTINEL study of differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: research protocol for a prospective cohort study

BMC Health Services Research

Study Protocol

Timothy Tchereni¹  Prudence Haimbe²  Nkgomeleng Lekodeba³  Sophie Pascoe³  Vinolia Ntjikelane³  Linda Sande³  Idah Mokhele³  Amy Huber³  Sydney Rosen⁴ 

[1] Clinton Health Access Initiative-Malawi, Private Bag 68, Lilongwe, Malawi;Clinton Health Access Initiative-Zambia, P.O. Box 51071, Ridgeway, Lusaka, Zambia;Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Sunnyside Office Park, Building C, First Floor, 32 Princess of Wales Terrace, Parktown, 2193, Johannesburg, South Africa;Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Sunnyside Office Park, Building C, First Floor, 32 Princess of Wales Terrace, Parktown, 2193, Johannesburg, South Africa;Department of Global Health, School of Public Health, Boston University, 801 Massachusetts Ave, 3rd Fl, 02118, Boston, MA, USA;

关键词: HIV;    Differentiated service delivery;    Malawi;    South Africa;    Zambia;    Antiretroviral therapy;    Provider satisfaction;    Patient satisfaction;    Costs;   

DOI  :  10.1186/s12913-023-09813-w

 received in 2023-05-22, accepted in 2023-07-13,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMany countries in sub-Saharan Africa are rapidly scaling up “differentiated service delivery” (DSD) models for HIV treatment to improve the quality of care, increase access, reduce costs, and support the continued expansion and sustainability of antiretroviral therapy (ART) programs. Although there is some published evidence about the health outcomes of patients in DSD models, little is known about their impacts on healthcare providers’ job satisfaction, patients’ quality of life, costs to providers or patients, or how DSD models affect resource allocation at the facility level.MethodsSENTINEL is a multi-year observational study that will collect detailed data about DSD models for ART delivery and related services from 12 healthcare facilities in Malawi, 24 in South Africa, and 12 in Zambia. The first round of SENTINEL included a patient survey, provider survey, provider time-and-motion observations, and facility resource use inventory. A survey of clients testing for HIV and a supplement to the facility resource use component to describe service delivery integration will be added for the second round. The patient survey will ask up to 10 patients enrolled in each DSD model at each study site about their experiences in HIV care and in DSD models, costs incurred seeking treatment, and preferences for HIV service delivery. The provider survey will ask up to 10 providers per site about the impact of DSD models on their positions and clinics. The time-and-motion component will directly observe the time use of a sample of providers implementing DSD models. Finally, the resource utilization component will collect facility-level data about DSD model availability and enrollment and the human and other resources needed to implement them. SENTINEL is planned to include four or more approximately annual rounds of data collection between 2021 and 2026.DiscussionAs national DSD programs for HIV treatment mature, it is important to understand how individual healthcare facilities are interpreting and implementing national guidelines and how healthcare workers and clients are adapting to new models of service delivery. SENTINEL will help policy makers and program managers understand the benefits and costs of differentiated service delivery and improve resource allocation going forward.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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