Provider experiences with three- and six-month antiretroviral therapy dispensing for stable clients in Zambia

ABSTRACT

Multi-month dispensing of antiretroviral therapy (ART) has been taken to scale in many settings in sub-Saharan Africa with the benefits of improved client satisfaction and decreased client costs. Six-month ART dispensing may further increase these benefits; however, data are lacking. Within a cluster-randomized trial of three- versus six-month dispensing in Malawi and Zambia, we performed a sub-study to explore Zambian provider experiences with multi-month dispensing. We conducted 18 in-depth interviews with clinical officers and nurses dispensing ART as part of INTERVAL in Zambia. Interview questions focused on provider perceptions of client acceptability, views on client sharing and selling of ART, and perceptions on provider workload and clinic efficiency, with a focus on differences between three- and six-month dispensing. Interviews were analyzed using inductive thematic analysis to identify key themes and patterns within the data. Providers perceived significant benefits of multi-month dispensing, with advantages of six-month over three-month dispensing related to a reduced burden on clients, and for reductions in their own workload and clinic congestion. Among nearly all providers, the six-month dispensing strategy was perceived as ideal. Further research is needed to quantify clinical outcomes of six-month dispensing and feasibility of scaling-up this intervention in resource-limited settings.

Clinical Trial Number: NCT03101592.

KEYWORDS:

• Differentiated models of care
• multi-month dispensing
• HIV/AIDS
• Zambia
• health provider perspectives

Acknowledgements

We are grateful to the study participants, the facility staff who supported multi-month dispensing, and the research staff who conducted the interviews. R. H. conceived the study; R. H., C. M., A. B. developed the interview guide; J. H. led data collection with support from K. P., E. L., K. B. and K. D. Data analysis was done by K. P. and K. M. R. H., C. M., and P. T. P. supported with the interpretation of data. K. P. and K. M. led manuscript writing and all the other authors reviewed the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) under Cooperative Agreement [grant number AID-OAA-A-15-00070].