Contribution of differentiated service delivery model upon retention in care among PLWHs in Kiwoko hospital Nakaseke district

Abstract

Differentiated service delivery is a patient-centered approach to HIV prevention, care, and treatment. Its aim was to increase service efficiencies and impact through improved access to and quality of prevention, testing, treatment and care services for people living with and vulnerable to HIV with the introduction of the test and treat policy and overwhelming number of clients. Achieving the global targets of 90 90 90 is not easy as global funding for HIV has plateaued, the growing numbers of patients on ART have led to overcrowding at health facilities, increasing waiting times for patients, overwhelming clinicians, and consequently compromising patient satisfaction. Finally, gaps in program quality, such as suboptimal retention rates, threaten both individual patient outcomes and public health goals so differentiated service delivery is a practical approach to addressing these challenges. The study assessed the Effectiveness of the DSDM model towards retention to ART/care in Kiwoko hospital Nakaseke district. Methodology: A descriptive cross sectional study involving mixed methods research design using both qualitative and quantities methods, FGD, Key informant interview and Questionnaires were employed to answer the research questions. A sample size of 327 respondents on ART and DSDM and analysis was done using SPSS. Respondents enrolled in fast track and CCLAD had more time to concentrate on Income Generating activities as they had visited the facility once in the previous quarter for fast track and once for those under CCLAD. Service satisfaction was key as they reported it being convenient and staff being approachable while for CBAGs many had only been on treatment for a year and were not suppressing viral load and experienced a drug reaction during drug initiation however the perceived clinic assessments as not good as the waiting time was too long. Staff reported the model to have improved retention and clinic appointments however faced challenges ranging from stocking, follow up and finances to start up income generating activities for clients. Conclusion & Recommendations: Drug supply should be strengthened to avoid episodes of drug stock outs and ensure consistency so that clients who are enrolled in the different groups are not frustrated by frequent visits to facility due to stock outs, also avail drugs for side effects for clinic based ART groups to manage the patients but generally the model is improving retention in care.