Differentiated HIV Care Models: An Implementation Science Study

Despite remarkable advances in biomedical HIV prevention and treatment, gaps remain in viral suppression and PrEP engagement among populations disproportionately impacted by HIV. Intervenable barriers to engagement in HIV services may include facility-based stigma and limited access to prioritized primary care. Differentiated service delivery models have recently been implemented as demonstration projects in South Africa, providing a unique opportunity to assess feasible and acceptable implementation strategies as well as analyze the effectiveness and cost of integrating prioritized primary care services as well as and stigma-reduction strategies into HIV care. This observational, multi-site, mixed methods prospective implementation study will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation science evaluation framework to meet the following aims: (1) assess barriers, facilitators, acceptability, and feasibility of differentiated service delivery using site observation checklists, key informant interviews with facility staff, and longitudinal in-depth interviews with clients; (2) evaluate the effect of differentiated service delivery on viral suppression and PrEP adherence - testing for mediators, using a longitudinal cohort of clients, which compares participants enrolled at differentiated service delivery sites with participants enrolled in standard service delivery sites (200/arm on ART and 100/arm on PrEP for a total N = 600); and (3) estimate the cost associated with differentiated service delivery versus standard service delivery sites using a micro-costing approach to estimate the cost per service user served and per service user successfully treated at differentiated service delivery sites relative to standard service delivery sites, as well as the budget needed for successful country-wide implementation.