A controlled study to assess the effects of a Fast Track (FT) service delivery model among stable HIV patients in Lusaka Zambia

Bolton Moore, Carolyn, Pry, Jake M., Mukumbwawenechanya, Mpande, Eshun-Wilson, Ingrid, Topp, Stephanie, Mwamba, Chanda, Roy, Monika, Sohn, Hojoon, Dowdy, David W., Padian, Nancy, Holmes, Charles B., Geng, Elvin, and Sikazwe, Izukanji (2022) A controlled study to assess the effects of a Fast Track (FT) service delivery model among stable HIV patients in Lusaka Zambia. PLOS Global Public Health, 2 (8). e0000108.

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Abstract

Fast Track models—in which patients coming to facility to pick up medications minimize waiting times through foregoing clinical review and collecting pre-packaged medications—present a potential strategy to reduce the burden of treatment. We examine effects of a Fast Track model (FT) in a real-world clinical HIV treatment program on retention to care comparing two clinics initiating FT care to five similar (in size and health care level), standard of care clinics in Zambia. Within each clinic, we selected a systematic sample of patients meeting FT eligibility to follow prospectively for retention using both electronic medical records as well as targeted chart review. We used a variety of methods including Kaplan Meier (KM) stratified by FT, to compare time to first late pick up, exploring late thresholds at >7, >14 and >28 days, Cox proportional hazards to describe associations between FT and late pick up, and linear mixed effects regression to assess the association of FT with medication possession ratio. A total of 905 participants were enrolled with a median age of 40 years (interquartile range [IQR]: 34–46 years), 67.1% were female, median CD4 count was 499 cells/mm3 (IQR: 354–691), and median time on ART was 5 years (IQR: 3–7). During the one-year follow-up period FT participants had a significantly reduced cumulative incidence of being >7 days late for ART pick-up (0.36, 95% confidence interval [CI]: 0.31–0.41) compared to control participants (0.66; 95% CI: 0.57–0.65). This trend held for >28 days late for ART pick-up appointments, at 23% (95% CI: 18%-28%) among intervention participants and 54% (95% CI: 47%-61%) among control participants. FT models significantly improved timely ART pick up among study participants. The apparent synergistic relationship between refill time and other elements of the FT suggest that FT may enhance the effects of extending visit spacing/multi-month scripting alone. ClinicalTrials.gov Identifier: NCT02776254 https://clinicaltrials.gov/ct2/show/NCT02776254.

Item ID: 77182
Item Type: Article (Research - C1)
ISSN: 2767-3375
Copyright Information: © 2022 Bolton Moore et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Date Deposited: 18 Jan 2023 00:33
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 20%
42 HEALTH SCIENCES > 4203 Health services and systems > 420312 Implementation science and evaluation @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 30%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200399 Provision of health and support services not elsewhere classified @ 20%
20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 40%
20 HEALTH > 2002 Evaluation of health and support services > 200206 Health system performance (incl. effectiveness of programs) @ 40%
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