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      Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia

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          Abstract

          Introduction

          Ethiopia launched an Appointment Spacing Model in 2017, which involved a six-month clinical visit and medication refill cycle. This study aimed to assess the uptake of the Appointment Spacing Model of care and associated factors among stable adult HIV clients on ART in Ethiopia.

          Methods

          A cross-sectional study was conducted from October 3 to November 30, 2020 among 415 stable adult ART clients. EpiData version 4.2 was used for data entry and SPSS version 25 was used for cleaning and analysis. A multivariable logistic regression model was fitted to identify associated factors, with CI at 95% with AOR being reported to show the strength of association.

          Results

          The uptake of the appointment spacing model was 50.1%. Residence [AOR: 2.33 (95% CI: 1.27, 4.26)], monthly income [AOR: 2.65 (95% CI: 1.13, 6.24)], social support [AOR: 2.21 (95% CI: 1.03, 4.71)], duration on ART [AOR: 2.41 (95% CI: 1.48, 3.92)], baseline regimen change [AOR: 2.20 (95% CI: 1.02, 4.78)], viral load [AOR: 2.80 (95% CI: 1.06, 7.35)], and alcohol abstinence [AOR: 2.02 (95% CI: 1.21, 3.37)] were statistically significant.

          Conclusions

          The uptake of the ASM was low. Behavioral change communication, engaging income-generating activities, and facility-level service providers’ training may improve the uptake.

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          Most cited references41

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          Social support in the general population: standardization of the Oslo social support scale (OSSS-3)

          Background The objectives of the study were to generate normative data for the Oslo Social Support Scale (OSSS-3) for different age groups for men and women and to further investigate the factor structure in the general population. Methods Nationally representative face-to face household surveys were conducted in Germany in 2008 (n = 2524). Results Normative data for the Oslo Social Support Scale were generated for men and women (52.3% female) and different age levels (mean age (SD) of 48.9 (18.3) years). Men had mean scores comparable to women (10.1 [SD = 2.3] vs. 10.2 [SD = 2.2]). The EFA resulted in a clear one-factor solution for the OSSS-3. Conclusions The normative data provide a framework for the interpretation and comparisons of social support with other populations. Electronic supplementary material The online version of this article (10.1186/s40359-018-0249-9) contains supplementary material, which is available to authorized users.
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            Community-supported models of care for people on HIV treatment in sub-Saharan Africa.

            Further scale-up of antiretroviral therapy (ART) to those in need while supporting the growing patient cohort on ART requires continuous adaptation of healthcare delivery models. We describe several approaches to manage stable patients on ART developed by Médecins Sans Frontières together with Ministries of Health in four countries in sub-Saharan Africa.
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              Reframing HIV care: putting people at the centre of antiretroviral delivery

              The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programmes expand treatment eligibility, many people entering care will not be ‘patients’ but healthy, active and productive members of society 1. To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation. La délivrance des soins du VIH dans le déploiement initial rapide des soins et du traitement du VIH a été basée sur des modèles existants dans les cliniques, qui sont courants dans les régions bénéficiant d’importantes ressources et largement indifférenciées pour les besoins individuels. Un nouveau cadre est proposé ici pour le traitement basé selon les intensités variables de soins, adaptés aux besoins spécifiques des différents groupes de personnes à travers la cascade de soins. L’intensité des services est caractérisée par quatre éléments de délivrance: (1) les types de services délivrés, (2) l’emplacement de la délivrance des services, (3) Les prestataires des services de santé et (4) la fréquence des services de santé. La façon dont ces éléments sont développés dans un cadre de prestation de services peut varier selon les pays et les populations, l’intention étant d’améliorer les résultats d’acceptabilité et des soins. Le but d’obtenir plus de personnes sous traitement avant qu’ils ne tombent malades nécessitera des modèles innovateurs de prestation à la fois pour dépistage et pour les soins. Comme les programmes VIH étendent l’éligibilité au traitement, beaucoup de gens qui entrent dans les soins ne seront pas des “malades- mais des éléments sains de la société, actifs et productifs. Afin de tenir le cadre à l’échelle, il sera important de: (1) définir les individus qui peuvent être traités par un cadre alternatif de prestation, (2) renforcer les systèmes de santé qui soutiennent la décentralisation, l’intégration et le transfert des tâches; (3) rendre la chaîne d’approvisionnement plus robuste et (4) investir dans des systèmes de données pour le suivi des patients et pour le suivi et l’évaluation du programme. Los servicios de atención del VIH durante el inicio de la primera etapa de rápida expansión del tratamiento y cuidados del VIH estaban basados en modelos clínicos existentes, comunes en lugares con abundancia de recursos y poco diferenciados en cuanto a necesidades individuales. Aquí se propone un nuevo marco para el tratamiento basado en intensidades variables de cuidados, hecho a medida según las necesidades específicas de los diferentes grupos de individuos a lo largo del tratamiento. La intensidad del servicio se caracteriza por cuatro componentes de entrega: (1) tipología de los servicios ofrecidos, (2) lugar de entrega de los servicios, (3) proveedor de los servicios sanitarios, y (4) frecuencia de los servicios sanitarios. El cómo estos componentes conforman un marco de entrega de servicios variará según el país y la población, con la intención de mejorar la aceptabilidad y los resultados de los cuidados. El objetivo de conseguir que más personas reciban tratamiento antes de que enfermen requerirá de modelos innovadores en la oferta tanto de pruebas para detección como de los cuidados. A medida que los programas para el VIH expandan los criterios de elegibilidad para el tratamiento, muchas de las personas que comiencen a recibir cuidados no serán “pacientes- sino miembros sanos, activos y productivos de la sociedad. Con el fin de expandir la escala de esta estructura, sería importante: (1) definir cuales individuos pueden ser atendidos dentro de un marco de entrega de servicios alternativo; (2) fortalecer los sistemas sanitarios que apoyan la descentralización, integración y delegación de funciones; (3) robustecer la cadena de proveedores; e (4) invertir en sistemas de datos para el seguimiento de pacientes y para la monitorización y evaluación de programas.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: SoftwareRole: SupervisionRole: Writing – review & editing
                Role: MethodologyRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                30 December 2022
                2022
                : 17
                : 12
                : e0279760
                Affiliations
                [1 ] HIV/AIDS Care Program, International Center for AIDS Care Program, Bahir Dar, Ethiopia
                [2 ] Department of Public Health, College of Health Sciences, Debre Markos University, Debre Marqos, Ethiopia
                [3 ] Department of Health Informatics, College of Health Sciences, Debre Markos University, Debre Marqos, Ethiopia
                [4 ] College of Health Sciences, Injibara University, Injibara, Ethiopia
                [5 ] College of Nursing, University of Saskatchewan, Saskatoon, Canada
                [6 ] School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
                Kaohsiung Medical University, TAIWAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-4378-4266
                https://orcid.org/0000-0002-2388-3171
                https://orcid.org/0000-0002-8707-4963
                Article
                PONE-D-22-11061
                10.1371/journal.pone.0279760
                9803219
                36584153
                f42db00d-a3bd-46f7-b408-c0e3e9fd71e9
                © 2022 Asrade 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.

                History
                : 14 April 2022
                : 14 December 2022
                Page count
                Figures: 3, Tables: 4, Pages: 15
                Funding
                The author(s) received no specific funding for this work.
                Categories
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                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
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