Programmatic outcomes of adolescents in differentiated service delivery models in South Africa

Abstract

Background: Adolescents living with HIV face barriers that impede adherence and retention. Differentiated service delivery (DSD) models aim to improve retention and viral suppression (VS), but there is limited programmatic evidence from South Africa on DSD outcomes.

Objectives: This study aimed to measure 12 month retention and VS proportions in adolescents enrolled in DSD and clinic-based care, and measure the association between 12 month retention, VS and covariates.

Method: A retrospective cohort study was conducted in the Mopani District, Limpopo province, using TIER.Net data. The study included adolescents aged 10–19 years enrolled in DSD between 01 September 2019 and 30 September 2022, and those eligible for DSD with viral load < 50 copies/mL. The study measured 12-month retention and VS proportions. Multivariable logistic regression measured association among 12-month retention, VS and exposure variables.

Results: A total of 646 adolescents in DSD and 1282 in clinic-based care were included. Twelve-month retention was 92.7% (599/646) in DSD and 89.0% (1141/1282) in clinic-based care. There was no association between 12-month retention and being enrolled in DSD versus clinic-based care. Twelve-month VS (< 50 copies/mL) was 63.5% (251/395) in DSD, compared to clinic-based care 51.0% (494/969). In multivariable regression, being on DSD was associated with higher VS at < 50 copies/mL (Adjusted Odds Ratio [AOR] 1.6; 95% confidence interval: 1.2–2.1; p < 0.001) than clinic-based care.

Conclusion: Differentiated service delivery improved VS in adolescents in a rural setting and should be prioritised to improve outcomes.

Contribution: Differentiated service delivery improves adolescent VS in a rural setting.