Assessing health outcomes of ART Differentiated Care Models in Migori County, Kenya

Abstract

Background : HIV remains a substantial global health challenge. In Kenya, the prevalence is approximately 6%, with Migori County experiencing notably high rates. Despite this, only a small portion of its population receive antiretroviral therapy (ART). Differentiated care, an individualized approach to HIV treatment, enhances outcomes and eases strain on health systems. This study assesses health outcomes of ART differentiated care in Migori County, Kenya, focusing on retention and viral load results for stable individuals living with HIV.

Methodology :We employed a pre-post evaluation descriptive mixed methods study design to assess health outcomes following Differentiated Care Model (DCM) implementation. One hundred and ninety-two (192) stable HIV patients from Migori's rural sugar belt, meeting DCM inclusion criteria, were enrolled using single-stage cluster and systematic sampling. DCM outcomes were compared with the standard care model (control). Data sourced from patient records and key informant interviews were analyzed using Chi-square, Fisher's exact tests, logistic regression and thematic analysis.

Results : We observed notable statistical significance (p < 0.05) in the association between DCM and health outcomes, including patient activity at 6 and 12 months (p < 0.001), transfer-out retention at 6 and 12 months (p = 0.02), loss to follow-up retention at 6 and 12 months (p = 0.006 and p = 0.005, respectively), and deceased patient retention (p = 0.033). However, the viral load suppression post-DCM did not show statistical significance.

Conclusion : To conclude, Differentiated Care Models positively impact retention outcomes for stable HIV-positive patients, notably reducing lost-to-follow-up and deceased cases. Although not significant at 6 and 12 months, DCM shows promise in early-stage viral load suppression. Gender disparities exist in suppression rates. Patient adherence and viral load awareness are favourable