| INTERVENTIONS |
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Intervention type
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Intervention name
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Dose
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Duration
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Intervention description
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Group size
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Nature of control
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| Experimental Group |
Domain 1 Provider time |
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A sample of up to five providers will be selected at each study site, for a total sample size of up to 120 for up to 24 sentinel sites in each round of the study. (All data collection rounds expected to be completed by Dec 2025) |
The providers involved will include nurses, lay counsellors and/or community health workers, doctors/medical officers, and/or DSD model-specific staff, based on their role in providing HIV treatment. The participants will be purposively selected from within the site’s staff cadre and invited to participate, in agreement with the individual serving as facility in-charge or facility manager. Different calendar days will be observed during the study period, with days selected based on when each site schedules ART care and to represent typical patient care days for each cadre of provider. To minimize the burden on participants, no provider will be observed for more than two days. Questions in Domain 1 pertain to the allocation and efficiency of provider time use within the study clinics, which are expected to change as result of the scaling up of DSD models. These questions will be answered with a time-and-motion study. Data collection procedures and tools have been submitted and approved by the ethics committee. |
600 |
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| Experimental Group |
Domain 2 Provider experiences |
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We will administer a questionnaire to a sample of up to 10 providers per study site per data collection round (All data collection rounds to be completed by Dec 2025) |
For each round of the survey, we will enroll up to 10 providers per facility, preferentially including all staff who manage ART patients and the site’s operations manager, one or more lay counselors or community health workers, a pharmacist or pharmacy assistant, and any other cadre that is relevant to the DSD model program, as identified by the site. To select participants, we will ask the facility in-charge (facility manager) to choose the individuals in each cadre who are most involved in DSD model implementation. Questions in Domain 2 pertain to providers’ experiences with DSD models. These questions will be answered through a survey of providers at the study sites. Questionnaires will include both closed- and open-ended questions about the strengths and weaknesses of the models; how the advent of DSD models has changed provider responsibilities, work burden, and time allocation; and the effect of DSD models on job satisfaction. We will also ask participants to comment on challenges faced in implementing DSD models, the impact of DSD models on provider time allocation and efficiency (average time spent treating each patient) while caring for ART or non-ART patients, the implementation of differentiated HIV testing models, and other related topics. Data collection procedures and tools have been submitted and approved by the ethics committee. |
1200 |
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| Experimental Group |
Domain 3 Patient experiences with service delivery |
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We will aim to enroll up to 10 patients per site per model of care. We will include conventional care defined as two models: 1) patients eligible for, but not enrolled, in a differentiated model other than conventional care and 2) patients not eligible for DSD models, for each round (All data collection rounds to be completed by Dec 2025) |
A quantitative, structured questionnaire will be administered to ART patients at each annual round of data collection to understand patients’ satisfaction with their current model of care, motivation for enrolling in that model, and direct and indirect costs of accessing care. The focus will be on treatment service delivery, not on clinical aspects or outcomes of HIV treatment itself. Questions will address: 1. Costs to patients of seeking care (transport, time, lost wages, child care, etc.) 2.Time required for seeking care (travel, time at healthcare facility, time participating in DSD interactions) 3. Patient satisfaction with their current model of care 4. Patient’s preferences as to best and worst aspects of seeking care. Data collection procedures and tools have been submitted and approved by the ethics committee. |
8600 |
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| Control Group |
Domain 4 Resources |
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We will collect facility-level, aggregate data on patient volumes, reasons for visits for HIV and non-HIV patients, staff complements, and other operational indicators during each round of data collection (All data collection rounds to be completed by Dec 2025) |
The data to be collected for Domain 4 include routine reports and records generated by the facilities, District Health Offices, and nongovernmental partners. We will aim to collect the number of HIV, ART, and non-HIV patients presenting at the site in each time period and the number of full-time equivalent staff at the site in each time period, by cadre, including lay counselors, community health workers, and staff paid by external partners. We will also describe in detail the site’s operating procedures with relevance to models of HIV treatment. Data collection procedures have been submitted and approved by the ethics committee. |
120 |
Active-Treatment of Control Group |
| Experimental Group |
Domain 5 Patient experience with differentiated HIV testing |
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We will recruit individuals who are participating in facility-run HIV testing during the recruitment period. We will aim to enroll up to 50 patients per site. (All data collection rounds to be completed by Dec 2025) |
A structured questionnaire, designed for quantitative analysis, will be administered to a sample of patients at each site. Questions will address the testing modality, reason for testing, location in the clinic tested, department referred from, other services provided, and HIV testing history. For those testing HIV positive, questions will address prior ART exposure and readiness to initiate ART. For those who have previously been on ART, the questionnaire will ask about timing and reasons for disengagement, timing and reasons for re-engagement, and what services were provided at reengagement. For those testing HIV negative, questions will address the offer and uptake of PrEP and other preventive strategies after the negative test result. A structured questionnaire, designed for quantitative analysis, will be administered to a sample of patients at each site. Questions will address the testing modality, reason for testing, location in the clinic tested, department referred from, other services provided, and HIV testing history. For those testing HIV positive, questions will address prior ART exposure and readiness to initiate ART. For those who have previously been on ART, the questionnaire will ask about timing and reasons for disengagement, timing and reasons for re-engagement, and what services were provided at reengagement. For those testing HIV negative, questions will address the offer and uptake of PrEP and other preventive strategies after the negative test result. |
5000 |
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