Project Details
Description
Background: Adolescents living with HIV are less likely than adults living with HIV to be engaged in HIV care at all stages of the care cascade. In Uganda, only 56% of the adolescents living with HIV accessed antiretroviral therapy in 2020. Differentiated Service Delivery (DSD) approaches have shown equivalent or improved effect on viral load suppression and retention in care among adults living with HIV. However, these approaches are not tailored to the needs of the adolescents—a priority population with the greatest treatment needs in Uganda. Evidence on the impact of DSD approaches on viral load suppression and retention among adolescents in HIV care is lacking. Using a mixed methods approach, this study aims to address this evidence gap through an impact and economic evaluation. The study will be conducted for the Masaka region, Uganda; a region with one of the highest burdens of HIV among adolescents.
Methods: A multi phased study approach will be used in this PhD project. Phase I will be a systematic review conducted using the PRISMA guidelines to identify, appraise and synthesize evidence on the impact of the DSD approaches on viral load suppression and retention in care among adolescents (aged 10-19 years) living within sub–Saharan Africa from 2010 to date. Phase II will be a retrospective cohort analysis of adolescents living with HIV from Masaka region from 2013 to 2023. Pseudonymized patient data from 191 health facilities will be extracted from the open medical records system (MRS) of Uganda’s Ministry of Health. An interrupted time series with segmented regression analysis will be conducted to determine the impact of DSD approaches on viral load suppression and retention in care in this study compared with historical comparison group before DSD implementation. Survival analysis will further be conducted to compare retention in care and durability of viral suppression within the different DSD approaches. Phase III will be a process evaluation, employing both quantitative and qualitative data collection methods to provide insights on the processes and mechanisms through which the DSD approaches achieve the intended outcomes and impact. Phase IV will use a decision analytic design to estimate the incremental costs and effects of the DSD approaches obtained from Phase I and Phase II. Costs will be estimated from the health provider and societal perspectives informed by the critical components and pathways highlighted in Phase III. Disability Adjusted Life Years (DALYs) will be used as the effects measure. Incremental cost effectiveness ratios (ICER) and incremental net monetary benefit (INMB) will be used to determine the most cost-effective DSD approach. This project will adhere to ethical good practice by obtaining ethical clearance from relevant institutional review boards, obtain clearance from relevant administrative offices and informed consent from participants.
Expected Results/ Impact: The findings of the study will provide a better understanding of the impact of the DSD approaches, suggest recommendations for the most (cost-)effective approaches to maintaining viral suppression and retention among adolescents and inform policy decisions amidst reduced donor support. The implications of this PhD work extend beyond Masaka Region and can be applied to diverse settings and contexts throughout Africa.
Methods: A multi phased study approach will be used in this PhD project. Phase I will be a systematic review conducted using the PRISMA guidelines to identify, appraise and synthesize evidence on the impact of the DSD approaches on viral load suppression and retention in care among adolescents (aged 10-19 years) living within sub–Saharan Africa from 2010 to date. Phase II will be a retrospective cohort analysis of adolescents living with HIV from Masaka region from 2013 to 2023. Pseudonymized patient data from 191 health facilities will be extracted from the open medical records system (MRS) of Uganda’s Ministry of Health. An interrupted time series with segmented regression analysis will be conducted to determine the impact of DSD approaches on viral load suppression and retention in care in this study compared with historical comparison group before DSD implementation. Survival analysis will further be conducted to compare retention in care and durability of viral suppression within the different DSD approaches. Phase III will be a process evaluation, employing both quantitative and qualitative data collection methods to provide insights on the processes and mechanisms through which the DSD approaches achieve the intended outcomes and impact. Phase IV will use a decision analytic design to estimate the incremental costs and effects of the DSD approaches obtained from Phase I and Phase II. Costs will be estimated from the health provider and societal perspectives informed by the critical components and pathways highlighted in Phase III. Disability Adjusted Life Years (DALYs) will be used as the effects measure. Incremental cost effectiveness ratios (ICER) and incremental net monetary benefit (INMB) will be used to determine the most cost-effective DSD approach. This project will adhere to ethical good practice by obtaining ethical clearance from relevant institutional review boards, obtain clearance from relevant administrative offices and informed consent from participants.
Expected Results/ Impact: The findings of the study will provide a better understanding of the impact of the DSD approaches, suggest recommendations for the most (cost-)effective approaches to maintaining viral suppression and retention among adolescents and inform policy decisions amidst reduced donor support. The implications of this PhD work extend beyond Masaka Region and can be applied to diverse settings and contexts throughout Africa.
Status | Active |
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Effective start/end date | 1/01/25 → … |