Virological and care outcomes of community ART distribution: Experience with the PODI+ model in Kinshasa, Democratic Republic of the Congo

Michelle M Gill; Winnie Bakebua; John Ditekemena; Cady Nyombe Gbomosa; Dieudonné Tshishi; Aimé Loando; Abhigya Giri; Roger Beni Ngantsui; Heather J Hoffman

doi:10.1371/journal.pgph.0002343

Virological and care outcomes of community ART distribution: Experience with the PODI+ model in Kinshasa, Democratic Republic of the Congo

PLOS Glob Public Health. 2024 Jan 31;4(1):e0002343. doi: 10.1371/journal.pgph.0002343. eCollection 2024.

Authors

Michelle M Gill¹, Winnie Bakebua², John Ditekemena², Cady Nyombe Gbomosa³, Dieudonné Tshishi², Aimé Loando², Abhigya Giri⁴, Roger Beni Ngantsui⁵, Heather J Hoffman⁴

Affiliations

¹ Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America.
² Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa, Democratic Republic of the Congo.
³ Population Health Program, University of Ottawa, Ottawa, Canada.
⁴ Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America.
⁵ DRC Ministry of Health, National AIDS Control Program, Kinshasa, Democratic Republic of the Congo.

Abstract

Introduction: Differentiated service delivery models for HIV treatment can minimize unnecessary burdens on health systems and promote efficient delivery of antiretroviral therapy (ART). Under the PODI+ (poste de distribution communautaire) model, ART multi-month dispensation (MMD) was provided by lay workers (peers) in communities. We compared outcomes among clinically stable adults living with HIV receiving MMD via PODI+ or health facility (HF).

Methods: Clients receiving MMD at nine HFs and two PODI+ sites in Kinshasa were followed prospectively for one year (2018-2020). Medication possession ratio (MPR) was measured as proportion of total days with medication during the study through record abstraction at 3-month intervals. Viral load was assessed at enrollment and 12 months. We compared MPR and viral load suppression by arm and examined associations and potential confounders using unadjusted and adjusted odds ratios (AOR). Likert-style client satisfaction was collected during 12-month interviews and described by arm.

Results: Odds of maintaining viral load suppression at 12 months for PODI+ participants were two times that for HF participants. In adjusted models, PODI+ participants had 1.89 times the odds of being suppressed at 12 months compared to HF participants (95% CI: 1.10, 3.27). No significant differences in MPR were found between groups (OR: 0.86, 0.38-1.99). Older participants had significantly higher odds of MPR (AOR: 1.02, 95% CI: 1.01, 1.03) and viral suppression (AOR: 1.03, 95% CI: 1.00, 1.07). Satisfaction with services was ≥87% overall, but PODI+ participants rated time spent at site, provider attributes and other care aspects more favorably.

Conclusions: Participants receiving MMD via peer-run community distribution points had similar MPR, but better virological outcomes and greater satisfaction with care than clinically similar participants receiving MMD through facilities. PODI+ could be a useful model for expansion to serve larger clinic populations from overburdened health facilities, particularly as policy shifts towards more inclusive MMD eligibility requirements.

Copyright: © 2024 Gill 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.

Grants and funding

This study was made possible by the United States Agency for International Development and the generous support of the American people through USAID Cooperative Agreement No. AID-660-A-17-00002. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.