Is the Differentiated Service Delivery Model Suited to the Needs of People Living with HIV in Rwanda?

J Sebeza; C Muiruri; D J Riedel; K Stafford; H Omari; P Memiah; M C Lavoie; S Tuyishime; G Rwibasira; N Deyessa; J Ntaganira

doi:10.1007/s10461-024-04376-1

Is the Differentiated Service Delivery Model Suited to the Needs of People Living with HIV in Rwanda?

AIDS Behav. 2024 May 23. doi: 10.1007/s10461-024-04376-1. Online ahead of print.

Authors

J Sebeza¹, C Muiruri², D J Riedel³, K Stafford^{4

5}, H Omari⁴, P Memiah⁶, M C Lavoie^{4

5}, S Tuyishime⁷, G Rwibasira⁷, N Deyessa⁸, J Ntaganira⁸

Affiliations

¹ College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Gasabo District, 103KG 47ST, Kigali, Rwanda. jsebeza@gmail.com.
² Department of Population Health Sciences, Duke University, Duke, NC, USA.
³ Institute of Human Virology, Division of Infectious Diseases, School of Medicine, University of Maryland, Baltimore, MD, USA.
⁴ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁶ Graduate School, University of Maryland Baltimore, Baltimore, MD, USA.
⁷ Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.
⁸ College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Gasabo District, 103KG 47ST, Kigali, Rwanda.

PMID: 38780868
DOI: 10.1007/s10461-024-04376-1

Abstract

The primary goal of antiretroviral treatment is to improve the health of individuals with HIV, and a secondary goal is to prevent further transmission. In 2016, Rwanda adopted the World Health Organization's "treat-all" approach in combination with the differentiated service delivery (DSD) model. The model's goal was to shorten the time from HIV diagnosis to treatment initiation, regardless of the CD4 T-cell count. This study sought to identify perceptions, enablers, and challenges associated with DSD model adoption among PLHIV.This study included selected health centers in Kigali city, Rwanda, between August and September 2022. The patients included were those exposed to the new HIV care model (DSD) model and those exposed to the previous model who transitioned to the current model. Interviews and focus group discussions were also held to obtain views and opinions on the DSD model. The data were collected via questionnaires and audio-recorded focus group discussions and were subsequently analyzed.The study identified several themes, including participants' initial emotions about a new HIV diagnosis, disclosure, experiences with transitioning to the DSD model, the effect of peer education, and barriers to and facilitators of the DSD model. Participants appreciated reduced clinic visits under the DSD model but faced transition and peer educator mobility challenges.The DSD model reduces waiting times, educates patients, and aligns with national goals. Identified barriers call for training and improved peer educator retention. Recommendations include enhancing the DSD model and future research to evaluate its long-term impact and cost-effectiveness.

Keywords: Differentiated service delivery model; Peer educators.