Lingrui Liu1,2, Sarah Christie1, Maggie Munsamy3, Phil Roberts4, Merlin Pillay4, Sheela V Shenoi5, Mayur M Desai1,6, Erika L Linnander7,8. 1. Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA. 2. Department of Health Policy and Management, Yale School of Public Health, New Haven, USA. 3. National Department of Health, Pretoria, South Africa. 4. Project Last Mile, Pretoria, South Africa. 5. Department of Medicine, Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA. 6. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. 7. Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA. erika.linnander@yale.edu. 8. Department of Health Policy and Management, Yale School of Public Health, New Haven, USA. erika.linnander@yale.edu.
Abstract
BACKGROUND: South Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel challenge of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) of South Africa launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients who have chronic diseases, including HIV, with alternative access to medications via community-based pick-up points. This study describes the expansion of CCMDD toward national scale. METHODS: Yale monitors CCMDD expansion as part of its mixed methods evaluation of Project Last Mile, a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication provided [ART only; NCD only; and ART-NCD] and collection sites preferred by patients [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis. RESULTS: As of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88 % of South Africa's districts), and 2,037 external pick-up points had been contracted by the NDoH. A total of 2,069,039 patients were actively serviced through CCMDD, a significant increase since 2018 (p < 0.001), including 76 % collecting ART [64 % ART only, 12 % ART plus NCD/comorbidities] and 479,120 [24 %] collecting medications for chronic diseases only. Further, 734,005 (35 %) of patients were collecting from contracted, external pick-up points, a 73 % increase in patient volume from 2018. DISCUSSION: This longitudinal description of CCMDD provides an example of growth of a national differentiated service delivery model that integrates management of HIV and noncommunicable diseases. This study demonstrates the success of the program in engaging patients irrespective of their chronic condition, which bodes well for the potential of the program to address the rising burden of both HIV and NCDs in South Africa. CONCLUSIONS: The CCMDD program expansion signals the potential for a differentiated service delivery strategy in resource-limited settings that can be agnostic of the patients chronic disease condition.
BACKGROUND: South Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel challenge of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) of South Africa launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients who have chronic diseases, including HIV, with alternative access to medications via community-based pick-up points. This study describes the expansion of CCMDD toward national scale. METHODS: Yale monitors CCMDD expansion as part of its mixed methods evaluation of Project Last Mile, a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication provided [ART only; NCD only; and ART-NCD] and collection sites preferred by patients [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis. RESULTS: As of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88 % of South Africa's districts), and 2,037 external pick-up points had been contracted by the NDoH. A total of 2,069,039 patients were actively serviced through CCMDD, a significant increase since 2018 (p < 0.001), including 76 % collecting ART [64 % ART only, 12 % ART plus NCD/comorbidities] and 479,120 [24 %] collecting medications for chronic diseases only. Further, 734,005 (35 %) of patients were collecting from contracted, external pick-up points, a 73 % increase in patient volume from 2018. DISCUSSION: This longitudinal description of CCMDD provides an example of growth of a national differentiated service delivery model that integrates management of HIV and noncommunicable diseases. This study demonstrates the success of the program in engaging patients irrespective of their chronic condition, which bodes well for the potential of the program to address the rising burden of both HIV and NCDs in South Africa. CONCLUSIONS: The CCMDD program expansion signals the potential for a differentiated service delivery strategy in resource-limited settings that can be agnostic of the patientschronic disease condition.
Authors: Lingrui Liu; Sarah Christie; Maggie Munsamy; Phil Roberts; Merlin Pillay; Sheela V Shenoi; Mayur M Desai; Erika L Linnander Journal: BMC Health Serv Res Date: 2021-06-04 Impact factor: 2.655
Authors: Melanie A Bisnauth; Natasha Davies; Sibongile Monareng; Helen Struthers; James A McIntyre; Kate Rees Journal: Glob Health Action Date: 2022-12-31 Impact factor: 2.640
Authors: Isaac Derickk Kimera; Christabellah Namugenyi; Jeremy I Schwartz; Douglas Joseph Musimbaggo; Rebecca Ssenyonjo; Praise Atukunda; Gerald Mutungi; Frank Mugabe; Fortunate Ambangira; Mary Mbuliro; Rodgers Katwesigye; Dinesh Neupane; Isaac Ssinabulya; Fred Collins Semitala; Christian Delles; Martin Muddu Journal: J Hum Hypertens Date: 2022-03-04 Impact factor: 3.012