Differentiated HIV Service Delivery vs Conventional Care: Tuberculosis Preventive Therapy Outcomes for People Living with HIV in Sub-Saharan Africa

INTRODUCTION: Differentiated service delivery (DSD) models, which reduce provider visits and offer varied ART delivery methods for people with HIV, are expanding across sub-Saharan Africa. However, their impact on services beyond ART, including the uptake and completion of tuberculosis preventive therapy (TPT), remains unclear. METHODS: Using the RE-AIM framework, we analyzed data from Opt4TPT, a longitudinal cohort study examining TPT delivery in South Africa and Zimbabwe. We constructed multivariate logistic regression models to evaluate the association of receiving ART from a DSD model with TPT initiation and completion, as measured by electronic medication boxes. We constructed a Cox proportional hazards model to assess time to TPT initiation. RESULTS: Among 1193 participants, 276 received ART through a DSD model, while 917 used the conventional model. Overall, 1035(87%) initiated TPT, including 242(88%) in DSD models and 793(86%) in conventional models. Receiving ART from a DSD model was not significantly associated (OR 1.11, 95%CI 0.74-1.67, p=0.61) with TPT initiation. DSD models had a significantly longer mean time to initiation (6.5vs. 2.7 days, p=0.01). Among 731(71%) with MERM box data, 356(49%) completed TPT. Bivariate analysis showed higher odds of completing TPT among those in DSD models (OR 1.53, 95%CI 1.06-2.21, p=0.024), but this was not significant after adjusting for demographic and clinical factors (OR 0.89, 95%CI 0.58-1.36, p=0.58). CONCLUSIONS: High TPT uptake in DSD and conventional models indicate TPT delivery in DSD models is feasible. TPT completion was low in both models of care, showing a need to focus on improving TPT completion overall.