{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:12:29Z","timestamp":1772118749743,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"S6","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1192640"],"award-info":[{"award-number":["OPP1192640"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2021,10]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n Differentiated service delivery (DSD) models aim to improve the access of human immunodeficiency virus treatment on clients and reduce requirements for facility visits by extending dispensing intervals. With the advent of the COVID\u201019 pandemic, minimising client contact with healthcare facilities and other clients, while maintaining treatment continuity and avoiding loss to care, has become more urgent, resulting in efforts to increase DSD uptake. We assessed the extent to which DSD coverage and antiretroviral treatment (ART) dispensing intervals have changed during the COVID\u201019 pandemic in Zambia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We used client data from Zambia's electronic medical record system (SmartCare) for 737 health facilities, representing about three\u2010fourths of all ART clients nationally. We compared the numbers and proportional distributions of clients enrolled in DSD models in the 6 months before and 6 months after the first case of COVID\u201019 was diagnosed in Zambia in March 2020. Segmented linear regression was used to determine whether the outbreak of COVID\u201019 in Zambia further accelerated the increase in DSD scale\u2010up.<\/jats:p>\n <\/jats:sec>\n \n Results and discussion<\/jats:title>\n \n Between September 2019 and August 2020, 181,317 clients aged 15 or older (81,520 and 99,797 from 1 September 2019 to 1 March 2020 and from 1 March to 31 August 2020, respectively) enrolled in DSD models in Zambia. Overall participation in all DSD models increased over the study period, but uptake varied by model. The rate of acceleration increased in the second period for home ART delivery (152%),\n \n 2\u2010month fast\u2010track (143%) and 3\u2010month MMD (139%). There was a significant reduction in the enrolment rates for 4\u2010 to 6\u2010month fast\u2010track (\u221228%) and \u201cother\u201c models (\u221219%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Participation in DSD models for stable ART clients in Zambia increased after the advent of COVID\u201019, but dispensing intervals diminished. Eliminating obstacles to longer dispensing intervals, including those related to supply chain management, should be prioritized to achieve the expected benefits of DSD models and minimize COVID\u201019 risk.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jia2.25808","type":"journal-article","created":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T01:34:54Z","timestamp":1635471294000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Changes in HIV treatment differentiated care uptake during the COVID\u201019 pandemic in Zambia: interrupted time series analysis"],"prefix":"10.1002","volume":"24","author":[{"given":"Youngji","family":"Jo","sequence":"first","affiliation":[{"name":"Section of Infectious Diseases Department of Medicine Boston Medical Center Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6560-2964","authenticated-orcid":false,"given":"Sydney","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Global Health Boston University School of Public Health Boston Massachusetts USA"},{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karla Therese L.","family":"Sy","sequence":"additional","affiliation":[{"name":"Department of Global Health Boston University School of Public Health Boston Massachusetts USA"},{"name":"Department of Epidemiology Boston University School of Public Health Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bevis","family":"Phiri","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy N.","family":"Huber","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muya","family":"Mwansa","sequence":"additional","affiliation":[{"name":"Ministry of Health Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilda","family":"Shakwelele","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prudence","family":"Haimbe","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mpande M.","family":"Mwenechanya","sequence":"additional","affiliation":[{"name":"The Centre for Infectious Disease Research in Zambia Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla","family":"Lumano\u2010Mulenga","sequence":"additional","affiliation":[{"name":"Ministry of Health Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-4999","authenticated-orcid":false,"given":"Brooke E.","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Global Health Boston University School of Public Health Boston Massachusetts USA"},{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"Department of Medical Microbiology Amsterdam University Medical Centre Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"World Health Organization. The Cost of Inaction: COVID\u201019\u2010Related Service Disruptions Could Cause Hundreds of Thousands of Extra Deaths from HIV.2020. Available from:https:\/\/www.who.int\/news\/item\/11\u201005\u20102020\u2010the\u2010cost\u2010of\u2010inaction\u2010covid\u201019\u2010related\u2010service\u2010disruptions\u2010could\u2010cause\u2010hundreds\u2010of\u2010thousands\u2010of\u2010extra\u2010deaths\u2010from\u2010hiv. Accessed 11 March 2021."},{"key":"e_1_2_9_3_1","unstructured":"CDC2021. Operational Considerations for Maintaining Essential Services and Providing Care and Treatment for Those Living with HIV in Low\u2010Resource Non\u2010US Settings During the COVID\u201019 Pandemic. Available from:https:\/\/www.cdc.gov\/coronavirus\/2019\u2010ncov\/downloads\/global\u2010covid\u201019\/COVID\u2010Essential\u2010services\u2010HIV.pdf. Accessed 11 March 2021."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002549"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-020-05010-w"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12539"},{"key":"e_1_2_9_7_1","volume-title":"Zambia consolidated guidelines for treatment & prevention of HIV infection","author":"Republic of Zambia Ministry of Health","year":"2016"},{"key":"e_1_2_9_8_1","unstructured":"CQUIN Mulenga P. Zambia Update2020. 4th CQUIN Annual Meeting. Available from:https:\/\/cquin.icap.columbia.ed\/wp\u2010content\/uploads\/2020\/12\/4th\u2010CQUIN\u2010Annual\u20102020\u2010Virtual\u2010Meeting_Zambia\u2010Presentation_Final.pdf. Accessed 11 March 2021."},{"key":"e_1_2_9_9_1","volume-title":"Zambia: differentiated service delivery framework","author":"Ministry of Health","year":"2018"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002737"},{"key":"e_1_2_9_11_1","unstructured":"Ministry of Health ZambiaZambia Consolidated Guidelines for Prevention and Treatment of HIV Infection. 2018 [cited 2019 15 August]. Available from:http:\/\/www.hivst.org\/files1\/Final\u2010Zambia\u2010Consolidated\u2010Guidelines_2018\u2010Print.pdf. Accessed 11 March 2021."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-20-00532"},{"issue":"1","key":"e_1_2_9_13_1","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Bernal JL","year":"2017","journal-title":"Int J Epidemiol"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","unstructured":"CDC2020. First 100 Persons with COVID\u201019 \u2013 Zambia 18 March\u201328 April 2020.https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6942a5.htm. Accessed 11 March 2021.","DOI":"10.15585\/mmwr.mm6942a5"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25704"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00039-5"},{"key":"e_1_2_9_17_1","unstructured":"Anna Grimsrud2020. Impacts of COVID 19 to HIV Service Delivery. Available from:https:\/\/www.differentiatedservicedelivery.org\/Portals\/0\/adam\/Content\/EBB9KL28MUOMZ6NaaUclaA\/File\/WEBINAR1_1_IAS_Anna_presentation.pdf. Accessed 11 March 2020."}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25808","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.25808","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25808","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T13:12:06Z","timestamp":1693228326000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25808"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":16,"journal-issue":{"issue":"S6","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1002\/jia2.25808"],"URL":"https:\/\/doi.org\/10.1002\/jia2.25808","archive":["Portico"],"relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.03.20.21254021","asserted-by":"object"}]},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]},"assertion":[{"value":"2021-03-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e25808"}}