{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:35:15Z","timestamp":1783110915171,"version":"3.54.6"},"reference-count":20,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Differentiated service delivery (DSD) models aim to tailor health services delivery to clients\u2019 preferences and clinical characteristics while reducing the burden on health systems. In Uganda, DSD models developed for HIV care were adapted to the tuberculosis (TB) services context to mitigate disruptions from the COVID\u201019 pandemic and inform national efforts to improve TB care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Beginning in April 2021, four facility\u2010based and five community\u2010based DSD models were implemented in 28 TB clinics in Kampala and Soroti Regions. All clients in the intensive (months 1\u20132) and continuation (months 3\u20136) phases of treatment were eligible. Client preference and clinician concurrence determined model choice. All models allowed TB medication dispensing intervals ranging from biweekly to multi\u2010month dispensing (MMD; \u2265\u00a02 months). Data abstracted in December 2022 from TB registers and DSD enrolment tracking tools at 21 of 28 implementing facilities were used to evaluate the intervention. The TB treatment success rate (i.e. proportion cured or who completed treatment, vs. those who died, failed, were lost\u2010to\u2010follow\u2010up or had no recorded outcome) in the DSD cohort was compared to facilities\u2019 2018\u20132019 results using Fischer's exact test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most facilities offered one (Kampala) or two (Soroti) facility\u2010based models and one community\u2010based model. Among 1864 TB clients enrolled between April 2021 and March 2022, 1822 (97.7%) used \u2265\u00a01 DSD models; 210\/1822 (11.5%) ever switched models. Overall, 70.5% (1284\/1822) of clients enrolled in \u2265\u00a01 facility\u2010based model and 40.5% (737\/1822) in \u2265\u00a01 community\u2010based model. The use of community\u2010based models increased during the continuation phase. Facility\u2010Based Individual Management and Home Delivery were the most\u2010used models. In the intensive phase, the longest medication dispensation interval was biweekly for 50.0% of patients, monthly for 41.3% and MMD for 8.8%. During the continuation phase, the longest interval was biweekly for 0.6%, monthly for 71.7% and MMD for 27.6%. Overall, 1582\/1864 (84.9%) clients were successfully treated, compared to 858\/1177 (72.9%) in 2018\u20132019 (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Seven (0.4%) patients failed treatment, 32 (1.7%) were lost to follow\u2010up, 101 (5.4%) died and 142 (7.6%) were not evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TB DSD models were successfully implemented. TB treatment outcomes under DSD compared favourably to historical outcomes. Investigating factors affecting MMD use and model choice could further inform programme design.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26483","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:32:03Z","timestamp":1751884323000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Introducing differentiated service delivery models for tuberculosis treatment: a pilot project to inform national policy in Uganda"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6180-9271","authenticated-orcid":false,"given":"Odile","family":"Ferroussier\u2010Davis","sequence":"first","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Global Health Center, Division of Global HIV &amp; TB  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deus","family":"Lukoye","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Global Health Center, Division of Global HIV &amp; 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TB  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius N.","family":"Kalamya","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Global Health Center, Division of Global HIV &amp; TB  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benson","family":"Nasasira","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute (IDI)  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estella","family":"Birabwa","sequence":"additional","affiliation":[{"name":"United States Department of Defense (DOD)  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyoum","family":"Dejene","sequence":"additional","affiliation":[{"name":"United States Agency for International Development  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Murungi","sequence":"additional","affiliation":[{"name":"United States Agency for International Development  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3555-0312","authenticated-orcid":false,"given":"Immaculate","family":"Ddumba","sequence":"additional","affiliation":[{"name":"United States Agency for International Development  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Moore","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Global Health Center, Division of Global HIV &amp; 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