BACKGROUND: Multi-month dispensing (MMD) is a vital strategy for differentiated service delivery (DSD) to enhance care and treatment outcomes of people living with HIV. However, MMD coverage in children and adolescents living with HIV (CALHIV) is limited. This study examines the association between interventions provided by the community based ACHIEVE project on MMD coverage in CALHIV receiving ART in Tanzania.
METHODS: Data from 43,668 CALHIV aged 0-17 years who were beneficiaries of the ACHIEVE project as of 31 July 2023 was used. MMD, a clinical characteristic of the CALHIV obtained from health facilities, was the outcome variable in three categories: not on MMD, MMD 3-5 months, and MMD 6+ months. Data analysis involved cross tabulations and multivariable mixed-effects ordinal logistic regression model to identify how different interventions of the ACHIEVE project influenced MMD in the CALHIV.
RESULTS: The analysis included CALHIV aged 10.5 years on average, 52.3% of whom were female. Their MMD status as of 31 July 2023 was 31.3%, 11.2%, and 57.5% for not on MMD, 3-5 months, and 6+ months, respectively. After adjusting for several characteristics, the likelihood of CALHIV to be on MMD was positively influenced by the ACHIEVE project interventions, including longer duration in the project (6-11 months: aOR = 3.65, 95% CI 2.85–4.69; 12+ months: aOR = 3.73, 95% CI 2.91–4.79), provision of ART calendar (aOR = 1.61, 95% CI 1.47–1.77, caregiver participation in savings groups (aOR = 1.23, 95% CI 1.13–1.34), teen club attendance (aOR = 2.57, 95% CI 2.32–2.84), and provision of health insurance (aOR = 1.25 95% CI 1.16–1.35).
CONCLUSIONS: The findings reveal a significant, positive association between interventions provided by the ACHIEVE project and the likelihood of CALHIV to be on MMD. This highlights the potential role of community-based programs in DSD for improving MMD utilization.