ArticleJournal of the International AIDS Society2025
Introducing differentiated service delivery models for tuberculosis treatment: a pilot project to inform national policy in Uganda.
Article in Journal of the International AIDS Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Defining person-centred treatment support for multidrug-resistant TB: a discrete choice experiment.IJTLD open · 2026Article
- Tailoring TB services for improved treatment adherence in Ghana - A mixed-methods study.Journal of public health research · 2026Article
- Implementation of differentiated service delivery strategies for patients with tuberculosis in Haiti during a severe humanitarian crisis, January-August 2021.PLOS global public health · 2026Article
- Build, do not dismantle: leveraging a differentiated service delivery approach for broader health impact amidst funding changes.Journal of the International AIDS Society · 2025Article
- "Now that I took TPT, it's affecting my ART adherence, viral load, even my wellbeing in the community". Exploring acceptability and experience of Tuberculosis Preventive Treatment among adolescents living with HIV in Zimbabwe.PLOS global public health · 2025Article
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25 authors.
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Abstract
introductionDifferentiated service delivery (DSD) models aim to tailor health services delivery to clients' 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-19 pandemic and inform national efforts to improve TB care.
methodsBeginning in April 2021, four facility-based and five community-based DSD models were implemented in 28 TB clinics in Kampala and Soroti Regions. All clients in the intensive (months 1-2) and continuation (months 3-6) 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-month dispensing (MMD; ≥ 2 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-to-follow-up or had no recorded outcome) in the DSD cohort was compared to facilities' 2018-2019 results using Fischer's exact test.
resultsMost facilities offered one (Kampala) or two (Soroti) facility-based models and one community-based model. Among 1864 TB clients enrolled between April 2021 and March 2022, 1822 (97.7%) used ≥ 1 DSD models; 210/1822 (11.5%) ever switched models. Overall, 70.5% (1284/1822) of clients enrolled in ≥ 1 facility-based model and 40.5% (737/1822) in ≥ 1 community-based model. The use of community-based models increased during the continuation phase. Facility-Based Individual Management and Home Delivery were the most-used 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 2018-2019 (p < 0.001). Seven (0.4%) patients failed treatment, 32 (1.7%) were lost to follow-up, 101 (5.4%) died and 142 (7.6%) were not evaluated.
conclusionsTB 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.
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