ArticleBMC health services research2026
Factors associated with opting care from closer location to residence among PLHIV at Andhra Pradesh, India between 2023 and 2024.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDecentralization of antiretroviral therapy (ART) services is a key component of differentiated service delivery models to improve access and retention among people living with HIV (PLHIV). In Andhra Pradesh, India, many PLHIV continue to travel long distances for ART refills despite the availability of services at decentralized facilities. This analysis describes PLHIV preferences for decentralized ART services and the treatment outcomes.
methodsFrom October 2022 to April 2023, staff from 53 ART centers in Andhra Pradesh identified and systematically contacted PLHIV traveling more than 50 km to collect ART. Using a standard script, PLHIV were offered the option to receive care at decentralized facilities closer to their residence. We estimated the proportion of PLHIV opting for decentralized care and used modified Poisson regression with robust standard errors to identify factors associated with uptake, reported as adjusted relative risks (aRR). Retention in care over 12 months was compared between those receiving decentralized care and those continuing care at distant facilities using Kaplan-Meier methods.
resultsAmong 213,375 PLHIV alive in care, 20,761 (9.7%) traveled > 50 km for ART access. Of the 18,418 (88.7%) who were contacted, 8,877 (48.2%) opted for decentralized ART care (care closer to residence); however, only 6,639 (74.8%) reached the decentralized facility. Uptake was higher among females (aRR: 1.10; 95% CI: 1.07-1.14), those on ART for ≤ 3 years (aRR: 1.23; 95% CI: 1.19-1.28), and individuals with prior loss to follow-up, including < 3 interruptions (aRR: 1.17; 95% CI: 1.13-1.21) and ≥ 3 interruptions (aRR: 1.27; 95% CI: 1.22-1.32). At 12 months, retention was slightly higher among those receiving decentralized care (96.5%; 95% CI: 96.1-96.9) compared with those continuing care at distant facilities (95.2%; 95% CI: 94.8-95.7), with lower loss to follow-up (2.3% vs. 3.6%), while mortality was similar (1.2% in both groups). Common reasons for declining closer care included access to co-located health services (37%), perceived anonymity (29%), proximity to workplace (13%), staff familiarity (10%), and self-perceived stigma (5%).
conclusionPLHIV choice with decentralized ART delivery improved retention modestly without compromising mortality, while highlighting the need to address stigma, anonymity, and integrated service access when expanding decentralized care. Strengthening person-centered models may enhance service efficiency and equitable access to HIV care and treatment.
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