Community-based HIV treatment delivery models are as effective as standard clinic-based care in maintaining viral suppression and keeping patients engaged in therapy across Africa, according to a new study.
The systematic review and meta-analysis, published in AIDS Research and Therapy, examined evidence from 15 randomized controlled trials conducted in six African countries between 2018 and 2024.
Researchers found no significant difference in viral non-suppression rates between differentiated service delivery models and conventional facility-based care, suggesting that stable patients can safely receive treatment with fewer clinic visits.
Differentiated service delivery approaches include community antiretroviral refill groups, adherence clubs, home-based drug delivery, fast-track medication pick-up services and multi-month dispensing of antiretroviral therapy.
The study comes as African health systems face growing strain from rising numbers of people on lifelong HIV treatment.
By the end of 2022, around 39 million people worldwide were living with HIV, with Africa accounting for about 65% of cases, the authors said.
While expanded access to antiretroviral therapy has improved life expectancy, it has also increased pressure on overstretched clinics and health workers, particularly in low-resource settings.
The analysis showed that viral non-suppression risk was similar between delivery models, with a pooled risk ratio of 0.89 and a confidence interval spanning 0.74 to 1.07.
Retention outcomes were also comparable.
The risk of non-retention in care was not significantly different between differentiated models and standard treatment, with a pooled risk ratio of 1.03.
Loss to follow-up rates likewise showed no clear difference, although uncertainty remained due to wide confidence intervals.
The authors said differentiated models could help reduce clinic congestion, lower service delivery costs and allow healthcare workers to focus on patients with advanced disease or unstable treatment outcomes.
They cautioned, however, that the overall certainty of evidence ranged from low to moderate, partly due to differences in study design and follow-up periods, which were mostly limited to 12 months.
Further long-term research is needed to assess sustained outcomes, the researchers added.
The findings support broader adoption of people-centred HIV care strategies as African countries seek to expand treatment coverage and meet global HIV targets.
