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Sydney Rosen - One of the best experts on this subject based on the ideXlab platform.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
Global health science and practice, 2021Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization's models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an "organization-model." Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific Service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel. Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
medRxiv, 2020Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Abstract Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization’s models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to one organization supporting one model of care as an “organization-model.”. Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility based individual models, 21 out-of-facility based individual models, 14 healthcare worker led groups, and 3 client led groups; jointly, these encompassed 12 Service delivery strategies. Over 2/3 (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established healthcare facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from a low of 2 to a high of 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff (doctors, nurses, pharmacists), while group models made greater use of lay personnel (community health workers, counselors). Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
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patients are not the same so we cannot treat them the same a qualitative content analysis of provider patient and implementer perspectives on Differentiated Service delivery models for hiv treatment in south africa
Journal of the International AIDS Society, 2020Co-Authors: Sophie Pascoe, Amy N Huber, Sydney Rosen, Nancy Scott, Rachel M Fong, Joshua Murphy, Aneesa Moolla, Mokgadi Phokojoe, Marelize GorgensAbstract:INTRODUCTION In 2014, the South African government adopted a Differentiated Service delivery (DSD) model in its "National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)" (AGL) to strengthen the HIV care cascade. We describe the barriers and facilitators of the AGL implementation as experienced by various stakeholders in eight intervention and control sites across four districts. METHODS Embedded within a cluster-randomized evaluation of the AGL, we conducted 48 in-depth interviews (IDIs) with healthcare providers, 16 IDIs with Department of Health and implementing partners and 24 focus group discussions (FGDs) with three HIV patient groups: new, stable and those not stable on treatment or not adhering to care. IDIs were conducted from August 2016 to August 2017; FGDs were conducted in January to February 2017. Content analysis was guided by the Consolidated Framework for Implementation Research. Findings were triangulated among respondent types to elicit barriers and facilitators to implementation. RESULTS New HIV patients found counselling helpful but intervention respondents reported sub-optimal counselling and privacy concerns as barriers to initiation. Providers felt insufficiently trained for this intervention and were confused by the simultaneous rollout of the Universal Test and Treat strategy. For stable patients, repeat prescription collection strategies (RPCS) were generally well received. Patients and providers concurred that RPCS reduced congestion and waiting times at clinics. There was confusion though, among providers and implementers, around implementation of RPCS interventions. For patients not stable on treatment, enhanced counselling and tracing patients lost-to-follow-up were perceived as beneficial to adherence behaviours but faced logistical challenges. All providers faced difficulties accessing data and identifying patients in need of tracing. Congestion at clinics and staff attitude were perceived as barriers preventing patients returning to care. CONCLUSIONS Implementation of DSD models at scale is complex but this evaluation identified several positive aspects of AGL implementation. The positive perception of RPCS interventions and challenges managing patients not stable on treatment aligned with results from the larger evaluation. While some implementation challenges may resolve with experience, ensuring providers and implementers have the necessary training, tools and resources to operationalize AGL effectively is critical to the overall success of South Africa's HIV control strategy.
Amy N Huber - One of the best experts on this subject based on the ideXlab platform.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
Global health science and practice, 2021Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization's models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an "organization-model." Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific Service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel. Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
medRxiv, 2020Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Abstract Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization’s models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to one organization supporting one model of care as an “organization-model.”. Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility based individual models, 21 out-of-facility based individual models, 14 healthcare worker led groups, and 3 client led groups; jointly, these encompassed 12 Service delivery strategies. Over 2/3 (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established healthcare facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from a low of 2 to a high of 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff (doctors, nurses, pharmacists), while group models made greater use of lay personnel (community health workers, counselors). Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
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patients are not the same so we cannot treat them the same a qualitative content analysis of provider patient and implementer perspectives on Differentiated Service delivery models for hiv treatment in south africa
Journal of the International AIDS Society, 2020Co-Authors: Sophie Pascoe, Amy N Huber, Sydney Rosen, Nancy Scott, Rachel M Fong, Joshua Murphy, Aneesa Moolla, Mokgadi Phokojoe, Marelize GorgensAbstract:INTRODUCTION In 2014, the South African government adopted a Differentiated Service delivery (DSD) model in its "National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)" (AGL) to strengthen the HIV care cascade. We describe the barriers and facilitators of the AGL implementation as experienced by various stakeholders in eight intervention and control sites across four districts. METHODS Embedded within a cluster-randomized evaluation of the AGL, we conducted 48 in-depth interviews (IDIs) with healthcare providers, 16 IDIs with Department of Health and implementing partners and 24 focus group discussions (FGDs) with three HIV patient groups: new, stable and those not stable on treatment or not adhering to care. IDIs were conducted from August 2016 to August 2017; FGDs were conducted in January to February 2017. Content analysis was guided by the Consolidated Framework for Implementation Research. Findings were triangulated among respondent types to elicit barriers and facilitators to implementation. RESULTS New HIV patients found counselling helpful but intervention respondents reported sub-optimal counselling and privacy concerns as barriers to initiation. Providers felt insufficiently trained for this intervention and were confused by the simultaneous rollout of the Universal Test and Treat strategy. For stable patients, repeat prescription collection strategies (RPCS) were generally well received. Patients and providers concurred that RPCS reduced congestion and waiting times at clinics. There was confusion though, among providers and implementers, around implementation of RPCS interventions. For patients not stable on treatment, enhanced counselling and tracing patients lost-to-follow-up were perceived as beneficial to adherence behaviours but faced logistical challenges. All providers faced difficulties accessing data and identifying patients in need of tracing. Congestion at clinics and staff attitude were perceived as barriers preventing patients returning to care. CONCLUSIONS Implementation of DSD models at scale is complex but this evaluation identified several positive aspects of AGL implementation. The positive perception of RPCS interventions and challenges managing patients not stable on treatment aligned with results from the larger evaluation. While some implementation challenges may resolve with experience, ensuring providers and implementers have the necessary training, tools and resources to operationalize AGL effectively is critical to the overall success of South Africa's HIV control strategy.
Sophie Pascoe - One of the best experts on this subject based on the ideXlab platform.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
Global health science and practice, 2021Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization's models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an "organization-model." Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific Service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel. Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
medRxiv, 2020Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Abstract Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization’s models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to one organization supporting one model of care as an “organization-model.”. Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility based individual models, 21 out-of-facility based individual models, 14 healthcare worker led groups, and 3 client led groups; jointly, these encompassed 12 Service delivery strategies. Over 2/3 (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established healthcare facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from a low of 2 to a high of 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff (doctors, nurses, pharmacists), while group models made greater use of lay personnel (community health workers, counselors). Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
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patients are not the same so we cannot treat them the same a qualitative content analysis of provider patient and implementer perspectives on Differentiated Service delivery models for hiv treatment in south africa
Journal of the International AIDS Society, 2020Co-Authors: Sophie Pascoe, Amy N Huber, Sydney Rosen, Nancy Scott, Rachel M Fong, Joshua Murphy, Aneesa Moolla, Mokgadi Phokojoe, Marelize GorgensAbstract:INTRODUCTION In 2014, the South African government adopted a Differentiated Service delivery (DSD) model in its "National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)" (AGL) to strengthen the HIV care cascade. We describe the barriers and facilitators of the AGL implementation as experienced by various stakeholders in eight intervention and control sites across four districts. METHODS Embedded within a cluster-randomized evaluation of the AGL, we conducted 48 in-depth interviews (IDIs) with healthcare providers, 16 IDIs with Department of Health and implementing partners and 24 focus group discussions (FGDs) with three HIV patient groups: new, stable and those not stable on treatment or not adhering to care. IDIs were conducted from August 2016 to August 2017; FGDs were conducted in January to February 2017. Content analysis was guided by the Consolidated Framework for Implementation Research. Findings were triangulated among respondent types to elicit barriers and facilitators to implementation. RESULTS New HIV patients found counselling helpful but intervention respondents reported sub-optimal counselling and privacy concerns as barriers to initiation. Providers felt insufficiently trained for this intervention and were confused by the simultaneous rollout of the Universal Test and Treat strategy. For stable patients, repeat prescription collection strategies (RPCS) were generally well received. Patients and providers concurred that RPCS reduced congestion and waiting times at clinics. There was confusion though, among providers and implementers, around implementation of RPCS interventions. For patients not stable on treatment, enhanced counselling and tracing patients lost-to-follow-up were perceived as beneficial to adherence behaviours but faced logistical challenges. All providers faced difficulties accessing data and identifying patients in need of tracing. Congestion at clinics and staff attitude were perceived as barriers preventing patients returning to care. CONCLUSIONS Implementation of DSD models at scale is complex but this evaluation identified several positive aspects of AGL implementation. The positive perception of RPCS interventions and challenges managing patients not stable on treatment aligned with results from the larger evaluation. While some implementation challenges may resolve with experience, ensuring providers and implementers have the necessary training, tools and resources to operationalize AGL effectively is critical to the overall success of South Africa's HIV control strategy.
Alaa S Youssef - One of the best experts on this subject based on the ideXlab platform.
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performance management for cluster based web Services
IEEE Journal on Selected Areas in Communications, 2005Co-Authors: Giovanni Pacifici, Asser N Tantawi, Mike Spreitzer, Alaa S YoussefAbstract:We present an architecture and prototype implementation of a performance management system for cluster-based web Services. The system supports multiple classes of web Services traffic and allocates server resources dynamically so to maximize the expected value of a given cluster utility function in the face of fluctuating loads. The cluster utility is a function of the performance delivered to the various classes, and this leads to Differentiated Service. In this paper, we will use the average response time as the performance metric. The management system is transparent: it requires no changes in the client code, the server code, or the network interface between them. The system performs three performance management tasks: resource allocation, load balancing, and server overload protection. We use two nested levels of management. The inner level centers on queuing and scheduling of request messages. The outer level is a feedback control loop that periodically adjusts the scheduling weights and server allocations of the inner level. The feedback controller is based on an approximate first-principles model of the system, with parameters derived from continuous monitoring. We focus on SOAP-based web Services. We report experimental results that show the dynamic behavior of the system.
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performance management for cluster based web Services
Integrated Network Management, 2003Co-Authors: R Levy, J Nagarajarao, Giovanni Pacifici, A Spreitzer, Asser N Tantawi, Alaa S YoussefAbstract:We present an architecture and prototype implementation of a performance management system for cluster-based Web Services. The system supports multiple classes of Web Services traffic and allocates server resources dynamically so to maximize the expected value of a given cluster utility function in the face of fluctuating loads. The cluster utility is a function of the performance delivered to the various classes, and this leads to Differentiated Service. In this paper we use the average response time as the performance metric. The management system is transparent: it requires no changes in the client code, the server code, or the network interface between them. The system performs three performance management tasks: resource allocation, load balancing, and server overload protection. We use two nested levels of management mechanism. The inner level centers on queuing and scheduling of request messages. The outer level is a feedback control loop that periodically adjusts the scheduling weights and server allocations of the inner level. The feedback controller is based on an approximate first-principles model of the system, with parameters derived from continuous monitoring. We focus on SOAP-based Web Services. We report experimental results that show the dynamic behavior of the system.
Lawrence Long - One of the best experts on this subject based on the ideXlab platform.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
Global health science and practice, 2021Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization's models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an "organization-model." Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific Service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel. Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
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Differentiated Service delivery models for hiv treatment in malawi south africa and zambia a landscape analysis
medRxiv, 2020Co-Authors: Amy N Huber, Sophie Pascoe, Brooke E Nichols, Lawrence Long, Salome Kuchukhidze, Bevis Phiri, Timothy Tchereni, Sydney RosenAbstract:Abstract Introduction Many countries in Africa are scaling up Differentiated Service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods We interviewed DSD model implementing organizations for descriptive information about each of the organization’s models of care. We described the key characteristics of each model, including population of patients served, location of Service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to one organization supporting one model of care as an “organization-model.”. Results The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility based individual models, 21 out-of-facility based individual models, 14 healthcare worker led groups, and 3 client led groups; jointly, these encompassed 12 Service delivery strategies. Over 2/3 (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established healthcare facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from a low of 2 to a high of 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff (doctors, nurses, pharmacists), while group models made greater use of lay personnel (community health workers, counselors). Conclusions As of 2019, there was a large variety of Differentiated Service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.
