Utilization and Associated Factors of the Community-Based Differentiated Service Delivery Model Among ART Users in Dessie Public Health Facilities, Northeast Ethiopia: A Mixed Method Study

Background Differentiated service delivery models (DSDMs) are client-centered approaches to HIV care that improve efficiency through simplification, task shifting, and decentralization. However, utilization of Ethiopia's community-based DSDM remains low, and its determinants are not well understood. Objective To assess the utilization of and factors associated with community-based DSDM among ART users in Dessie public health facilities, Northeast Ethiopia, 2025. Methods A convergent mixed-methods cross-sectional study was conducted among 635 randomly selected ART users. Quantitative data were collected using interviewer-administered questionnaires and analyzed using multivariable logistic regression in STATA 16. In-depth interviews with purposively selected ART users were analyzed thematically to explore contextual barriers and facilitators. Results Overall, 17.1% (95% CI: 14.3-20.3%) utilized community-based DSDM. Utilization was positively associated with primary education, HIV status disclosure, and ART regimen change, but negatively associated with prior loss to follow-up and baseline CD4 ≥ 500 cells/mm 3 . Qualitative findings highlighted information gaps, stigma, and misconceptions as barriers, while peer support facilitated uptake. Conclusion Community-based DSDM utilization remains suboptimal, underscoring the need for strengthened counseling, stigma reduction, and targeted patient education to enhance uptake.