Implementation of DSD models in selected health facilities in Zambia: a RE-AIM framework analysis

Zambia has a significant prevalence of HIV, with a large number of infected individuals receiving Antiretroviral Therapy (ART). A patient-centered style of ART distribution called Differentiated Service Delivery (DSD) models was established with the aim of enhancing patient outcomes and improving the efficiency of health systems. There is limited knowledge regarding the deployment of these models, including the facilitators and barriers to implementation from both the providers and end users. This paper explores the implementation of different DSD models in selected health facilities in Zambia. This study used a case study design. Data was collected through in-depth interviews with individuals who were receiving ART through a DSD model and through key informant interviews with program implementers at various levels, from provincial officials to health facility workers. These interviews were conducted using semi-structured interview guides. Both Key informants and ART clients were selected using purposive sampling. All interviews were recorded and transcribed verbatim. Thematic analysis was employed to conduct the analysis, which was guided by the RE AIM framework. The overall reach of the DSD models is influenced by the cost and distance to the health facility. The DSD models were found to be effective as they improve ART adherence and allowed for health facility staff to plan client visits systematically. To facilitate adoption, modifications were implemented, including the utilization of IEC materials and the participation of traditional and community leaders. The DSD models were successfully implemented as planned, with regular monitoring and training provided for the models. It was recommended that capacity building and human resource expansion be implemented in order to maintain the models. Furthermore, it was proposed that models should be created with a specific focus on meeting the needs of people with disabilities. Based on the detailed and comprehensive RE AIM framework DSD models show promise in improving the delivery of ART services. The findings highlight the importance of rolling out these models to cater to more people throughout the country.