Indirect Effects of HIV Differentiated Service Delivery Programmes on Quality of Clinic Care: A Retrospective Cohort Study of Clients Starting Antiretroviral Therapy

Abstract Introduction In countries with high HIV prevalence, differentiated service delivery programmes (DSD) for antiretroviral therapy (ART) play a vital role in improving access to ART for people living with HIV (PLHIV). While the benefits of DSD for clients enrolled in these programmes have been described, it is unknown whether DSD additionally benefits clients who are ineligible for these programmes, through allowing more clinic resources to be directed towards them. We aimed to assess whether increases in DSD referrals are associated with better care for clients initiating ART. Methods De-identified, routinely collected TIER.Net data from 112 clinics in KwaZulu-Natal, South Africa were used to assess service delivery for clients initiated during 2022-2023. Outcomes were the probability of newly-initiated clients having an initiation CD4 count result, a 6-month viral load result (among those visiting at 6 months) and being retained for 6 months after initiation (