Differentiated service delivery for TB treatment

BACKGROUND Differentiated service delivery (DSD) includes service decentralisation, multi-month medication dispensing, and treatment support. We describe demographic and clinical characteristics, treatment support, and outcomes among clients treated under a TB treatment DSD model in five facilities in Lusaka and Livingstone, Zambia, from February 2022 to March 2023. METHODS Medicines were dispensed for 2 months in intensive and 4 months in the continuation phases of TB treatment. Treatment support was provided through text message, phone, and home visits to monitor symptoms, adherence, and adverse events. Association between demographic, clinical, and treatment support variables and likelihood of successful treatment was examined using Pearson’s χ² or Fisher’s exact tests. RESULTS Among 970 clients treated under DSD, most were HIV-negative (72%) and had pulmonary TB (94%). Only 6% of the clients ever-responded to text-based surveys, while 85% were reached by phone or home visit. Overall, 83% of the clients were successfully treated for TB. Significant differences in treatment success were observed by facility (74%–91%, P < 0.001), form of TB (extra-pulmonary 72%, pulmonary 84%, P = 0.020), and received any treatment support (no, 76%, yes, 85%, P = 0.006). CONCLUSION DSD models including treatment support may give clients more control over how, when, and where they receive care while achieving treatment success.