Promising results have been found in models using fixed community points. Evidence has come from the community drug distribution point (CDDP) model in Uganda, the community ART distribution points (PODI) in the Democratic Republic of the Congo (DRC), external pick-up points in South Africa, community pick-up points in Zambia and community private pharmacy collection in Nigeria and Uganda.
In Uganda, cross-sectional outcomes for clients initiating ART from 2004 to 2009 (median time on ART: 5.7 years; interquartile range, IQR: 4.1-7.2 years) in the CDDP model were that 69% were retained in care, 17% had died, 6% were transferred out and 9% were lost to follow up (LTFU). Among CDDP clients, viral load suppression (<1,000 copies/mL) was 93% (median time on ART: 7.0 years; IQR; 5.0-8.0) (1). In a subsequent conference abstract, LTFU was reported as 16.5% in the facility arm and 4.28% in the CDDP arm (p<0.0001) (2). A costing comparison study in Uganda put the model from The AIDS Support Organization (TASO), including TASO-run clinics for new initiations and the CDDP model for stable clients, at US$74/visit and $332/client/year compared with a mobile ART delivery model utilizing expert clients to dispense ART (US$45/visit; $404/client/year) and a facility-based nurse-led model (US$38/visit; $257/client/year) (3).
In the DRC, a retrospective cohort analysis found LTFU and death among PODI clients to be at 2.2% and 0.1% at six months,4.8% and 0.2% at 12 months and 9% and 0.3% at 24 months, respectively, with overall crude attrition of 5.66/100 person years with little variation over time (4). Two 2018 conference abstracts also reported on PODI outcomes. The first on 576 clients enrolled in a PODI from October 2016 to December 2017 reported 12-month retention of 98% (5). The second on 1484 ART clients enrolled at the four PODI houses which resulted in decanting of linked facilities by 44%- 47%. The four PODI houses show high retention rates of 92-100% at 3, 6 and 9 months and VL suppression above 90% (6).