Assessing HIV-infected patient retention in a program of differentiated care in sub-Saharan Africa: a G-estimation approach

Yiannoutsos Constantin T. (), Wools-Kaloustian Kara, Musick Beverly S., Kosgei Rose, Kimaiyo Sylvester and Siika Abraham
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Yiannoutsos Constantin T.: Department of Biostatistics and Health Data Science, Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
Wools-Kaloustian Kara: Indiana University School of Medicine, Division of Infectious Diseases, Indianapolis, IN, USA
Musick Beverly S.: Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
Kosgei Rose: University of Nairobi, Nairobi, Kenya
Kimaiyo Sylvester: Moi University College of Health Sciences & Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
Siika Abraham: Moi University College of Health Sciences & Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

The International Journal of Biostatistics, 2024, vol. 20, issue 1, 279-291

Abstract: Differentiated care delivery aims to simplify care of people living with HIV, reflect their preferences, reduce burdens on the healthcare system, maintain care quality and preserve resources. However, assessing program effectiveness using observational data is difficult due to confounding by indication and randomized trials may be infeasible. Also, benefits can reach patients directly, through enrollment in the program, and indirectly, by increasing quality of and accessibility to care. Low-risk express care (LREC), the program under evaluation, is a nurse-centered model which assigns patients stable on ART to a nurse every two months and a clinician every third visit, reducing annual clinician visits by two thirds. Study population is comprised of 16,832 subjects from 15 clinics in Kenya. We focus on patient retention in care based on whether the LREC program is available at a clinic and whether the patient is enrolled in LREC. We use G-estimation to assess the effect on retention of two “strategies”: (i) program availability but no enrollment; (ii) enrollment at an available program; versus no program availability. Compared to no availability, LREC results in a non-significant increase in patient retention, among patients not enrolled in the program (indirect effect), while enrollment in LREC is associated with a significant extension of the time retained in care (direct effect). G-estimation provides an analytical framework useful to the assessment of similar programs using observational data.

Keywords: G-estimation; observational data; program evaluation; HIV/AIDS (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1515/ijb-2023-0031

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