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30-05-2021 Open Access

Beyond viral suppression: Quality of life among stable ART clients in a differentiated service delivery intervention in Tanzania

Quality of Life Research
Nwanneka Ebelechukwu Okere, Veronica Censi, Clementina Machibya, Kathleen Costigan, P. Katambi, Giulia Martelli, Josien de Klerk, Sabine Hermans, Gabriela B. Gomez, Anton Pozniak, Tobias Rinke de Wit, Denise Naniche
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Supplementary Information

The online version contains supplementary material available at https://​doi.​org/​10.​1007/​s11136-021-02889-z.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



With antiretroviral therapy, more people living with HIV (PLHIV) in resource-limited settings are virally suppressed and living longer. WHO recommends differentiated service delivery (DSD) as an alternative, less resource-demanding way of expanding HIV services access. Monitoring client’s health-related quality of life (HRQoL) is necessary to understand patients’ perceptions of treatment and services but is understudied in sub-Saharan Africa. We assessed HRQoL among ART clients in Tanzania accessing two service models.


Cross-sectional survey from May–August 2019 among stable ART clients randomly sampled from clinics and clubs in the Shinyanga region providing DSD and clinic-based care. HRQoL data were collected using a validated HIV-specific instrument—Functional Assessment of HIV infection (FAHI), in addition to socio-demographic, HIV care, and service accessibility data. Descriptive analysis of HRQoL, logistic regression and a stepwise multiple linear regression were performed to examine HRQoL determinants.


629 participants were enrolled, of which 40% accessed DSD. Similar HRQoL scores [mean (SD), p-value]; FAHI total [152.2 (22.2) vs 153.8 (20.6), p 0.687] were observed among DSD and clinic-based care participants. Accessibility factors contributed more to emotional wellbeing among DSD participants compared to the clinic-based care participants (53.4% vs 18.5%, p =  < 0.001). Satisfactory (> 80% of maximum score) HRQoL scoring was associated with (OR [95% CI], p-value) being male (2.59 [1.36–4.92], p 0.004) among clinic participants and with urban residence (4.72 [1.70–13.1], p 0.001) among DSD participants.


Similar HRQoL was observed in DSD and clinic-based care. Our research highlights focus areas to identify supporting interventions, ultimately optimizing HRQoL among PLHIV.

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