# A sequential, adaptive model of differentiated service delivery to reach persons living with HIV who are lost-to-follow-up or who have detectable viral load

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2022 · $40,007

## Abstract

ABSTRACT
While there is no effective cure for HIV, taking HIV medicine called antiretroviral therapy (ART) can reduce the
amount of HIV in the blood of people with HIV to almost complete suppression of viral replication and
undetectable viral load. In South Africa, the vast majority of ART is dispensed through clinics. The COVID-19
pandemic demonstrated how disruptions to health care services can impact individuals' access to care. However,
novel approaches to health care delivery have allowed providers to continue to meet the needs of their patients
throughout the pandemic. Specifically for HIV care, home delivery of ART has the potential to both increase
coverage for decentralized ART delivery in rural communities and be cost-effective in comparison to clinic-based
ART refills. In the pilot Deliver Health Study, we demonstrated that home delivery and monitoring of ART,
including a client fee for service, increased viral suppression compared to standard clinic-based services.
Furthermore, home delivery of ART would likely reduce the number of people commuting to clinics with personal
vehicles and public transportation, decrease overall emissions, and have a positive impact on environmental
health. The goal of the proposed Diversity Supplement is to compare the cost, cost-effectiveness, environmental
impact, and COVID-19 service disruptions of two different ART resupply mechanisms on viral suppression in
KwaZulu-Natal, South Africa. This project will utilize data from a pilot study conducted in 2020, the Deliver Health
Study, to inform the ongoing sequential multiple assignment randomized controlled trial of scalable interventions
for antiretroviral therapy delivery (SMART ART) in South Africa co-led by Dr. Ruanne Barnabas at the University
of Washington in Seattle and Dr. Alastair van Heerden at the Human Sciences Research Council in South Africa.

## Key facts

- **NIH application ID:** 10524390
- **Project number:** 3R01MH124465-02S1
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Ruanne Vanessa Barnabas
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $40,007
- **Award type:** 3
- **Project period:** 2022-06-16 → 2024-06-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10524390

## Citation

> US National Institutes of Health, RePORTER application 10524390, A sequential, adaptive model of differentiated service delivery to reach persons living with HIV who are lost-to-follow-up or who have detectable viral load (3R01MH124465-02S1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10524390. Licensed CC0.

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