Clients' satisfaction with HIV differentiated service delivery models and associated factors in sub-Saharan Africa: a...

Differentiated Service Delivery (DSD) models for HIV are antiretroviral therapy (ART) mechanisms for stable people living with HIV (PLHIV) and are meant to be patient-centered to achieve treatment goals. One key element to achieve treatment goals is clients' satisfaction with DSD models. Despite extensive implementation and scale-up of DSD models in sub-Saharan Africa, satisfaction levels remain unclear. Thus far, no comprehensive systematic review and meta-analysis regarding clients' satisfaction level with DSD models and associated factors has been published. Therefore, we aim to conduct a systematic review and meta-analysis (1) to establish the level of clients' satisfaction with DSD models, (2) to determine which specific DSD models clients are most likely to be satisfied with, and (3) to identify factors associated with clients' satisfaction with DSD models.

All eligible studies reporting empirical evidence will be identified using a predetermined search strategy in several electronic databases such as EMBASE, PubMed, Scopus, Web of Science, CINAHL, and ProQuest. Observational studies that have been conducted in sub-Saharan African countries regardless of the year of publication will be included in the systematic review and meta-analysis. We will conduct this review and meta-analysis according to the guidelines by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A random effects model will be used to conduct the meta-analysis using Stata 19.5 software. Heterogeneity will be assessed by using Cochran's Q test and the I² statistic. Bias will be evaluated using Egger's and Begg's tests as well as visually by funnel plot.

To the best of our knowledge, this review and meta-analysis will be the first to be conducted in the sub-Saharan Africa region to synthesize empirical evidence regarding clients' satisfaction with DSD models and associated factors, as well as identify common DSD models most clients are likely to be satisfied with. Collection of existing evidence will improve and guide implementation, scale-up, and adoption of different DSD models. Such knowledge can inform program managers and implementers which DSD models are likely to result in desired HIV treatment outcomes.

PROSPERO CRD420251085833.