Impact of a community-based antiretroviral therapy delivery model for people living with HIV in Cambodia

Abstract

Cambodia achieved the UNAIDS 90-90-90 targets in 2017; however, clinic congestion, stigma, and mental health disparities continue to challenge sustained HIV care. This quasi-experimental study evaluated a community-based antiretroviral therapy delivery model compared with multi-month dispensing among people living with HIV across 20 clinics (N = 4,089) from 2021 to 2023. Baseline and endline surveys and clinical data assessed treatment adherence, viral suppression, retention in care, stigma, depressive symptoms, and quality of life. Both approaches achieved high retention in care (>97%) and viral suppression rates (>99%). The community-based model showed significantly improved adherence, reduced depressive symptoms, and higher physical health-related quality of life. Modest reductions in experienced stigma were observed, but effects on internalised and anticipated stigma were inconclusive. These findings indicate that community-based antiretroviral therapy delivery effectively sustains adherence and improves health outcomes, supporting its integration into Cambodia’s HIV care system alongside interventions targeting stigma reduction.