AMBIT: Alternative models of ART delivery—optimizing the benefits

Please visit the AMBIT project website at https://sites.bu.edu/ambit/

Most high HIV-prevalence countries in sub-Saharan Africa and elsewhere are experimenting with and scaling up different approaches to providing antiretroviral treatment (ART) for HIV that are tailored to specific groups of patients. Expectations for “differentiated service delivery models” (DSD) include better access to and outcomes of treatment for patients, increased clinic capacity and quality, and lower costs for providers and patients. Although many specific models of care are being tried and evaluated, there is little evidence available on the big picture—the proportion of clinics offering alternative models, eligibility criteria, numbers of patients eligible under those criteria, number of patients actually participating, program-wide outcomes, resource utilization and costs compared to traditional care, fidelity to guidelines, financial sustainability, and other system-wide indicators.

AMBIT is a multi-year research and evaluation project in sub-Saharan Africa launched in September 2018 and supported by the Bill & Melinda Gates Foundation, with a focus on South Africa, Malawi, and Zambia. It is being implemented by the Boston University School of Public Health in the U.S., the Health Economics and Epidemiology Research Office (HE2RO) in South Africa, and the Clinton Health Access Initiative (CHAI) in Malawi and Zambia. The project includes data synthesis, data collection, data analysis, and modeling activities aimed at generating information for near- and long-term decision making and creating an approach and platform for ongoing evaluation. Activities include literature reviews, analysis of retrospective data and implementation reports, cost estimates, surveys, modeling, and primary data collection and analysis.

AMBIT’s five main components address COVERAGE (current extent of alternative model implementation); ALLOCATION (development of a mathematical model to optimize distribution of alternative models at national level); BENEFITS AND COSTS (empirical estimates of the overall potential costs and benefits of large-scale adoption of alternative models in the focus countries); GAPS (limited primary research in the focus countries to strengthen the evidence base); and PARTNERSHIPS AND DISSEMINATION (integration of AMBIT with other related projects, establishment of partnerships, and widespread dissemination of results).

To learn more about AMBIT and our research and our team, please visit the project website or contact our study coordinator, Salome Kuchukhidze.

Boston University investigators Sydney Rosen (PI), Brooke Nichols
Partner investigators HE2RO: Sophie Pascoe, Amy Huber, Idah Mokhele, Cheryl Hendrickson, Lise Jamieson;  CHAI: Timo Tcherini (Malawi), Bevis Phiri (Zambia)
Countries South Africa, Malawi, Zambia
Project period September 2018-February 2022
Funder Bill & Melinda Gates Foundation
Project website https://sites.bu.edu/ambit/
Contacts Sydney Rosen (Boston); Sophie Pascoe (South Africa)

Publications and Other Documents

For access to downloadable publications, reports, policy briefs, and other documents produced by the AMBIT project, please click here.