Impact of a community-based antiretroviral therapy delivery model on treatment outcomes, mental health, and quality of life among stable people living with HIV in Cambodia: a quasi-experimental study

Cambodia’s HIV response successfully met the UNAIDS 90-90-90 targets in 2017; however, ongoing systemic barriers such as clinic congestion, stigma, and mental health disparities pose a threat to this progress. This quasi-experimental study evaluated a community-based antiretroviral (ART) delivery (CAD) model against multi-month dispensing (MMD) for stable people living with HIV from 2021 to 2023 across 20 ART clinics, enrolling a total of 4,089 participants (2,040 in CAD, 2,049 in MMD). The study employed baseline and endline surveys along with clinical data to assess various outcomes, including ART adherence, viral suppression, retention in HIV care, stigma, mental health, and quality of life. Results indicated high retention (97.3%) and viral suppression (> 99%) rates for both models, with CAD showing a significant improvement in ART adherence ( P  = 0.002), a smaller decline in participants with no depressive symptoms ( P  = 0.001) and enhanced physical health ( P  < 0.001). Although CAD resulted in modest decreases in externalised stigma, the effects on internalised stigma remained inconclusive. The findings suggest that CAD is an effective community-based model for sustaining ART adherence and improving health outcomes, supporting the integration of such approaches within Cambodia’s HIV care system while also advocating for the combination of CAD with stigma-reduction strategies.