Uptake of Appointment Spacing Model of Care and Determinants Among Adult Clients on Antiretroviral Treatment in Ethiopia.

IntroductionTo sustain progress toward epidemic control, it remains essential to enhance and refine Appointment Spacing Model (ASM) implementation while reinforcing coordination between health facilities and community services. Nonetheless, even with the rollout of the six-month multi-month scripting (MMS)/ASM, there is still limited evidence on its nationwide adoption and the factors that affect its utilization.MethodsThis systematic review and meta-analysis followed a protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the reference number CRD42024597279. Articles were retrieved from multiple electronic databases, including PubMed/MEDLINE, Wiley Online Library, Cochrane Library, and African Journal Online, with additional gray literature searched via Google Scholar. Data were initially extracted in Microsoft Excel and subsequently imported into STATA version 11 for analysis. Study heterogeneity was assessed using Cochran's Q test and the I² statistic.ResultsThe initial search yielded 1026 primary articles, which were managed using EndNote X7. Of these, 54 were from PubMed, 14 from Wiley Online Library, 6 from the Cochrane Library, 17 from African Journal Online, and 935 from Google Scholar. Ultimately, 8 studies with a combined sample size of 3328 were included in the review. In this study, the pooled prevalence of ASM uptake among people on antiretroviral therapy (ART) in Ethiopia was estimated at 48.22% (95% CI: 31.01-65.44, I² = 92.9%, P = .000). Strong social support (Pooled Odds Ratio [POR]: 1.92, 95% CI: 1.46, 2.54), baseline regimen change (POR: 2.26, 95% CI: 1.74, 2.93), and duration of ART more than five years (POR: 2.15, 95% CI: 1.57-2.97) were factors associated with ASM.ConclusionsThe uptake of the ASM for ART care was relatively low at 48.22%, falling short of the 70% target. Key factors influencing uptake included strong social support, changes to the baseline treatment regimen, and duration on ART. To enhance the adoption of the six-month MMS/ASM care model, public health hospitals and both governmental and nongovernmental organizations should implement targeted interventions addressing these determinants.