Patrick Kaonga ^1* Mutale Sampa ¹ Mwiche Musukuma ¹ Mulanda J. Mulawa ² Mataanana Mulavu ² Doreen Sitali ² Given Moonga ¹ Oliver Mweemba ² Tulani F. Matenga ² Cosmas Zyambo ³ Twaambo E. Hamoonga ⁴ Henry Phiri ⁵ Hikabasa Halwindi ³ Malizgani P. Chavula ⁶ Joseph M. Zulu ⁶ Choolwe Jacobs ¹

• ¹ Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
• ² Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia
• ³ Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
• ⁴ Department of Population Studies and Global Health, School of Public Health, University of Zambia, Lusaka, Zambia
• ⁵ Ministry of Health, Lusaka Zambia, Lusaka, Zambia
• ⁶ Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia

Background There is persistent pressure for countries with high burden of HIV infection to reach desired targets for HIV treatment outcomes. This has led to moving from “one-size-fits-all” model to differentiated service delivery (DSD) models which are meant to be more patient-centered, efficient but without compromising on the quality of patient care. However, for DSD models to be efficient, facilities should have indicators of HIV services available and ready to provide the DSD models. We aimed to assess availability of HIV service indicators and readiness of facilities to provide DSD models for HIV treatment in selected public health facilities in Zambia. Methods We conducted a nation-wide cross-sectional survey among public health facilities in Zambia that provide antiretroviral therapy (ART) services. We used an interviewer-administered questionnaire based on a World Health Organization (WHO) Service Availability Readiness Assessment (SARA) tool to assess availability of HIV service indicators and readiness of facilities to implement DSD models for HIV treatment. Availability and readiness were considered as latent constructs and therefore, we used structural equation modeling (SEM) to determine the correlations between them as well as their respective indicators. Results Out of 60 public health ART facilities, the overall availability of HIV service indicators was 80.0% (48/60) and readiness to provide the DSD models was 81.7% (48/60). However, only 48% and 39% of the facilities had all indicators of availability and readiness, respectively. Retention into care and HIV multidisciplinary team were more likely to be in urban than rural areas. SEM showed that the standardized estimate between availability and readiness was significantly and positively correlated (r = 0.73, p<0.0001). Additionally, both availability and readiness were significantly and positively correlated with most of their respective indicators. Conclusion Although most facilities had available HIV service indicators and ready to provide DSD models, most facilities did not have all indicators of availability and readiness. In addition, there were differences between rural and urban in some indicators. There is need for persistent and heightened efforts meant to implement DSD in HIV treatment especially in rural areas to accelerate reaching the desired HIV treatment outcomes.