Table 3 Key considerations for PDMC by delivery system
Facility-based | Community-based | Self-initiated | |
|---|---|---|---|
Caregiver collects PDMC drugs from a health facility | PDMC drugs are delivered to the caregiver at home or collected at a nearby location (e.g., local dispensary) | All PDMC drugs are given to the caregiver on discharge | |
PROS | Creates an opportunity for providers to check the child/touch base with caregiver on recovery Helps provider to monitor adherence to the monthly courses Monitoring for side effects and adverse events to drug | Reduced burden (financial) on caregiver because drugs are provided closer/delivered Could improve adherence as reduces access barriers Caregiver still has contact with health system via CHW/local dispensary | Reduces time and financial burden on caregivers Potentially improves adherence because the caregiver has all drugs Recent acceptability trial in Malawi indicated this was the preference of caregivers Potentially most cost-effective, feasible delivery model |
CONS | Time and financial burden on caregiver to travel to the facility and collect drugs Failure of caregiver to return for subsequent courses due to burden—adherence issues | Additional workload for CHWs Relies on timely drug delivery to caregivers by CHWs Relies on strong linkages between discharging facility and CHWs Training requirements for CHWs | Fewer opportunities for providers to monitor adherence Caregiver-related issues (e.g., forgetfulness, sharing drugs with others, drugs lost) |