Does centralized dispensing and distribution of medicines improve health outcomes? A retrospective cohort study in Ndola, Zambia

Abstract Background The global shift toward universal test and treat policy for individuals living with HIV has triggered an unprecedented surge in healthcare demand. In response, Zambia's government implemented a centralized dispensing and distribution intervention. Despite successful implementation, empirical evidence of its impact within Zambia remains lacking. This study aims to assess this intervention's utilization patterns and measure its effect on medicine collection rates, retention, and plasma viral load levels. Methods We conducted a retrospective cohort study by analysing programmatic data from 17,157 stable patients who received chronic antiretroviral therapy through the intervention across nine high-volume treatment facilities in Ndola, Zambia, from January 2018 to September 2021. We computed the annual ratios of the key health outcomes. Results Between January 2018 and September 2021, a total of 17,157 clients were enrolled, 75% of the total target during the implementation period. Out of those enrolled, there were more females 69% than males 31%, with most clients aged 20 years and above. The yearly rates of beneficiary medicine collection and retention consistently surpassed the benchmark, reaching 93% (90% CI: 85% − 100%) and 97% (95% CI: 95% – 99%), respectively. However, less than 1% of those ever-enrolled experienced escalated viral load levels warranting discontinuation from the program. Conclusion Our study establishes that implementing the centralized dispensing and distribution intervention in Ndola produced a notable positive impact on enrolled beneficiaries' critical health outcomes. This reinforces the intervention's viability as a scalable solution, holding potential for broader population-level benefits.