Differentiated service delivery for HIV treatment

DSD is a person-centered approach that simplifies and adopts HIV services across the cascade in ways that both serve the needs of people living with or vulnerable to HIV and reduce unnecessary burden on the health system. As presented by WHO at the ongoing 24th International AIDS conference, DSD models for HIV treatment can be described within four categories:

•    Group models managed by Health Care workers
•    Group models managed by clients
•    Individual models based at facilities
•    Individual models not based at facilities

To support DSD implementation, WHO has developed a criteria to determine whether a person has been successfully established on ART i.e.

•    Receiving ART for at least 6 months
•    No current illness which does not include well-controlled chronic health conditions
•    Good understanding of lifelong adherence; i.e. adequate adherence counselling provided
•    Evidence of treatment success. At least one suppressed viral load test result within the past six months

This criteria is to ensure that no one is excluded

The WHO has also put together new service delivery recommendations in furtherance of DSD:

•    ART initiation may be offered outside the health facility
•    Clinical visits every 3-6 months, preferably every six months if feasible (i.e. for people established on ART)
•    ART dispensing every 3-6 months, preferably every 6 months if feasible
•    Training and support for people who have disengaged
•    SRH services, including contraception, may be integrated with HIV services
•    Diabetes and hypertension care may be integrated with HIV services
•    Psychological interventions should be provided to all adolescents and young adults living with HIV
•    Task sharing of specimen collection and point-of-care testing with non-lab personnel when professional capacity is limited

WHO 2022 five key recommendations for the patient monitoring system was also presented:

1.    Analyse and use routing testing data to optimize HIV testing services
2.    Use person-centered patient data to assess ART interruptions, improve re-engagement and retention in care
3.    Integrate monitoring of DSD models within HIV patient monitoring system
4.    Enhance data quality and use
5.    Use drug stock data

Other presenters also recommended integration of the following services for HIV person-centered care.

•    TB treatment and prevention
•    Family planning
•    Cervical cancer screening and treatment
•    Cardiovascular risk assessment and management of hypertension and diabetes
•    Screening and management of depression, anxiety and substance abuse

The goal of integration should be to provide a one-stop service for the recipient of care

DSD is has being recognized as a stepping stone to self-care. Self-care as defined by WHO is “the ability of individuals, families and communities to promote health, prevent disease, maintain health and cope with illnesses and disability with or without the support of a health care provider”. Even though DSD emerged from treatment models, it has applications in HIV preventions, stigma interventions and other service delivery areas.