Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility survey
Abstract Introduction In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client‐centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implement...
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2025-07-01
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| Online Access: | https://doi.org/10.1002/jia2.26477 |
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| author | Nathalie Verónica Fernández Villalobos Fabrice Helfenstein Vohith Khol Christella Twizere Mayara Secco Barbara Castelnuovo Jacqueline Huwa Thierry Tiendredbeogo C. William Wester Siew Moy Fong Gad Murenzi Yanink Caro‐Vega Rita Elias Lyamuya Idiovinio Rafael Djimon Marcel Zannou Kathy Petoumenos Dominique Mahambou Nsonde Jorge Pinto Kara Wools‐Kaloustian Carolyn Bolton Moore Ounoo Elom Takassi Sasisopin Kiertiburanakul Rogers Ajeh Awoh Shamim M. Ali Geoffrey Fatti Karen Malateste Elizabeth Zaniewski Marie Ballif the International epidemiology Databases to Evaluate AIDS |
| author_facet | Nathalie Verónica Fernández Villalobos Fabrice Helfenstein Vohith Khol Christella Twizere Mayara Secco Barbara Castelnuovo Jacqueline Huwa Thierry Tiendredbeogo C. William Wester Siew Moy Fong Gad Murenzi Yanink Caro‐Vega Rita Elias Lyamuya Idiovinio Rafael Djimon Marcel Zannou Kathy Petoumenos Dominique Mahambou Nsonde Jorge Pinto Kara Wools‐Kaloustian Carolyn Bolton Moore Ounoo Elom Takassi Sasisopin Kiertiburanakul Rogers Ajeh Awoh Shamim M. Ali Geoffrey Fatti Karen Malateste Elizabeth Zaniewski Marie Ballif the International epidemiology Databases to Evaluate AIDS |
| author_sort | Nathalie Verónica Fernández Villalobos |
| collection | DOAJ |
| description | Abstract Introduction In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client‐centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low‐ and middle‐income countries (LMICs) in Latin America, Africa and the Asia‐Pacific before the COVID‐19 pandemic. Methods We analysed facility‐level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi‐month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models. Results We included 175 facilities in the Asia‐Pacific (n = 30), Latin America (n = 8), Central Africa (n = 21), East Africa (n = 74), Southern Africa (n = 28) and West Africa (n = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility‐based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client‐managed group models (60%). Out‐of‐facility individual models were available at 48% of facilities. Facility‐based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD. Conclusions In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility‐based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long‐term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre‐COVID‐19 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client‐centred care. |
| format | Article |
| id | doaj-art-9199d02f44b34365a1c3e78b4531c1be |
| institution | Matheson Library |
| issn | 1758-2652 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj-art-9199d02f44b34365a1c3e78b4531c1be2025-07-08T02:40:40ZengWileyJournal of the International AIDS Society1758-26522025-07-0128S3n/an/a10.1002/jia2.26477Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility surveyNathalie Verónica Fernández Villalobos0Fabrice Helfenstein1Vohith Khol2Christella Twizere3Mayara Secco4Barbara Castelnuovo5Jacqueline Huwa6Thierry Tiendredbeogo7C. William Wester8Siew Moy Fong9Gad Murenzi10Yanink Caro‐Vega11Rita Elias Lyamuya12Idiovinio Rafael13Djimon Marcel Zannou14Kathy Petoumenos15Dominique Mahambou Nsonde16Jorge Pinto17Kara Wools‐Kaloustian18Carolyn Bolton Moore19Ounoo Elom Takassi20Sasisopin Kiertiburanakul21Rogers Ajeh Awoh22Shamim M. Ali23Geoffrey Fatti24Karen Malateste25Elizabeth Zaniewski26Marie Ballif27the International epidemiology Databases to Evaluate AIDSInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerlandInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerlandNational Center for HIV/AIDS, Dermatology & STDsPhnom PenhCambodiaCentre National de Référence en matière de VIH/SIDA (CNR)BujumburaBurundiInstituto Nacional de Infectologia Evandro Chagas (INI)Fundação Oswaldo CruzRio de Janeiro BrazilInfectious Diseases Institute, College of Health SciencesMakerere UniversityKampalaUgandaLighthouse TrustLilongwe MalawiUniversity of BordeauxNational Institute for Health and Medical Research (INSERM) UMR 1219Research Institute for Sustainable Development (IRD) EMR 271Bordeaux Population Health Research CentreBordeauxFranceDivision of Infectious DiseasesDepartment of MedicineVanderbilt University Medical Center (VUMC)NashvilleTennesseeUSADepartment of PediatricsHospital LikasKota KinabaluMalaysiaEinstein‐Rwanda Research and Capacity Building Program, Research for Development and Rwanda Military Referral and Teaching HospitalKigali RwandaDepartamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránCiudad de México MéxicoMorogoro Regional Hospital – CTCIndiana UniversityMorogoroTanzaniaSolidarMedPembaMozambiqueCentre national de référence pour la recherche et la prise en charge des PVVIH au Centre National Hospitalier Universitaire HK MAGA (CNHU‐HKM)CotonouBéninThe Kirby Institute, UNSW SydneySydneyNew South WalesAustraliaCentre de Traitement Ambulatoire of BrazzavilleBrazzavilleCongoUniversidade Federal de Minas Gerais (UFMG)Belo HorizonteBrazilDepartment of MedicineIndiana University School of MedicineIndianapolisIndianaUSACentre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambiaLome UniversityLomeTogoFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailandUniversity of BueaBueaCameroonSchool of Medicine, College of Health SciencesMoi UniversityEldoretKenyaKheth'Impilo AIDS Free LivingCape TownSouth AfricaUniversity of BordeauxNational Institute for Health and Medical Research (INSERM) UMR 1219Research Institute for Sustainable Development (IRD) EMR 271Bordeaux Population Health Research CentreBordeauxFranceInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerlandInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerlandAbstract Introduction In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client‐centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low‐ and middle‐income countries (LMICs) in Latin America, Africa and the Asia‐Pacific before the COVID‐19 pandemic. Methods We analysed facility‐level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi‐month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models. Results We included 175 facilities in the Asia‐Pacific (n = 30), Latin America (n = 8), Central Africa (n = 21), East Africa (n = 74), Southern Africa (n = 28) and West Africa (n = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility‐based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client‐managed group models (60%). Out‐of‐facility individual models were available at 48% of facilities. Facility‐based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD. Conclusions In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility‐based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long‐term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre‐COVID‐19 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client‐centred care.https://doi.org/10.1002/jia2.26477antiretroviral therapydifferentiated service deliveryHIVkey and vulnerable populationslow‐ and middle‐income countriespatient‐centred care |
| spellingShingle | Nathalie Verónica Fernández Villalobos Fabrice Helfenstein Vohith Khol Christella Twizere Mayara Secco Barbara Castelnuovo Jacqueline Huwa Thierry Tiendredbeogo C. William Wester Siew Moy Fong Gad Murenzi Yanink Caro‐Vega Rita Elias Lyamuya Idiovinio Rafael Djimon Marcel Zannou Kathy Petoumenos Dominique Mahambou Nsonde Jorge Pinto Kara Wools‐Kaloustian Carolyn Bolton Moore Ounoo Elom Takassi Sasisopin Kiertiburanakul Rogers Ajeh Awoh Shamim M. Ali Geoffrey Fatti Karen Malateste Elizabeth Zaniewski Marie Ballif the International epidemiology Databases to Evaluate AIDS Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility survey Journal of the International AIDS Society antiretroviral therapy differentiated service delivery HIV key and vulnerable populations low‐ and middle‐income countries patient‐centred care |
| title | Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility survey |
| title_full | Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility survey |
| title_fullStr | Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility survey |
| title_full_unstemmed | Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility survey |
| title_short | Scale of differentiated service delivery implementation in HIV care facilities in low‐ and middle‐income countries: a global facility survey |
| title_sort | scale of differentiated service delivery implementation in hiv care facilities in low and middle income countries a global facility survey |
| topic | antiretroviral therapy differentiated service delivery HIV key and vulnerable populations low‐ and middle‐income countries patient‐centred care |
| url | https://doi.org/10.1002/jia2.26477 |
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