Reimagining HIV service delivery: the role of differentiated care from prevention to suppression

There is broad agreement that a ‘‘one-size-fits-all’’ model of HIV services will not succeed in providing sustainable access to antiretroviral therapy and support services for the 37 million people living with HIV today

Anna Grimsrud

2016

Scholarcy highlights

  • There is broad agreement that a ‘‘one-size-fits-all’’ model of HIV services will not succeed in providing sustainable access to antiretroviral therapy and support services for the 37 million people living with HIV today
  • Differentiated care is a client-centred approach that simplifies and adapts HIV services across the cascade, in ways that both serve the needs of PLHIV better and reduce unnecessary burdens on the health system
  • Well-known models of differentiated care have focused on ART delivery to clients who are clinically stable and have largely been implemented in high-prevalence countries in sub-Saharan Africa
  • To succeed differentiated care must not be limited to stable client models or solely to ART delivery
  • By considering the context of the client and health system, differentiated care can help to address policy barriers related to who can dispense versus distribute ART and who can conduct HIV testing
  • While national policies endorsing differentiated care are necessary for scale-up of HIV services, successful implementation will be dependent on an enabling environment inclusive of a robust drug supply; access to laboratory monitoring, in particular viral load; a reliable monitoring and evaluation system; and recognition of lay workers
  • Ministries of health, implementing partners, donors, civil society and communities of people living with HIV will first need to unite around a differentiated care concept that puts people at the centre of services

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