June 01, 2022
Differentiated service delivery (DSD) is a person-centered approach to simplifying HIV care while maintaining high quality services delivery. The World Health Organization (WHO) officially endorsed the approach in 2015, and DSD has since become a significant strategy in achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets by 2030.
The University of Maryland, Baltimore (UMB) and Ciheb-Kenya recently released a report, “Evaluation of Differentiated Service Delivery Model,” which summarizes results, as related to DSD, from its PACT Endeleza and PACT Timiza programs in Kenya. The evaluation focused on the effect of multi-month dispensing (MMD) (three months or more) compared to conventional care.
PACT Endeleza operated in Nairobi, Kenya’s capital, and PACT Timiza operated in Kisii and Migori counties, which lie farther west of Nairobi. In addition to working to achieve the UNAIDS’ 95-95-95 targets, the two programs aimed to reduce HIV incidence and AIDS-related mortality by providing timely HIV services, including testing and antiretroviral therapy (ART). As of September 2021, when both programs ended, more than 124,000 people were on treatment.
2022 DSD Report Cover
Key Takeaways
Ciheb’s recently released report found that individuals return to the clinic by six months irrespective of the type of care provided (MMD or conventional care). Similarly, loss to follow up (LTFU), an event in which clients discontinue care, and viral rebound occurred in low levels across the client population, whether clients were enrolled in MMD or on the conventional care. Notably, though, individuals on DSD had a lower likelihood of experiencing viral rebound compared to those on the standard of care. This finding is encouraging, as MMD is a key implementation strategy as part of the DSD framework.
DSD uptake from January 2018 to December 2019 by program
DSD implies that clients should have a range of options when arranging their care. Sometimes the best option is fewer visits; other times the best option is more frequent visits—the best option depends on the client’s unique needs and preferences and their consultations with their healthcare providers. In the differentiated care model in Kenya, stable clients were given multi-month prescriptions and were allowed fewer clinic visits. Allowing fewer clinic visits, in this case, benefitted both clients and the health system because it enabled them to save time and money associated with frequent travel costs.
Above all, Ciheb’s findings support that both models—DSD and conventional care—benefit clients. Offering quality choice of service delivery models is critical to deliver people-centered care.
Contact
Center for International Health, Education, and Biosecurity
Institute of Human Virology
Tyler New
Scientific Writer
tnew@ihv.umaryland.edu
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