Scale of differentiated service delivery implementation in HIV care facilities in low- and middle-income countries: a global facility survey

1

Issued Date

2025-07-01

Resource Type

Article

eISSN

17582652

DOI

10.1002/jia2.26477

Scopus ID

2-s2.0-105010662288

Pubmed ID

40622380

Journal Title

Journal of the International AIDS Society

Volume

28

Rights Holder(s)

SCOPUS

Bibliographic Citation

Journal of the International AIDS Society Vol.28 (2025) , e26477

Suggested Citation

Fernández Villalobos N.V., Helfenstein F., Khol V., Twizere C., Secco M., Castelnuovo B., Huwa J., Tiendredbeogo T., Wester C.W., Fong S.M., Murenzi G., Caro-Vega Y., Lyamuya R.E., Rafael I., Zannou D.M., Petoumenos K., Nsonde D.M., Pinto J., Wools-Kaloustian K., Moore C.B., Takassi O.E., Kiertiburanakul S., Awoh R.A., Ali S.M., Fatti G., Malateste K., Zaniewski E., Ballif M. 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 Vol.28 (2025) , e26477. doi:10.1002/jia2.26477 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111335

Title

Scale of differentiated service delivery implementation in HIV care facilities in low- and middle-income countries: a global facility survey

Author(s)

Fernández Villalobos N.V.
 Helfenstein F.
 Khol V.
 Twizere C.
 Secco M.
 Castelnuovo B.
 Huwa J.
 Tiendredbeogo T.
 Wester C.W.
 Fong S.M.
 Murenzi G.
 Caro-Vega Y.
 Lyamuya R.E.
 Rafael I.
 Zannou D.M.
 Petoumenos K.
 Nsonde D.M.
 Pinto J.
 Wools-Kaloustian K.
 Moore C.B.
 Takassi O.E.
 Kiertiburanakul S.
 Awoh R.A.
 Ali S.M.
 Fatti G.
 Malateste K.
 Zaniewski E.
 Ballif M.

Author's Affiliation

The University of Alabama at Birmingham
 University of Bern
 Universidade Federal de Minas Gerais
 Indiana University School of Medicine
 Vanderbilt University Medical Center
 University Hospital Bern
 Instituto Nacional de la Nutrición Salvador Zubiran
 Stellenbosch University, Faculty of Medicine and Health Sciences
 The Kirby Institute
 Faculty of Medicine Ramathibodi Hospital, Mahidol University
 Bordeaux Population Health Research Center (BPH)
 Makerere University College of Health Sciences
 University of Buea
 Instituto Nacional de Infectologia Evandro Chagas (INI)
 Moi University
 University of Lome
 Institute of Social and Preventive Medicine
 Centre for Infectious Disease Research in Zambia
 Lighthouse Trust
 National Center for HIV/AIDS
 Hospital Likas
 Kheth'Impilo AIDS Free Living
 Research for Development and Rwanda Military Hospital
 Centre National de Référence en matière de VIH/SIDA (CNR)
 SolidarMed
 Centre de Traitement Ambulatoire
 Centre national de référence pour la recherche et la prise en charge des PVVIH au Centre National Hospitalier Universitaire HK MAGA (CNHU-HKM)
 Indiana University

Corresponding Author(s)

Fernández Villalobos N.V.

Other Contributor(s)

Mahidol University

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/123456789/111335

Collections

Scopus 2025