Welcome to the second differentiated service delivery (DSD) newsletter of 2024 from IAS – the International AIDS Society. In this edition, we focus on DSD for re-engagement in HIV treatment services.
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Welcome to the second differentiated service delivery (DSD) newsletter of 2024 from IAS – the International AIDS Society. In this edition, we focus on DSD for re-engagement in HIV treatment services.

The importance of supporting re-engagement in HIV treatment services: A new WHO policy brief

Clarice Pinto, Technical Officer, DSD for HIV Treatment, at the World Health Organization (WHO) writes:

Significant progress has been made toward achieving the UNAIDS 95-95-95 targets. Nevertheless, treatment interruptions, which are common, challenge these gains: studies show that in central, eastern, southern and western Africa, 20-50% of ART clients have previously interrupted treatment.

Supporting tracing and re-engagement in HIV treatment services is crucial. Disengagement from HIV care can lead to advanced HIV disease, increased mortality, higher rates of transmission and drug resistance. WHO’s 2021 consolidated guidelines on HIV include a strong recommendation for tracing people who have disengaged from care and providing support for re-engagement to reduce the chance of future disengagement.

A recent systematic review examining reasons for disengagement during the “treat-all” era showed that the reasons for disengagement are multifaceted, encompassing individual, interpersonal, health system and structural factors.

WHO’s upcoming Supporting Re-engagement in HIV Treatment Services: Policy Brief is, therefore, timely and essential. This brief consolidates existing WHO recommendations and summarizes evidence-based strategies to address barriers to sustained engagement in HIV treatment and care. By focusing on person-centred solutions, it emphasizes understanding the diverse needs and challenges faced by individuals who disengage from treatment.

Read the full piece

 

DSD in action: Re-engagement in care in Zimbabwe

We spoke with Chiedza Mupanguri, National Antiretroviral Therapy Coordinator in Zimbabwe’s Ministry of Health and Child Care (MOHCC) about national policies and measures to support sustained engagement in HIV care.

Algorithm for the management of a recipient of care re-engaging in care, Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe (2022)

Chiedza, please could you describe the policy frameworks that guide HIV service delivery in Zimbabwe?

In 2022, the MOHCC updated its HIV prevention, testing and treatment guidelines in line with WHO guidance and launched a revised Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe (OSDM) with the aim of increasing retention at all steps of the cascade. Re-engagement in care is one of the updates in the national HIV guidelines and OSDM.

Can you share details of how the new OSDM supports sustained engagement and re-engagement in care?

The OSDM defines what re-engagement in care is, describes the re-engagement cycle across the whole cascade, provides algorithms for the management of recipients of care re-engaging in care, and assists healthcare workers on how to approach and counsel this group of recipients of care.

What are some of the priorities around HIV service delivery more specifically?

We need to leverage technology, such as mobile health applications, telemedicine and text messaging, which can help overcome geographical barriers and improve access to care. Such innovations can facilitate appointment reminders, medication adherence support and access to health information.

Lastly, addressing the issue of community engagement and support is critical. Involving people living with HIV and their communities in the design, implementation and monitoring of HIV programmes has proven effective and can help reduce stigma, improve access to care and ensure the relevance and acceptance of interventions.

Read the full piece

 

Don't miss

Discover this roadmap, which lists relevant DSD sessions and posters to be presented at AIDS 2024, the 25th International AIDS Conference, in Munich, Germany, from 20 to 26 July.

Get involved

Explore the two new modules of the DSD online course, developed by the IAS. The latest modules focus on DSD for re-engagement and DSD for pre-exposure prophylaxis (PrEP).

 

Looking ahead, looking back

Looking ahead...

  • Join us for these IAS DSD events at AIDS 2024:
    • 20 July: Pre-conference – Differentiated service delivery beyond HIV treatment: Learnings from and for NCDs and family planning towards integrated DSD
    • 22 July: Satellite – Models to simplify, normalize and diversify PrEP service delivery for scale and equitable access
    • 23 July: Satellite – Differentiated strategies to support sustained engagement and re-engagement in HIV services in eastern and southern Africa
  • ICAP and the South African National Department of Health will co-host the second CQUIN all-network meeting on differentiated HIV testing services in Durban, South Africa, on 9 July. This meeting will focus on sharing progress updates from member countries and highlight advancements in implementing country action plans.
  • Register for HIVR4P 2024, the 5th HIV Research for Prevention Conference, to take place in Lima, Peru, and virtually from 6 to 10 October. The HIV Research for Prevention Conference is the only global scientific conference focused exclusively on the field of HIV prevention research.

Looking back...

  • Access the slides and recording of the webinars, “Optimizing Family Planning and HIV Integration: Lessons From Early Adopters in the CQUIN Network” and “Optimizing Hypertension and HIV Integration in the CQUIN Network: Case Studies from Nigeria and Uganda”, organized by the CQUIN network.
  • The Meeting Targets and Maintaining Epidemic Control (EpiC) project hosted a webinar highlighting innovative approaches to integrating HIV and primary healthcare services. Examples from Vietnam, Mozambique, Thailand, Nigeria and the Philippines were shared. Access the webinar recording here and the presentations here.
  • Discover resources shared at CQUIN’s all-network meeting, titled “Integrating non-HIV Services into HIV Programs: Delivering Person-Centered Care for People Living with HIV”, in Nairobi, Kenya. Plenary talks included family planning and NCDs.

 

What we're reading

Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF's Welcome Service, Arendse KD et al, Sci Rep, March 2024

This mixed-methods study evaluated the “Welcome Service” intervention providing person-centred care at re-engagement, implemented in Khayelitsha, South Africa. Findings showed variable achievement of implementation objectives, from partial knowledge of the intervention among healthcare workers and positive client care experiences to moderate achievement of clinical objectives and ongoing judgemental healthcare worker attitudes.

The cyclical cascade of HIV care: Temporal care engagement trends within a population-wide cohort, Euvrard J et al, PLoS Med, May 2024

The traditional HIV treatment cascade aims to visualize the journey of each person living with HIV, from diagnosis through ART initiation to treatment success. This observational cohort study aimed to populate, refine and explore the utility of a cyclical representation of the HIV cascade, using routine data from people living with HIV in the Western Cape, South Africa. Results showed nonlinear care journeys, demonstrating that disengagement from care was common and occurred at various points along the cascade.

Cost-Effectiveness and Budget Impact Analysis of the Implementation of Differentiated Service Delivery Models for HIV Treatment in Mozambique: a Modelling Study, Moiana Uetela DA et al, J Int AIDS Soc, May 2024

Since 2018, the Mozambican government has recommended implementation of DSD models, including fast-track, three-month multi-month dispensing (3MMD), community ART groups, adherence clubs, and family-approach and one-stop-shop models. This cost-effectiveness and budget-impact analysis compares these models with conventional services. DSD models were less expensive and more effective in retaining clients 12 months after ART initiation and were estimated to have saved approximately USD 14 million for the health system from 2022 to 2024.

Satisfaction with service delivery among HIV treatment clients enrolled in differentiated and conventional models of care in South Africa: a baseline survey, Mokhele I et al, J Int AIDS Soc, March 2024

This study assessed and compared client experiences in DSD models with those in conventional care at a sample of facilities and clients in South Africa through the AMBIT project’s SENTINEL survey. Most participants across both conventional care and DSD reported being satisfied with their care and to be receiving high quality of care. Participants in DSD models were more likely to report a high level of satisfaction with the care received than their counterparts remaining in conventional care.

Effects of Multimonth Dispensing on Viral Suppression and Continuity in Treatment Among Children Living With HIV Aged 2-9 Years: A Cohort Study in Western Kenya, Oyuga R et al, J Acquir Immune Defic Syndr, July 2024

During the COVID-19 pandemic, the Kenyan Ministry of Health started recommending 3MMD to all people living with HIV, including children. This retrospective cohort study assessed the association between 3MMD and clinical outcomes among children in western Kenya, showing comparable or improved HIV health outcomes among this group. The association between 3MMD and retention and viral suppression was significant among individuals who were unsuppressed at baseline.

Exploring adolescent girls and young women's PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa, Rousseau E et al, J Int AIDS Soc, May 2024

The Prevention Options for Women Evaluation Research (POWER) study in Cape Town, South Africa, provided PrEP to adolescent girls and young women from four DSD platforms: mobile clinic, government facility, courier delivery, and community-based youth club. This qualitative POWER implementation study explored PrEP-user preferences, decision making, influences and habits related to PrEP. Mobile clinics were the most used PrEP delivery platform, described as acceptable and convenient. The second most popular platform was courier delivery, selected for its privacy, convenience and limited interaction needed.

 

What we're watching

DSD for clients re-engaging in HIV care

Watch this explainer video, developed by the IAS, outlining differentiated re-engagement for clients who have been out of care. The videos are also available in French and Portuguese.

 

Get in touch

Do you have content for the next newsletter? We want to hear from you.
Email us at dsd@iasociety.org.


www.differentiatedservicedelivery.org

 

Photo credits in order of appearance: 
(1) MSF/Luca Sola (2) Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe 

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