By Khumbo Niyrenda, Partners in Hope, Malawi
AIDS 2024 provided a critical platform for extensive discussions on the evolution of DSD, including its expansion beyond HIV-specific care towards a broader, person-centred healthcare model. The pre-conference, “Differentiated service delivery beyond HIV treatment: Learnings from and for NCDs and family planning towards integrated DSD”, set the stage for these discussions. Throughout the conference, presentations acknowledged health needs beyond HIV and explored the potential application of DSD principles to chronic care services for the general population.
Key enablers of DSD for HIV treatment were highlighted, including non-toxic regimens, simplified clinical guidance, reliable adherence measures (such as viral load monitoring) and cohort monitoring. These enablers not only support the success of DSD in HIV care, but also point to its potential adaptability to other health domains. A case study from Malawi showcased the integration of DSD principles with family planning services, highlighting the success of community-based distribution of contraceptives and the introduction of self-injectable options.
A session on new strategies for optimizing person-centred care brought together several innovative approaches to HIV prevention and treatment.
AIDS 2024 clearly showed that DSD has moved beyond its origins in HIV care to become a versatile approach for improving healthcare delivery across domains. As DSD continues to evolve, it promises to play a crucial role in improving access to care and health outcomes across a wide range of services and populations.
By Jabulani Chacha, Julio Pacca, Alexa Smith-Rommel and the ECHO project team
In Mozambique, the six-month multi-month dispensing (6MMD) model has shown strong potential for maintaining high levels of care while reducing burdens on clients and healthcare providers. The 6MMD model allows “stable” clients to receive a six-month supply of antiretrovirals and visit the health facility twice a year.
The model was rolled out in 24 facilities across four provinces in Mozambique and then evaluated by the PEPFAR-funded USAID Efficiencies for Clinical HIV Outcomes (ECHO) project. ECHO’s study, presented at AIDS 2024, showed that retention in care remained exceptionally high during 6MMD enrolment, with 98% of clients continuing their treatment. Viral load (VL) suppression was also strong, matching retention at 98%, and VL coverage reached 82%. Extended dispensing intervals can create challenges, such as people disengaging from care during the longer periods between visits. In ECHO-supported provinces in Mozambique, clients enrolled in 6MMD experienced no discernible decline in care or outcomes.
The success of 6MMD in Mozambique underscores its potential as a scalable solution for other regions seeking to optimize ART outcomes while easing operational and resource burdens on health systems.
