Reflections on AIDS 2022 from a DSD perspective
Nittaya Phanuphak, Executive Director at the Institute of HIV Research and Innovation in Bangkok, Thailand, writes:
The current state of differentiated service delivery (DSD) and innovative DSD strategies to enhance HIV treatment, integration, pre-exposure prophylaxis (PrEP) and testing service delivery were discussed extensively at AIDS 2022, held in person in Montreal, Canada, and virtually, from 29 July to 2 August.
Acknowledging that a growing number of people living with HIV may have periods of treatment interruption, the IAS-organized pre-conference meeting, “Differentiated service delivery for HIV treatment in 2022”, dedicated one of its sessions to highlighting the role of DSD in supporting sustained re-engagement. Differentiation at re-engagement was shown to be an area where more work will be necessary in the coming years.
The World Health Organization’s technical brief with implementation guidance for simplified and DSD for PrEP, launched during AIDS 2022, removes the need to obtain creatinine and hepatitis serology test results before PrEP initiation. This will likely enable many more DSD models to explore offering more PrEP service delivery options for clients. The global goal to reach 3 million people with PrEP by 2020 was missed and the new goal is to reach 10 million people with PrEP by 2025. Therefore, we need to significantly scale up PrEP roll out in order to end the HIV epidemic. DSD is a key guiding principle for achieving that goal.
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DSD in action: Integrating hypertension services in DSD models in Malawi
"One of the big lessons from our work on integration of HIV treatment and hypertension is that people really like MMD and it was clear that the strategy does address some of the socioeconomic barriers at an individual level."
We spoke with Khumbo Nyirenda who works as Senior Implementation Science Manager at Partners in Hope (PIH) in Lilongwe, Malawi.
What are the key components of the PIH service delivery model to integrate hypertension services within DSD for HIV treatment models in Malawi?
PIH implements a wide range of DSD models for HIV treatment, including multi-month dispensing (MMD), using up to six-month MMD and community ART distribution. These DSD models have been proven to reduce the risk of disengagement from care and also reduce the cost of care to an individual. Formative work from our group showed that people living with HIV and hypertension do experience these barriers as well, but did not have access to DSD models.
What are the key lessons learnt from implementing the PIH project on hypertension integration within DSD in Malawi?
One of the big lessons from our work on integration of HIV treatment and hypertension is that people really like MMD and it was clear that the strategy does address some of the socioeconomic barriers at an individual level. However, despite MMD and alignment of ART and hypertension medications, blood pressure control levels are still quite low, suggesting that we do need additional interventions to be able to positively influence clinical outcomes like blood pressure control.
At a policy level, what needs to be done to support integration of NCDs into DSD for HIV treatment models?
We need more evidence that integration of HIV treatment and non-communicable diseases (NCDs), especially hypertension, works for the health facilities and systems in terms of supply of commodities and also showcasing evidence that people do really want and appreciate DSD models that integrate MMD and medication alignment for hypertension. More research around other interventions that can influence clinical outcomes, like blood pressure control, would facilitate decision making at the policy level.
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