Differentiated Service Delivery Models for HIV Treatment in Malawi, South Africa, and Zambia: A Landscape Analysis.

Amy Huber,Sydney Rosen,Salome Kuchukhidze,Timothy Tchereni,Sophie Pascoe,Lawrence Long,Bevis Phiri,Brooke Nichols

doi:10.9745/ghsp-d-20-00532

Abstract

Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. We interviewed DSD model implementing organizations for descriptive information about each of the organization's models of care. We described the key characteristics of each model, including population of patients served, location of service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an "organization-model." The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel. As of 2019, there was a large variety of differentiated service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.

Highlights

Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use
DSD models are intended as an alternative to traditional or conventional care, which has typically been delivered at fixed-site clinics and requires at least 4 patient visits to the clinic per year, if not more
We surveyed a total of 8 organizations in Malawi, 16 in South Africa, and 10 in Zambia

Summary

Introduction

Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. Conclusions: As of 2019, there was a large variety of differentiated service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations. Landscape for Differentiated HIV Treatment Delivery in Southern Africa www.ghspjournal.org One response to this challenge is the development of “differentiated service delivery models” (DSD models) for HIV treatment.[5] DSD models typically reduce clinic visits and/or move services out of the clinic and may alter the provider cadre and package of services provided. Models for other populations such as children and those with detectable viral loads have been developed

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