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We hope that you enjoy the fifth edition of the differentiated service delivery (DSD) newsletter. This newsletter promotes knowledge sharing among stakeholders working on DSD and provides updates on related activities.
Differentiated service delivery offers a path to sustaining HIV control 
Geoff Garnett, Deputy Director, Global Development and Global Health, at the Bill & Melinda Gates Foundation

A system under mounting pressure can either break or adapt. I believe that in DSD, we have a framework to facilitate the adaptation of the HIV response so that we can sustain efficient HIV treatment without sacrificing quality. Reserving intense client management for the few allows a simpler and easier “public health” approach to be followed for the many, reducing the burden for both the client and provider. Asking for the minimum effective package should drive our programming and we are seeing, in early results from Zambia, Ethiopia and South Africa presented at AIDS 2018, that less frequent appointments and easy drug collection are improving clinical outcomes. Such simplification is a necessity, but the innovation, experimentation and shared lessons should make the spread of DSD models more successful.
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Phakamani Moyo, Peer Counsellor at United Bulawayo Hospital, Paediatric Adolescent Treatment Africa (PATA) and IAS 2018 Youth Champion for youth-friendly HIV service delivery

What’s your definition of “youth-friendly HIV service delivery”?
Young people want HIV and sexual and reproductive health services that are comprehensive and integrated, including private and confidential HIV prevention, treatment and monitoring, supportive psychosocial and mental health services, and counselling. Services should recognize that young people are diverse and strive to be safe and inclusive. For this to happen, DSD is the way to go. DSD not only improves the quality of care, but also access to treatment for young people living with HIV. DSD for young people is innovative, particularly in my country, Zimbabwe, and overcomes some of the challenges of the previous one-size-fits-all approach to HIV treatment because, as young people, we are diverse in our own ways and DSD recognizes those differences. This is very important for youth-friendly HIV service delivery.  
Read the full interview


A key population-led, differentiated health services model in Thailand’s
Thai Red Cross AIDS Research Centre (TRCARC)

TRCARC, with key population organizations, has developed a model of key population-led health services to improve prevention, testing and treatment for men who have sex with men (MSM), transgender women (TGW) and MSM and TGW sex workers. It is funded by the PEPFAR/USAID LINKAGES Thailand project and managed by FHI 360. Key population-led HIV services are strategically differentiated across the cascade to meet various needs of these groups. These interventions include outreach (online, offline, peer led), testing (self-testing, mobile testing), prevention (condom, lubricants, pre- or post-exposure prophylaxis) and same-day ART initiation and maintenance. These approaches have resulted in increased HIV service uptake, contributing significantly to meeting national targets.
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Looking back …
  • The HIV Coverage, Quality, and Impact Network (CQUIN) held its second annual meeting in Addis Ababa from November 5-7 2018. The 10 countries in the network reflected on the “year of scale-up” and discussed plans for 2019. This meeting built on the June 27-29 2018 workshop on the science and practice of DSD scale up that was held in Ezulwini, Eswatini. Download the workshop report here.
  • AMBIT, a two and a half-year research and evaluation project in sub-Saharan Africa, was launched in September 2018 to address gaps in evidence in the “big picture” of DSD. This includes the proportion of clinics offering alternative models, number of clients actually participating, programme-wide outcomes, resource utilization and costs compared with traditional care, financial sustainability and other system-wide indicators. Find more information here.
  • Differentiated service delivery featured strongly in the 22nd International AIDS Conference (AIDS 2018) conference programme with abstract-driven sessions, workshops and satellites, including a satellite hosted by the IAS and the World Health Organization (WHO). Click here to download a road map summarizing the DSD sessions at AIDS 2018.
  • The Joep Lange Institute hosted an AIDS 2018 pre-conference on Sunday, 22 July 2018, to discuss potential solutions to addressing challenges in the HIV response, including DSD to improve the coverage, quality and impact of HIV service delivery. Download the full report and fact sheet here.  
  • With funding from PEPFAR, Human Resources for Health in 2030 (HRH2030) developed a simple, standardized, client-centred tool to help programme managers maximize the use of their health workforce for the rollout of “Test and Start” utilizing DSD models. Find the tool here.  
Looking ahead …
  • A youth chapter on DSD advocacy will be launched at the upcoming PATA Summit taking place in Dar es Salaam, Tanzania, on 26-28 November 2018. The chapter, “What works for us – youth-led advocacy for DSD”, will be available for download. Stay informed on social media using #WhatWorksForMe.
  • Late-breaking abstract submission for CROI 2019 opens on 3 December 2018.
Retention on ART and predictors of disengagement from care in several alternative community‐centred ART refill models in rural Swaziland, Lorraine Pasipamire, Robin C Nesbitt, Sindiso Ndlovu, Gibson Sibanda, Sipho Mamba, Nomthandazo Lukhele, Munyaradzi Pasipamire, Serge M Kabore, Barbarba Rusch, Iza Ciglenecki and Bernhard Kerschberger 

This compares retention in care and on ART and identifies predictors of disengagement with care in relation to community‐centred ART delivery models in Eswatini.
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Patient and health worker experiences of differentiated models of care for stable HIV patients in Malawi: A qualitative study, Margaret L Prust, Clement K Banda, Katie Callahan, Rose Nyirenda, Frank Chimbwandira, Thokozani Kalua, Michael Eliya, Peter Ehrenkranz, Marta Prescott, Elizabeth McCarthy, Elya Tagar and Andrews Gunda

This qualitative study is aimed at understanding the challenges and successes of implementing models of care and of the process of client differentiation.
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Experiences of HIV-positive postpartum women and health workers involved with community-based antiretroviral therapy adherence clubs in Cape Town, South Africa, Zara Trafford, Yolanda Gomba, Christopher J Colvin, Victoria O Iyun, Tamsin K Phillips, Kirsty Brittain, Landon Myer, Elaine J Abrams and Allison Zerbe
This qualitative paper reports on feedback from both postpartum women and health workers who care for them on their respective experiences of adherence clubs.
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A Successful Model of Expedited Antiretroviral Therapy for Clinically Stable Patients Living With HIV in Haiti, Colette Guiteau Moise, Vanessa R Rivera, Kelly A Hennessey, Clovy Bellot, Chris Nicholas, Anna P Fang, Rose Irène Verdier, Patrice Severe, Alix Sainvil, Benedict Charles, Derothy Dorval, Juseline St. Amour, Jean W Pape and Serena P Koenig

This paper provides analysis of expedited visits, including nurse-led assessments and point-of-service antiretroviral therapy dispensing for clinically stable clients in Haiti.
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HIV self-testing strategic framework: A guide for planning, introducing and scaling up, WHO

This framework is intended to be a brief guide for countries and implementers that are planning, starting or scaling up HIV self-testing implementation.
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Providing differentiated delivery to children and adolescents, Child Survival Working Group: IAS, UNICEF, WHO

This is a policy brief by the Child Survival Working Group that advocates for an accelerated scale up of differentiated service delivery for children and adolescents.
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Impact of a Family Clinic Day Intervention On Pediatric and Adolescent Appointment Adherence and Retention to ART, Clinton Health Access Initiative 

This is a policy brief on a DSD model prioritizing HIV treatment and counselling for paediatric and adolescent clients, which improved client adherence to ART appointment schedules in Uganda. 
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Differentiated service delivery models at AIDS 2018
View an abstract-driven DSD session at AIDS 2018, co-chaired by Tsitsi Apollo and Nomthandazo Lukhele. 
Meet Jane! Differentiated Service Delivery for Adolescents
Watch the new cartoon by the Adolescent HIV Treatment Coalition.
Youth Care Clubs
Watch a video by the Wits Reproductive Health and HIV Institute (Wits RHI).
DSD for HIV: A Decision Framework for differentiated antiretroviral therapy delivery for key populations
The third in the Decision Framework series, it outlines the methodology for identifying specific challenges, deciding what DSD models could solve these challenges and how to systematically adapt or build a differentiated model of ART delivery for a specific key population. English, French and Portuguese versions are available. 
DSD for HIV: A Decision Framework for HIV testing services
The fourth in the Decision Framework series, this document is a practical tool to guide HIV programme managers on how to consider HIV testing and linkage services differently. English, French and Portuguese versions are available.
Sign up for the IAS 2019 Abstract Mentor Programme
  • The Abstract Mentor Programme for the 10th IAS Conference on HIV Science (IAS 2019) offers free mentoring to improve written abstract skills of young or less experienced researchers. Sign up now to become a mentor or submit your abstract for mentoring from 26 November 2018. 
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Photo credits in order of appearance: 
IAS (1), (2), Jirantanin T./USAID LINKAGES, MPLUS (3), Akram Ali/Photoshare (4)
Copyright © 2018 International AIDS Society, All rights reserved.

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