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We hope that you enjoy the 14th edition of the differentiated service delivery (DSD) newsletter. This newsletter focuses on DSD and contraceptive care, spotlighting work in Kenya and sharing the latest DSD news and upcoming webinars.
“Globally, approximately 60 million additional women and girls are using contraceptive today than were in 2012. And yet, there is so much more to do.” 

Beth Schlachter, Executive Director, FP2020, writes:  

Since our launch in 2012, Family Planning 2020 (FP2020) has been working with our partners – more than 120 commitment makers from across governments, civil society, foundations, the private sector, youth-led organizations, academics and researchers, across the world – to support all women and girls to decide, freely and for themselves, when, whether and how many children they want to have. As a result of this global movement, approximately 60 million additional women and girls are using contraception than eight years ago. 

And yet, there is so much more to do. As those of us in global health have long known and was reinforced during the release of last year’s ECHO trial, far too many women, especially young women and adolescent girls, remain simultaneously at risk for both unintended pregnancy and HIV infection. Comprehensive sexual and reproductive healthcare that includes family planning and HIV and STI prevention and treatment services is essential to provide women and their families with the protection they need and the lives they deserve.  

In other words, as a global community, we must move toward providing both services together – ideally in one place, by the same provider, on the same day. This means putting the woman’s or girl’s perspectives, needs and rights at the centre of any and all interventions.  

Read Beth Schlachter’s full perspective here. And join FP2020 and IAS – the International AIDS Society – for our next joint webinar on 2 December. Find out more here
  • Leveraging differentiated ART delivery models to strengthen family planning is an IAS DSD supplement that was released earlier this year in EnglishFrench and Portuguese to support national and district ART programme managers, implementing partners and donors. 
  • The next instalment of the FP2020-IAS webinar series takes place next Wednesday, 2 December at 09:00 EDT/15:00 CAT. “Family planning and HIV Integration – Policy priorities, on-the-ground realities and opportunities ahead” will include a panel of expert speakers, explore sexual and reproductive health and HIV integration, and launch a global call to action to make this integration a reality. This is a webinar you do not want to miss. Click here to register. 
The Journal of the International AIDS Society (JIAS) has opened a call for abstracts for its upcoming supplement, “The impact of COVID-19 on differentiated service delivery for HIV”. The due date for submissions is 6 January 2021. Further information on scope and content is available here
Putting the client at the centre

“The need to have continuous engagement with women and girls of childbearing potential to enable them to have information on all FP options and to support them in making informed choices cannot be emphasized enough.” 

Dr Lazarus Momanyi is a medical doctor and public health specialist with over 10 years’ experience designing and implementing HIV programmes in Kenya. As Technical Advisor for HIV DSD at the National AIDS and STI Control Programme (NASCOP), a division of Kenya Ministry of Health, he is currently involved in coordinating the design, implementation and scale up of client-centred DSD models. 

What does NASCOP do?  

NASCOP leads Kenya’s health sector response to HIV and AIDS, sexually transmitted infections (STIs) and viral hepatitis through policy and guidelines formulation, procurement and supply chain management coordination, capacity building and monitoring and evaluation. 

What is the biggest current challenge for NASCOP in DSD and family planning?  

Despite making great progress in scaling up DSD in Kenya, we are yet to implement to scale “one-stop” shops where women are able to access comprehensive services, including family planning (FP), through various facility and community models.  

Proudest achievement to date?  

One of our successes has been the progressive scale up of the integration of FP services within HIV clinics over the years. We have achieved this through routine pregnancy intention screening of women of childbearing potential, capacity building of healthcare workers, and infrastructural support. 

As you scale up DSD models, what opportunities are there for FP within community DSD models?  

As we make efforts to implement community models at scale, we need to continually rethink innovative ways to integrate FP within the models. Some of the practical opportunities include alignment of FP for the women during six-monthly facility clinic visits and dispensing of oral FP in community ART groups (CAGs), as well as delivery of injectable FP in the community with healthcare worker-led CAGs. 

Read more about Dr Momanyi’s typical working week, his lessons learned and advice for those implementing similar models here.  

LinkedIn: Dr Lazarus Momanyi │Twitter @lazmomanyi 

Looking ahead…
  • On now! APCOM is currently hosting the Rights, Resources, Resilience Asia Pacific Conference (RRRAP Con) 2020 as part of its APCOM Community Summit 2020. The virtual conference runs from 23 to 27 November and includes an IAS-hosted session on HIV DSD and COVID-19. Find the programme and registration link here.  
  • 1 December is the deadline for abstract submissions for the Conference on Retroviruses and Opportunistic Infections (CROI 2021). This annual conference brings together top researchers from around the world to share the latest HIV-related studies, developments and research methods. 
  • 1 December is World AIDS Day, an international day of awareness and activism for HIV and AIDS. UNAIDS has put together this resource page, with free-to-use videos and campaign materials for raising awareness about important HIV-related public health and human rights issues. 
  • 2 December will see the next instalment of the FP2020-IAS webinar series at 09:00 EDT/15:00 CAT. “Family planning and HIV Integration – Policy priorities, on-the-ground realities and opportunities ahead” will include a panel of expert speakers, explore sexual and reproductive health and HIV integration, and launch a global call to action to make this integration a reality. Click here to register. 
  • 7 December will see the IAS host a webinar on ‘’COVID-19 and HIV: Latest updates and guidance’’, focused on the latest news from the WHO and global lessons from Malaysia, Mozambique and across South East Asia. Register here
Looking back …

Community-based delivery of HIV treatment in Zambia: costs and outcomes 
Nichols BE, Cele R, Jamieson L, Long LC, Siwale Z, Banda P et al.

This health economics paper compares the cost of three community-based DSD models with a three-monthly facility-based care approach. 

The Ritshidze website 

Ritshidze, a community-led clinic monitoring programme in South Africa, has just launched its new website. It includes DSD quality assessment tools and resources, such as “Adherence Club Member” and “Adherence Club Facility” surveys. 

Outcomes of patients on second- and third-line ART enrolled in ART adherence clubs in Maputo, Mozambique 
Finci I, Flores A, Gutierrez Zamudio AG, Matsinhe A, de Abreu E, Issufo S 

This study investigated the impact of an adherence club DSD model on retention in care and viral load suppression for clients with a history of ART treatment failure. 

Expanding the vision for differentiated service delivery: a call for more inclusive and truly patient-centered care for people living with HIV 
Ehrenkranz P, Grimsrud A, Holmes C, Preko P, Rabkin M  

This paper proposes a shift from HIV-focused DSD to more client-centred DSD, with integration of care for other chronic conditions. 

‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa 
Marriott Keene C, Zokufa N, Venables E, Wilkinson L, Hoffman R, Cassidy T et al.  

This study engaged with clients, healthcare workers and key informants to explore experiences of six-monthly extended ART refills in adherence clubs in a peri-urban setting. 

Implementing TB preventive treatment within differentiated HIV service delivery models in global programs 
Boyd AT, Moore B, Shah M, Tran C, Kirking H, Cavanaugh JS et al. 

This commentary looks at the actual implementation of DSD integrated TB preventative therapy, from service planning to operation.  

The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the U.S. – applying lessons from high-burden settings 
Collins L, Colasanti J, Nguyen M, Moran C, Lahiri C, Marconi V et al. 

This commentary considers the COVID-19 pandemic as a catalyst for expanding DSD in the USA. 


What is Differentiated Service Delivery (DSD)? Now you know  

Launched in 2019, this explainer video on what DSD is was developed by the International Treatment Preparedness Coalition (ITPC) to support its #TreatPeopleRight campaign and increase awareness of DSD. Watch here.  

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Photo credits in order of appearance:
(1) FP2020 (2) FP2020 (3) Dr Lazarus Momanyi (4) Ritshidze (5) ITPC
Copyright © 2020 International AIDS Society, All rights reserved.

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