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We hope that you enjoy the eighth edition of the differentiated service delivery (DSD) newsletter. This newsletter promotes knowledge sharing among stakeholders working on DSD and provides updates on related activities.
Men's right to health: Meaningful engagement of men and boys in the HIV response
Philip Nyakwana, Movement of Men against AIDS in Kenya, Kenya

While the link between gender inequality and HIV vulnerability is recognized, current programming often focuses on women and girls, with limited attention to the role that men can play in addressing gender inequality and harmful gender norms that lead to negative health outcomes for everyone. Programmes are not taking into consideration men in all their diversity and nor are they exploring ways to sensitize men and boys. We need to do a better job of addressing this as part of a comprehensive HIV response.

At my organization, Movement of Men against AIDS in Kenya, we try to do things differently by involving boys and men as our target group from the initial phase of the programme design and planning process. This approach is used to strengthen and create sustainable responses that are owned by the men and boys. The same group is then trained on how to: engage peers using evidence-based interventions and strategies that adopt and use gender-transformative approaches; advocate for male-friendly services in the workplace and community; and support men living with HIV to advocate for engaging men in HIV services and to build capacity of the target beneficiaries through a peer-to-peer approach. Read more

FACES OF DIFFERENTIATED SERVICE DELIVERY
Ndumiso Madubela, Desmond Tutu HIV Foundation, University of Cape Town, South Africa 

Can you tell us about your work and why you decided to pursue a career in the HIV field? 

I am a PhD candidate at the University of Cape Town, South Africa, and an early-career socio-behavioural scientist at the Desmond Tutu HIV Foundation. I have a long-held interest in HIV and sexual and reproductive health and rights (SRHR) in adolescents and young men, particularly in investigating interventions that improve accessibility and uptake of SRHR and HIV prevention and treatment
services among young men.

Growing up in the township of KwaMashu, Durban, I saw many friends and family members affected by HIV. Unfortunately, due to stigma, one could not openly engage in dialogue about it. There came a point where I was attending funerals every other month, losing friends and family members to AIDS. Thereafter, I made it a priority to actively participate in HIV research, advocate, educate and bring awareness. I continue expanding my experience in this field by pursuing a PhD to understand what young men want from health services. Read the full interview

DIFFERENTIATED SERVICE DELIVERY IN ACTION

Men’s clinics initiative in Lesotho
Dr Limpho Maile & Grace Mefane, Ministry of Health, Lesotho
Thabiso Lekhotsa & Makopano Letsatsi, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)

In 2017, the Lesotho Ministry of Health and EGPAF, with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR), established eight male-friendly clinics in the two highest HIV burden districts to improve men’s access to HIV testing and treatment. Improved access, retention and viral suppression rates have been recorded, driving the scale up of the initiative to 24 clinics in eight districts to date. The clinics provide comprehensive integrated STI/HIV/TB services from prevention to treatment, including screening and treatment for other co-infections.

Services are provided during extended hours to accommodate work schedules, as well as on an appointment basis and by male healthcare workers who are trained to provide male-friendly services. Each clinic has a dedicated waiting area for men and provides medical consultations and dispensing treatment in the same room to ensure privacy and confidentiality. From June 2017 to March 2019, the eight men’s clinics tested 35,390 men with an HIV-positive test yield of 10%. Close to 5,000 men were initiated on antiretroviral therapy with viral suppression above 95%.

Read more about the men’s clinics and watch a video featuring the voices of beneficiaries.

LOOKING BACK, LOOKING AHEAD
Looking back …
  • The “IAS consultation on differentiated ART delivery in West and Central Africa” convened more than 40 participants from ministries of health, implementers and community in eight countries in West and Central Africa (WCA) and global stakeholders in Accra, Ghana, on 17 May 2019. Find out more about the consultation and read the new WCA policy brief and the WCA supplement to A Decision Framework for antiretroviral therapy delivery.
  • Co-organized by the Amsterdam Institute for Global Health and Development and Virology Education, the 13th International Conference on HIV Treatment, Pathogenesis, and Prevention Research in Resource-limited Settings (INTEREST 2019), held in Accra, Ghana, on 14-17 May, provided a platform for HIV scientists in Africa to share latest findings and promote collaboration and exchange. The final INTEREST 2019 Abstract Book and presentations are available online.
  • UNAIDS, in partnership with UN Women, Sonke Gender Justice and Promundo, hosted a meeting on “Accelerating men’s HIV service delivery and updates in Eastern and Southern Africa (ESA)” in Johannesburg, South Africa, on 22-24 May. The event brought together eight countries from the ESA region to review the latest data, share research and promising practices, agree on a Men and HIV Fast-Track Acceleration Framework and develop draft national plans for scaling up an improved HIV-response among men. Download the meeting materials here.
  • The IAS and Women Deliver hosted the second Generation Now: Our Health, Our Rights pre-conference on 2 June 2019, ahead of the Women Deliver 2019 Conference (WD2019) in Vancouver, Canada. The meeting attracted hundreds of youth and adult change makers from around the world, inspiring multiple commitments to advocating for linked SRHR and HIV services, systems and policies.
  • The 9th South Africa AIDS Conference took place in Durban, South Africa, on 11-14 June. It included new data on differentiated service delivery in the country, including interim findings from a randomized control trial with six-month antiretroviral therapy refills within adherence clubs and a situational analysis of DSD for adolescents and young people in South Africa.
Looking ahead …
  • Don’t miss any of the DSD science at IAS 2019 – download the DSD roadmap here.
  • Register for the Men & HIV Forum convened by the IAS and partners in Mexico City, Mexico, on 20 July 2019. Click here for more information.
  • Join the IAS DSD team for the IAS 2019 satellite session, ‘Sticky linkage’: Latest evidence and new strategies in Mexico City, Mexico, on 21 July.
  • The UN High-Level Meeting (UN HLM) on Universal Health Coverage will take place in New York, USA, on 23 September 2019. Read the ZERO draft of the UN HLM Political Declaration and download the campaign toolkit here.
WHAT WE'RE READING
Mapping evidence of intervention strategies to improving men’s uptake to HIV testing services in sub-Saharan Africa: A systematic scoping review, Hlongwa M, Mashamba-Thompson T, Makhunga S, Hlongwana K

This systematic review of literature from sub-Saharan Africa summarizes the evidence base for how to improve uptake of HIV testing among men in the region, concluding that men would benefit from having more information about HIV testing and that services should be tailored for men.
Read more
Strategies for engaging men in HIV services, Colvin CJ

This review outlines factors driving poorer engagement of men in HIV services and summarizes strategies for improving men’s engagement. It concludes by laying out current debates in the design and delivery of HIV services for men and proposing the future research agenda.
Read more
 
Men’s perceptions of HIV care engagement at the facility- and provider-levels: Experiences in Cote d’Ivoire, Tibbels NJ, Hendrickson ZM, Naugle DA, Dosso A, Van Lith L, Mallalieu EC, Kouadio AM, Kra W, Kamara D, Dailly-Ajavon P, Cisse A

Drawing on qualitative data from focus group discussions and in-depth interviews with men living with HIV who are both in care and not in care, this article outlines factors that influence men’s engagement and retention in HIV care in Côte d'Ivoire.
Read more
Research to improve differentiated HIV service delivery interventions: Learning to learn as we do, Geng EH, Holmes CB.

This commentary articulates the balance between innovation and the need for evidence before scaling up an intervention. It also outlines “common perils in current conduct of implementation science”, arguing for “rigorous and relevant implementation research” within the HIV response.
Read more
Clients’ experiences utilizing a safer conception service for HIV affected individuals: implications for differentiated care service delivery models, Schwartz S, Davies N, Naidoo N, Pillay D, Makhoba N, Mullick S
 
Based on data from a clinic in Johannesburg, South Africa, this article describes the acceptability and attitudes, as well as knowledge and self-efficacy, among safer conception service clients. The authors highlight implications for safer conception in the era of differentiated service delivery with less frequent clinical contact.
Read more
Community-Based Antiretroviral Therapy (ART) Delivery for Female Sex Workers in Tanzania: 6-Month ART Initiation and Adherence, Tun W, Apicella L, Casalini C, Bikaru D, Mbita G, Jeremiah K, Makyao N, Koppenhaver T, Mlanga E, Vu L
 
This implementation study highlights improved outcomes among female sex workers in Tanzania who received community ART initiation and delivery compared with the standard of care, including with regard to the proportion of those who have initiated ART, retention at six months and level of internalized stigma.
Read more
Predictors of isoniazid preventive therapy completion among
HIV-infected patients receiving differentiated and non-differentiated HIV care in rural Uganda
, Tram KH, Mwangwa F, Chamie G, Atukunda M, Owaraganise A, Ayieko J, Jain V, Clark TD, Kwarisiima D, Petersen ML, Kamya MR
 
In this study, data are presented from five rural communities in Uganda, where completion rates for isoniazid preventive therapy were higher among those in a differentiated service delivery model than those in the standard of care. 
Read more
Re-thinking Linkage to Care in the Era of Universal Test and Treat: Insights from Implementation and Behavioral Science for Achieving the Second 90, Herce ME, Chi BH, Liao RC, Hoffmann CJ

This article argues that linkage to care should be viewed as a process and reframes linkage as requiring quality from testing through to early follow up. Further, it outlines the need to assess and address linkage barriers that may be at the health system, service delivery or client behaviour level.
Read more
WHAT WE'RE WATCHING

Six months’ supply of antiretroviral therapy in Khayelitsha, South Africa, MSF SAMU

This video showcases a differentiated service delivery model implemented by the Médecins Sans Frontières (MSF) Southern Africa Medical Unit (SAMU). Since 2017, stable clients in adherence clubs at the Ubuntu clinic in Khayelitsha have received six months’ supply of antiretrovirals. Listen to client “Lulama” as she shares her testimony on how the six-month supplies have made a difference in her life.

What is a Community Treatment Observatory (CTO)? Now You Know, International Treatment Preparedness Coalition (ITPC)

ITPC has been monitoring the scale up and quality of HIV treatment in different countries over the past decade. Through this work, ITPC has refined a model for community-led monitoring known as a community treatment observatory (CTO). Watch this short animation to learn more.

DON'T MISS
A toolkit for action: Young men and HIV prevention, UNFPA and Promundo

This guide serves to reinforce the benefits of working with young men and provides conceptual and practical information on how to design, implement and evaluate HIV prevention activities which incorporate a gender perspective and engage young men and relevant stakeholders.
Read more
GET INVOLVED
Share your thoughts with us!

The DSD online repository, www.differentiatedservicedelivery.org, is undergoing an evaluation to ensure future relevance and accessibility of its content. Please email us at dsd@iasociety.org if you are attending IAS 2019 and are interested in participating in one of the evaluation activities.
GET IN TOUCH
Do you have something for the next newsletter? We want to hear from you.
Email us at dsd@iasociety.org
Photo credits in order of appearance:
(1) MSF, (2) DTHF, (3) EGPAF/MoH Lesotho, (4) IAS/Cyril Otabil, (5) MSF SAMU, (6) ITPC
Copyright © 2019 International AIDS Society, All rights reserved.


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