Despite the remarkable progress made in the AIDS response in Africa, considerable gaps and challenges remain for achieving the 95-95-95 testing and treatment targets by 2025 and putting the continent on track to ending the AIDS epidemic by 2030. UNAIDS, the World Health Organization (WHO) and partners came together at a satellite session at the 2021 International Conference on AIDS and STIs in Africa to discuss how differentiated service delivery can bring the world closer to the targets.
People-centred differentiated service delivery is critical to accelerating access to and uptake of HIV testing and treatment services. While the COVID-19 pandemic has made many countries adapt HIV services to include delivery outside health facilities and by communities, and by scaling up multimonth dispensing of HIV and other medicines, it has also revealed a lack of resilience in key areas of systems for health, including the ability to ensure uninterrupted supplies of medicines and commodities, adequate funding for community-led organizations to provide services and support and the provision of integrated services for multiple health conditions. These adaptations and gaps have underlined the feasibility and importance of delivering differentiated, decentralized, integrated and community-based models of testing and treatment services across different settings.
During the session, representatives of ministries of health and communities, programme implementers, researchers and development partners highlighted ways in which differentiated service delivery has enhanced national efforts to reach their testing and treatment targets for all relevant population groups. They also presented new partnerships, tools, policies and best practices, and called attention to important policy shifts and innovations for scaling up differentiated service delivery, such as targeted community testing and self-testing for HIV, wider spacing of antiretroviral therapy dispensing and clinic visits, community antiretroviral therapy distribution and peer support for linkage to and retention in care for key and vulnerable populations.
“We see huge differences in testing and treatment uptake in different populations across different settings in Africa. For example, children are lagging behind adults, men are lagging behind women, and key populations living with HIV are lagging behind the general population of people living with HIV. Ensuring people- and community-centred differentiated service delivery approaches that respond to barriers to access and the diverse needs across all relevant populations together with conventional facility-based service delivery is critical to leaving no one behind,” said Ani Shakarishvili, UNAIDS Special Adviser, Access to Treatment, Care and Integration.
In April 2021, WHO released new guidelines on HIV prevention, testing, treatment, service delivery and monitoring. Updated service delivery recommendations include the initiation of antiretroviral therapy outside of the health facility, clinic visit spacing and dispensing of antiretroviral therapy every three to six months. The criteria for when a person is eligible to benefit from differentiated service delivery for HIV treatment have also been updated.
“The changes that have been made allow more people to access differentiated services for HIV treatment earlier in order to support their retention in care, meeting their needs and preferences and moving away from one-size-fits-all to more person-centred approaches,” said Clarice Pinto, a consultant on differentiated service delivery for HIV treatment at WHO.
On implementing and scaling differentiated models in countries, Anthony Ashinyo, the Deputy Programme Manager for the National AIDS/STI Control Programme in Ghana, underlined the need for multisectoral collaboration and partnerships between the government, implementers and communities to increase the uptake of differentiated service delivery.
“I see us being in the driving seat. I see us strengthening the influence of people living with HIV, recipients of care and affected communities in the design and implementation of national strategies and plans, so that they adequately reflect and respond to our lived realities and needs,” said Elsie Ayeh, the President of the Network of Persons Living with HIV/AIDS, Ghana.
The session concluded with the launch of a call to action to leave no one behind by scaling up differentiated HIV testing and treatment service delivery in Africa.