“It's time to deliver differently”

Jon Crisp, Baylor College of Medicine Children's Foundation Malawi/SHARE staff

Differentiated service delivery (DSD) has increasingly become the norm for HIV service providers and their clients; and not a moment too soon. In southern Africa, we are all too familiar with the one-size-fits-all approach to service delivery and the resulting challenges of overburdened facilities, long queues, exhausted healthcare workers, and poor client adherence. Viewing service provision from a client’s perspective, considering the different needs of different types of clients, and adapting service delivery to provide differentiated models has played a significant role in southern Africa’s progress towards the UNAIDS 90-90-90 targets, especially in countries like Malawi and Uganda that have embraced DSD. Yet gaps remain.

Kevin Osborne, Director of IAS, presents on the new DSD framework at the AIDS 2018 IAS sattelite session. Photo Credit: Johnathan Crisp.
Kevin Osborne, Director of IAS, presents on the new DSD frameworks at an AIDS 2018 satellite session, July 23, 2018. Photo Credit: Jon Crisp.


One of the biggest challenges is reaching men. Further, key populations – men who have sex with men (MSM), transgender women, people who inject drugs (PWID), and female sex workers (FSW) –  worldwide, including in southern Africa, have a significantly higher risk of HIV transmission and poor outcomes on ART compared to other populations. Nearly half (47%) of new HIV infections worldwide are among key populations. Additional guidance and new innovations on how best to adapt service delivery models to meet the needs of these key populations are essential.

Similarly, with renewed emphasis on HIV prevention and the advent of pre-exposure prophylaxis (PrEP) services in many southern African countries, we are only starting to grapple with how to best adapt HIV testing services (HTS) to prevent HIV transmission to high-risk clients. How do we integrate better prevention tools (including PrEP) into existing HTS programs as well as differentiate those services to meet the needs of prospective clients at high risk for HIV who are not currently reached by existing service models?

With these challenges and questions looming, we welcome new decision frameworks from the International AIDS Society and its many partners on DSD for HIV testing services and ART delivery to key populations, including A Decision Framework for HIV testing services and A Decision Framework for differentiated antiretroviral therapy delivery for key populations.

These new frameworks are particularly helpful in how they present different client archetypes and follow them through their challenges with current models, encouraging consideration of how differentiated services could better meet their needs. These new frameworks have the potential to help southern Africa better meet the unique needs of different types of clients in the coming years.

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