Differentiated service delivery models for antiretroviral treatment of HIV in sub-saharan Africa: A rapid systematic review ; AMBIT Project Report Number 04

By  Lawrence Long  Kuchukhidze S  Sophie Pascoe  Brooke Nichols  Refiloe Cele  Caroline Mandimika  Amy Huber  Flynn D  Sydney Rosen  |  | 

Throughout sub-Saharan Africa, most national HIV programs are striving to achieve the 90-90-90 (or even 95-95-95) targets for HIV diagnosis, treatment, and viral suppression. The rapid expansion of antiretroviral therapy (ART) programs to reach these targets has created shortfalls in health system capacity and quality.1 In response, many countries are scaling up alternative service delivery approaches, or differentiated service delivery (DSD) models. DSD models differ from conventional HIV care in the location and frequency of interactions with the healthcare system, cadre of provider involved, and/or types of services provided.2 Grimsrud and colleagues broadly categorize DSD models as individual or group models, with service delivery at a facility or in the community.3 DSD models aim to achieve a wide range of potential benefits to both providers and patients, including better clinical outcomes, greater patient satisfaction, lower cost to both providers and patients, and more efficient and convenient service delivery. Despite the large-scale rollout of DSD models in various formats across multiple countries, there is a dearth of evidence to document the purported benefits of the new models in routine implementation. The studies and evaluations available are widely inconsistent in their designs, methods, and outcomes,
making it difficult to draw an overall picture of the impact of the models. Monitoring and evaluation systems have not kept up with DSD model implementation; DSD participation is poorly captured in routine records, making it challenging to reliably estimate patient coverage and uptake.4 The information available to policy makers, funders, and program implementers is thus incomplete and difficult to interpret. To help fill this gap and create a baseline to guide future research, we conducted a rapid review of the most recent peer-reviewed reports of the outcomes of DSD model implementation in sub-Saharan Africa. In this report, we describe the DSD models in use and synthesize available information on model
uptake, coverage, effectiveness, and cost.

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