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We hope that you enjoy the 13th edition of the differentiated service delivery (DSD) newsletter. This newsletter summarizes the DSD content arising from AIDS 2020: Virtual, spotlights DSD in action in Trinidad and Tobago and Uganda, and shares the latest DSD news, publications and upcoming webinars.
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Reflections on AIDS 2020: Virtual from a DSD perspective
Dr Sophie Pascoe – Health Economics and Epidemiology Research Office HE2RO, South Africa
Only a few months ago, I imagined myself enjoying the delights of San Francisco and Oakland at AIDS 2020. Instead, I sat alone, glimpsing the homes and offices of colleagues around the world at the first International AIDS Conference of its kind: AIDS 2020: Virtual. This was a conference that required differentiated delivery to meet the needs of presenters and participants across the globe.
DSD was the focus of around 100 presentations, making it clear that scale up of DSD has continued apace over the past year. Most striking was how DSD models have enabled health system resilience and flexibility in the face of the COVID-19 pandemic, with many countries leveraging these models to support HIV programmes across the cascade. Anna Grimsrud explained that DSD provides the necessary tools to limit exposure to COVID-19 and co-infection among people living with HIV while they continue to access health services, and Wilkinson and Preko succinctly summarized the broad categories of DSD expansion and adaptation made by countries in response to COVID-19.
As Meg Doherty summarized, the COVID-19 challenges have inspired service delivery innovations, and we need to make the most of these resilient responses: multi-month dispensing, community delivery, social media and e-health.
Access Dr Pascoe’s full reflection here. Read her recent publication on perspectives of DSD for HIV treatment in South Africa here.
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FACES OF DIFFERENTIATED SERVICE DELIVERY
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Dr Nyla Lyons, Public Health Specialist, Medical Research Foundation of Trinidad and Tobago
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Dr Lyons, what do you want people to know about DSD in Trinidad and Tobago?
The Medical Research Foundation (MRF) is a non-governmental organization and the largest HIV/STI service provider in Trinidad and Tobago. With support from the government, the MRF began implementing DSD in 2017.
Today, DSD models in Trinidad and Tobago serve as best-practice examples for other developing countries, both within the Caribbean and internationally.
You presented a late-breaker poster at AIDS 2020: Virtual. Can you tell us about the impact of the COVID-19 pandemic on HIV services where you work?
Beginning in March 2020, our government implemented measures to avert community spread of COVID-19, which included restricting public gatherings and shutting down non-essential services. In response, the MRF expanded implementation of DSD, including community antiretroviral therapy pick-up and delivery services facilitated by “patient peers” and supporting telehealth services. [For more information, read the AIDS 2020: Virtual late breaker here.]
The role of “patient peers” in your setting has been strengthened in response to COVID-19-related service delivery challenges. How do these peers support DSD in Trinidad and Tobago?
These peers serve as a conduit to HIV services and work in collaboration with the clinicians at the MRF, assisting in linking newly diagnosed clients to treatment, monitoring and re-engaging clients in care, facilitating the delivery of medication and providing psychosocial support to clients affected by COVID-19. “Patient peers” also use social media to keep clients and communities informed and serve as a medium to connect clients to essential services during the stay-at-home period.
Read her full interview
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DIFFERENTIATED SERVICE DELIVERY IN ACTION
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Community-based adherence clubs for men who have sex with men in Uganda – Supporting viral suppression, retention in care and peer support
Susan Atuhura, Spectrum Uganda Initiatives
This work was presented at AIDS 2020: Virtual and awarded an IAS/MSD Prize for Operational and Implementation Research in Differentiated Service Delivery as one of the highest-scoring abstracts.
In response to community demand for ART adherence clubs and poor rates of viral suppression, Spectrum Uganda Initiatives recruited men who have sex with men to join adherence clubs in 2018. Men who have sex with men who were living with HIV and virally suppressed and had been in a community-based support group for a year or more were eligible to join.
Ten adherence clubs, each with four to 11 members, were formed (71 members in total) and met monthly for peer support, counselling and ART refills, with additional psychosocial support through a peer-run WhatsApp group. All activities, including clinical and viral load monitoring, took place in the community, and each club’s healthcare workers received gender and sexual diversity training.
As of November 2019, all 71 members were virally suppressed. Going forward, adherence clubs will be expanded to additional members and for other key population groups.
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LOOKING BACK, LOOKING AHEAD
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Looking back …
- Virtual Fast-Track Cities took place online on 9-10 September. Focusing on urban HIV, TB and hepatitis C (HCV) responses within the context of the COVID-19 pandemic, the conference featured an impressive line up of expert speakers, including a pre-conference plenary on service delivery. Visit the IAPAC website for more details.
- APCOM, with support from Linkages, hosted a webinar series focusing on the impact of COVID-19 on HIV service delivery in the Asia-Pacific region. View the slides and resources from the DSD-focused first session: “Community-Based Organizations and innovative solutions to address interruptions in HIV testing, treatment, and case management”.
- On 28-29 July, ICAP’s CQUIN project, in partnership with CHAI and Unitaid, convened a 17-country virtual workshop on DSD for advanced HIV disease. Click here to view the session recordings and slides.
- The winning abstracts for the 2020 IAS/MSD Prizes for Operational and Implementation Research in Differentiated Service Delivery were announced at AIDS 2020: Virtual. Click here to see their excellent DSD research contributions.
- The AIDS 2020: Virtual satellite session, “Bringing PrEP closer to home: Why is now the time for differentiated PrEP?”, was hosted by AIDS Vaccine Advocacy Coalition (AVAC), PATH and IAS. It highlighted how some countries have rapidly pivoted PrEP programming to be more differentiated and truly client centred. Click here to access the recording and slides
- The AIDS 2020: Virtual satellite session, “Differentiated service delivery in 2020 – Responding to the needs of people living with HIV before, during and after COVID-19”, featured programmes in Kenya, Sierra Leone and South Africa and focused on how DSD is adapting and evolving in 2020. Click here to view the recording and slides.
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Looking ahead…
- On 22 September CQUIN and the AMBIT project are hosting a virtual workshop, “Do DSD models for HIV treatment save money for health systems?”. This online event features presentations on DSD costing, country case studies and a panel discussion. Click here to register.
- On Tuesday, 13 October, the Indlela unit at HE2RO is hosting their second webinar, “How to nudge your HIV programme to success”, which will focus on the application of behavioural economics to HIV service delivery in South Africa. Click here to register.
- Don’t miss the two-part webinar series hosted by Family Planning 2020 and the IAS DSD initiative, “Integrating rights-based family planning and HIV care: Lessons learned from differentiated service delivery for HIV treatment”. Register here for the first webinar in the series on Wednesday, October 14.
- CQUIN has launched a bi-monthly webinar series on DSD, taking place on Tuesdays at 14:00 CAT. Stay tuned for upcoming sessions, which include integration of DSD for HIV and non-communicable diseases, DSD for key populations in Zimbabwe and the impact of COVID on DSD programmes in Mozambique and South Africa. Click here for recordings of past webinars and details on upcoming webinars.
- PEPFAR will be releasing its draft Country Operational Plan 2021 (COP 21) Guidance for public comment. Check here for details.
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Community-wide HIV testing, linkage case management, and defaulter tracing in Bukoba, Tanzania: pre-intervention and post-intervention, population-based survey evaluation
Steiner C, MacKellar D, Cham HJ, Rwabiyago OE, Maruyama H, Msumi O, Pals S, Weber R, Kund Gi, Byrd J, Kazaura K, Madevu-Matson C, Morales F, Justman J, Rutachunzibwa T, Rwebembera A
This paper on the Bukoba Combination Prevention Evaluation describes the pre- and post-intervention differences for this innovative, peer-delivered, linkage-case-management programme.
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The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review
Vanhamel J, Rotsaert A, Reyniers T, Nöstlinger C, Laga M, Van Landeghem E, Vuylsteke B
This review reveals that while PrEP services are mainly centralized and facility based, innovative differentiated approaches to service delivery are also being provided.
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Will differentiated care for stable HIV patients reduce healthcare systems costs?
Larson BA, Pascoe SJ, Huber A, Long LC, Murphy J, Miot J, Fox MP, Fraser-Hurt N, Rosen S
This JIAS debate article offers a health economics perspective on two DSD models implemented in South Africa.
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Participation in adherence clubs and on-time drug pickup among HIV-infected adults in Zambia: A matched-pair cluster randomized trial
Roy M, Bolton-Moore C, Sikazwe I, Mukumbwa-Mwenechanya M, Efronson E, Mwamba C, Somwe P, Kalunkumya E, Lumpa M, Sharma A, Pry J, Mutale W, Ehrenkranz P, Glidden DV, Padian N, Topp S, Geng E, Holmes CB
This study found that while adherence clubs were effective for reducing late ART pickup, flexibility within the model was crucial for ensuring client centredness and service efficacy.
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Understanding how community antiretroviral delivery influences engagement in HIV care: a qualitative assessment of the Centralised Chronic Medication Dispensing and Distribution programme in South Africa
Dorward J, Msimango L, Gibbs A, Shozi H, Tonkin-Crine S, Hayward G, Butler C, Ngobese H, Drain P, Garrett N
This qualitative study took the experiences of clients and healthcare workers into account and explored their engagement in HIV care through a large-scale community ART distribution programme.
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Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind
Grimsrud A, Wilkinson L, Eshun-Wilson I, Holmes C, Sikazwe I, Katz I
This review sought to describe where in the HIV care cascade people living with HIV are not engaging, as well as to highlight promising interventions.
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Models of service delivery for optimizing a patient’s first six months on antiretroviral therapy for HIV: an applied research agenda
Rosen S, Grimsrud A, Ehrenkranz P, Katz I
In this open letter, the case is made for reconsideration of the conventional models of care for the first six months on ART.
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AIDS 2020: Virtual plenary: Fighting HIV in the shadow of COVID-19
Peter Sands from the Global Fund to Fight AIDS, Tuberculosis and Malaria
delivered an inspiring plenary at AIDS 2020: Virtual, which highlighted the role of DSD in protecting and sustaining progress in the COVID-19-threatened fight against the HIV epidemic. Watch his recorded session here.
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DSD in the Time of COVID-19: Video Diaries From the Frontlines
ICAP’s CQUIN project has launched a series of two-minute video diaries, where network members describe their experiences of DSD in the time of COVID-19. Check out the first series of videos, in which representatives from four African countries talk about the measures they implemented to meet the challenges of providing HIV services during the pandemic.
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The DSD team at IAS have put together a slide deck featuring its top DSD picks from AIDS 2020: Virtual. Highlights include DSD integration, DSD for specific populations, DSD country planning and optimization, DSD costing, DSD enrolment strategies, DSD quantitative and qualitative outcomes, differentiated PrEP, re-engagement, testing and linkage, DSD for advanced HIV disease, and DSD and COVID-19. Click here to download the slides.
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The World Health Organization is updating guidance on HIV service delivery. Do you have opinions about the definition of “stable patient”? Complete this survey and provide input on what you believe the eligibility criteria for DSD should be.
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Do you have something for the next newsletter? We want to hear from you.
Email us at dsd@iasociety.org.
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