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Current HIV/AIDS Reports

, Volume 16, Issue 4, pp 324–334 | Cite as

A Review of Differentiated Service Delivery for HIV Treatment: Effectiveness, Mechanisms, Targeting, and Scale

  • Monika RoyEmail author
  • Carolyn Bolton Moore
  • Izukanji Sikazwe
  • Charles B. Holmes
Implementation Science (E Geng, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Implementation Science

Abstract

Purpose of Review

Differentiated service delivery (DSD) models were initially developed as a means to combat suboptimal long-term retention in HIV care, and to better titrate limited health systems resources to patient needs, primarily in low-income countries. The models themselves are designed to streamline care along the HIV care cascade and range from individual to group-based care and facility to community-based health delivery systems. However, much remains to be understood about how well and for whom DSD models work and whether these models can be scaled, are sustainable, and can reach vulnerable and high-risk populations. Implementation science is tasked with addressing some of these questions through systematic, scientific inquiry. We review the available published evidence on the implementation of DSD and suggest further health systems innovations needed to maximize the public health impact of DSD and future implementation science research directions in this expanding field.

Recent Findings

While early observational data supported the effectiveness of various DSD models, more recently published trials as well as evaluations of national scale-up provide more rigorous evidence for effectiveness and performance at scale. Deeper understanding of the mechanism of effect of various DSD models and generalizability of studies to other countries or contexts remains somewhat limited. Relative implementability of DSD models may differ based on patient preference, logistical complexity of model adoption and maintenance, human resource and pharmacy supply chain needs, and comparative cost-effectiveness. However, few studies to date have evaluated comparative implementation or cost-effectiveness from a health systems perspective.

Summary

While DSD represents an exciting and promising “next step” in HIV health care delivery, this innovation comes with its own set of implementation challenges. Evidence on the effectiveness of DSD generally supports the use of most DSD models, although it is still unclear which models are most relevant in diverse settings and populations and which are the most cost-effective. Challenges during scale-up highlight the need for accurate differentiation of patients, sustainable inclusion of a new cadre of health care worker (the community health care worker), and substantial strengthening of existing pharmacy supply chains. To maximize the public health impact of DSD, systems need to be patient-centered and adaptive, as well as employ robust quality improvement processes.

Keywords

Differentiated service delivery Sub-Saharan Africa HIV Implementation science Patient-centered care 

Notes

Acknowledgments

The authors thank Megha Mehrotra for her technical assistance.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Monika Roy
    • 1
    Email author
  • Carolyn Bolton Moore
    • 2
    • 3
  • Izukanji Sikazwe
    • 2
  • Charles B. Holmes
    • 4
    • 5
  1. 1.Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General HospitalUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Centre for Infectious Disease Research in ZambiaLusakaZambia
  3. 3.University of AlabamaBirminghamUSA
  4. 4.Johns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Center for Global Health and QualityGeorgetown University School of MedicineWashingtonUSA

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