TY - JOUR T1 - Differentiated Service Delivery Models for HIV Treatment in Malawi, South Africa, and Zambia: A Landscape Analysis JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-20-00532 AU - Amy Huber AU - Sophie Pascoe AU - Brooke Nichols AU - Lawrence Long AU - Salome Kuchukhidze AU - Bevis Phiri AU - Timothy Tchereni AU - Sydney Rosen Y1 - 2021/05/10 UR - http://www.ghspjournal.org/content/early/2021/05/10/GHSP-D-20-00532.abstract N2 - Key FindingsDifferentiated service delivery (DSD) models for HIV treatment in Malawi, South Africa, and Zambia can be grouped into 12 service delivery strategies that vary by population served, medication dispensing duration, location of medication delivery, frequency of health care system interactions, and other characteristics.As of 2019, most DSD models in Malawi, South Africa, and Zambia remained limited to clinically stable, adult patients and continue to depend on established facilities for clinical care; individual models relied more on clinical staff, while group models made greater use of lay personnel.DSD models required anywhere from 2 to 12 health care system interactions per year, imposing very different burdens on patients and clinics.Key ImplicationsPolicy makers should recognize that each DSD model is designed differently and requires different resources for implementation; the details of how a specific model operates are important to understanding the optimal model mix for future scale-up.Existing routine data systems do not capture patients’ participation in specific DSD models, making it difficult to assess model coverage or performance. Improving electronic medical record systems so that they reflect actual service delivery is a high priority.Introduction:Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time.Methods:We interviewed DSD model implementing organizations for descriptive information about each of the organization’s models of care. We described the key characteristics of each model, including population of patients served, location of service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an “organization-model.”Results:The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel.Conclusions:As of 2019, there was a large variety of differentiated service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations. ER -