Côte d’Ivoire

Differentiated Service Delivery Implementation in Côte d’Ivoire

Côte d’Ivoire joined CQUIN in 2018. The Côte d’Ivoire National Program for the Fight Against HIV (Programme National de Lutte Contre le SIDA, or PNLS), in collaboration with its donors and implementing partners, has prioritized two facility-based differentiated service delivery (DSD) models for adult and adolescent recipients of care who are doing well on ART. 

One of the first models to be launched was an individual appointment spacing model, in which people on ART receive three-monthly refills via fast track visits. The second was a group model, in which support groups (adherence clubs) are managed by community counselors and social assistants at health facilities. People in both models receive twice-yearly clinical evaluations with a medical doctor. These approaches continue to be rolled out and scaled up nationwide.

Once the two facility-based models had been launched, PNLS developed a community-based DSD model, designed specifically for people on ART living in remote areas where access to health facilities is difficult. 

Currently, five less-intensive DSD treatment models are available in Côte d’Ivoire, including:

• Two facility-based individual models: six-month multi-month scripting and Fast Track
• Two facility-based group models: the adult club model and a teen club model
• One community-based group model: peer-led community ART group

In October 2019, PNLS estimated that Côte d’Ivoire had 2,035 facilities providing ART and that 937 of them (46 percent) offered at least one less-intensive model. As of June 2019, an estimated 70 percent of those on ART were enrolled in the conventional treatment model versus 30 percent enrolled in less-intensive DSD models. The majority of those in less-intensive models were enrolled in the fast track model, which accounts for 28 percent of all people on ART. 

Côte d’Ivoire has utilized a number of lessons learned from its participation in the CQUIN learning network, most notably the inclusion of community based DSD models. In June 2018, CQUIN members from Côte d’Ivoire visited Eswatini on a south-to-south visit to learn more about community-based ART outreach services. The visit, which included a site tour of Mbabane Government Hospital, allowed the team to observe early morning ART refills as well as Eswatini’s community-based outreach efforts coupled with clinical service provision. Following the exchange, Côte d’Ivoire began supporting early morning refills and ART community refills at selected health facilities. 

As Côte d’Ivoire continues to expand DSD implementation, increasing community-based models that are adapted to the local context remains a priority.

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