Changing global guidelines and ambitious prevention, testing, and treatment targets have markedly increased the number of people eligible for HIV services.  At the same time, global funding for HIV has plateaued, and many countries are being asked to do more with less regarding HIV programming.

In addition, gaps in program quality and service delivery models that do not meet the needs and expectations of people living with HIV threaten both individual outcomes and public health goals.

Differentiated service delivery is a practical approach to addressing these challenges.

DSD varies the design and delivery of services offered to different groups and aims to enhance quality, efficiency, and recipient of care satisfaction. The goal is to place individuals at the center of service delivery while maximizing health system efficiency. Key elements of this approach include re-assessing the “when, where, who, and what” of HIV services for groups with different clinical, psychosocial, and contextual characteristics.

Differentiated antiretroviral therapy (DART) includes more-intensive service delivery models for people newly starting HIV treatment, those with opportunistic infections and/or co-morbidities, people with unsuppressed viral load, groups who typically need close follow-up such as children, adolescents, and pregnant people, and those with psychosocial barriers to adherence and retention.

DART also includes innovative less-intensive service delivery models for people doing well on ART. Less-intensive DART models include facility-based and community-based approaches, each of which may be provided in individual or group settings by health care workers or peers. These models typically emphasize education and empowerment of recipients of care, streamlined services, and less frequent visits to health facilities.

In addition to making HIV treatment more convenient and person-centered, DSD allows health workers to spend more of their time with people needing more intensive services, increasing efficiency and improving quality of care.

ICAP’s CQUIN team worked with network stakeholders to develop a capability maturity model for differentiated treatment, which describes the key domains needed for ministries of health to deliver high-quality DART at scale.