Changing global guidelines and ambitious treatment targets have markedly increased the number of people eligible for antiretroviral therapy (ART). To galvanize efforts toward ending the HIV epidemic, the United Nations and its partners have committed to the 90–90–90 targets to identify 90 percent of individuals with HIV, initiate 90 percent of those diagnosed on ART for 90 percent of those diagnosed, and maintain viral suppression in 90 percent of those on ART. To meet this target, the number of people on ART will need to double by 2020.
Achieving these targets will not be easy. Global funding for HIV has plateaued, and many countries are being asked to do more with less when it comes to HIV programming. A second challenge is that the growing numbers of patients on ART have led to overcrowding at health facilities, increasing wait times for patients, overwhelming clinicians, and consequently compromising patient satisfaction. Finally, gaps in program quality, such as suboptimal retention rates, threaten both individual patient outcomes and public health goals.
Differentiated service delivery is a practical approach to addressing these challenges. It varies the design and delivery of services offered to different groups of patients and aims to enhance quality, efficiency, and patient satisfaction. The goal is to place the client 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 patient groups with different clinical, psychosocial, and contextual characteristics.
The World Health Organization (WHO), the President’s Emergency Plan for AIDS Relief (PEPFAR), and an increasing number of national Ministries of Health have endorsed the differentiated service delivery strategy.