Differentiated Service Delivery (DSD) Approach

Differentiated service delivery (DSD) is a person-centered approach to HIV service delivery. Moving away from a one-size-fits-all model, DSD tailors HIV services to diverse groups of people living with HIV while maintaining the principles of the public health approach.

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, and 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.

Why Differentiated Service Delivery?

Changing global guidelines and ambitious treatment targets have markedly increased the number of people eligible for ART. At the same time, 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 growing numbers of people on ART have led to overcrowding at health facilities. This has increased wait times for recipients of care, overwhelmed clinicians, and compromised client satisfaction.

In addition, gaps in program quality—such as suboptimal retention rates—threaten both individual 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 and aims to enhance quality, efficiency, and client satisfaction. The goal is to place the recipient of care 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 recipient of care groups with different clinical, psychosocial, and contextual characteristics.

The World Health Organization (WHO), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and an increasing number of national ministries of health have endorsed the DSD strategy.

How it Works

Differentiated service delivery models vary the “when, where, who and what” of service delivery to create models that respond to different needs, contexts, and subpopulations.

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