Differentiated Service Delivery in Zambia
Differentiated service delivery (DSD) was integrated into Zambia’s National Guidelines in 2016. A strong technical working group on HIV care works with partners to roll out DSD and community based ART models. Data from the Population HIV Impact Assessment (PHIA) in Zambia has shown marked progress towards the UNAIDS 90-90-90 goals.
Implementing partners in Zambia are piloting and evaluating a variety of DSD models for stable patients. Current models include community ART groups in both rural and urban areas, community ART distribution, streamlined ART with multi-month scripting, and fast-track ART initiation.
Community health workers have been involved in the design of DSD models, including patient enrollment, counseling, and ART distribution. A priority of the Zambia Ministry of Health is to understand cost-effectiveness of DSD (preliminary data has shown modest costs savings compared to standard ART care).
With support from CQUIN, Zambia plans to appoint a national DSD coordinator, and develop a national operational and scale-up plan. Other priorities include standardization of monitoring and evaluation tools; advancing national DSD policies; including non-communicable disease management as part of scale-up; and developing models for key and priority populations.