The evidence base for less-intensive differentiated service delivery (DSD) models for people doing well on antiretroviral therapy (ART) has grown in recent years.
In contrast, there are fewer differentiated models of care for people with advanced HIV disease and people at high risk of HIV disease progression due to unsuppressed viral load, adherence challenges, and/or co-morbid conditions. There is an urgent need for innovative thinking and program design to optimize service delivery for people needing more-intensive DSD models, including how, by whom, and where services should be delivered for optimal impact.
To help address this need, CQUIN has hosted workshops and satellite sessions, drafted a “call to action” for new DSD models, and convened a multi-country community of practice to facilitate ongoing experience-sharing and resource co-creation. In July 2020, CQUIN partnered with Unitaid, and CHAI to host a multi-country workshop on DSD and advanced HIV disease.
In July 2022, CQUIN also hosted an AIDS 2022 satellite on a health systems strengthening approach to improving AHD services.
Community of Practice
DSD for AHD Community of Practice
Differentiated service delivery (DSD) for people with advanced HIV disease and those at high risk of HIV disease progression (P@HR) has been an important theme within the CQUIN network. Network participants selected it as a priority at the CQUIN Launch Meeting, and early network activities included hosting an all-network meeting on DSD for P@HR in Harare, the development of a Call to Action for differentiated treatment models for patients with advanced disease and those who are at high risk of progression and development of a screening tool for use by frontline health workers.
- Dr. Maureen Syowai, is the technical lead, supported by Ms. Christine Mburu (Project Operations Coordinator)
- In 2018-2019, 14 CoP members from Eswatini, Malawi, Uganda, and Zimbabwe worked to develop a P@HR screening tool.
- In 2020, CQUIN partnered with CHAI and Unitaid to convene a multi-country workshop on DSD for advanced HIV disease.
- The AHD CoP steering committee was launched in 2020 comprising 10 members drawn from 7 countries.
- In 2021-22, the CoP co-created a capability maturity model dashboard for AHD to enable countries to self-stage the maturity of their AHD systems.
- The dashboard has been used for self-staging by 11 countries to date: Cote d’Ivoire, Eswatini, Ethiopia, Kenya, Malawi, Mozambique, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia.
- The CoP hosted a satellite session on strengthening health systems to support AHD service delivery at the AIDS2022 conference in July 2022.
- At the 6th CQUIN Annual Meeting in December 2022, the CoP organized an AHD pre-meeting session for Community Advocacy Network (CAN) members, as well as a plenary and a parallel session on AHD.
- In May 2023, the CoP convened a meeting to review AHD findings from the pilot of the AHD Quality Standards and Indicators in Zambia, Eswatini, DRC, Kenya, and Mozambique. The tool was developed to help countries review barriers and gaps to AHD implementation.
Activities
Virtual Workshop
From July 28-29, 2020 CQUIN in collaboration with CHAI and Unitaid convened a multi-country workshop on DSD for advanced HIV disease.
Over 400 health experts from over 20 countries participated in this unique and fascinating virtual workshop. Participants shared experiences, best practices, and challenges in establishing DSD models for people living with advanced HIV disease and/or at high risk of disease progression.
View the summary report.
Call to Action
CQUIN developed a Call to Action for people with advanced HIV disease and/or at high risk of disease progression that describes currently recommended packages of care and reviews available DSD models. It is designed to motivate stakeholders to share their experiences, generate new evidence, and advocate for attention to innovative, more-intensive DSD models.
Satellites
24th International AIDS Conference (AIDS 2022), Montreal, Canada
On July 29, 2022, CQUIN convened experts from the World Health Organization (WHO), Global Fund, and representatives from ministries of health to discuss strengthening health systems to optimize the care and treatment of people with advanced HIV disease (AHD), and on lessons learned from the 21-country CQUIN learning network. More here.
10th International AIDS Society Conference on HIV Science in Mexico City
On July 21, 2019, CQUIN convened experts from the World Health Organization (WHO), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), ministries of health, implementing partners, and networks of people living with HIV at an IAS2019 satellite to discuss more effective approaches to identify and treat people living with advanced HIV disease and those at high risk of disease progression. Read more here.
20th International Conference on AIDS and STIs in Africa in Kigali, Rwanda
CQUIN hosted a satellite session at ICASA on December 4, 2019. Panelists from ICAP, CHAI, Unitaid, the University of Zimbabwe, the International AIDS Society, ministries of health, and networks of people living with HIV discussed the need for differentiated program design to reach people with advanced HIV disease and those at high risk of disease progression.
