Uganda has been a leader in developing innovative differentiated service delivery (DSD) models for HIV and taking them to scale.  In order to assess progress and prioritize the next steps, the Uganda Ministry of Health (MOH) worked with CQUIN to conduct a DSD Performance Review in two of the country’s health regions. In February 2021, MOH hosted dissemination meetings to share the lessons learned regarding health facility performance and adherence to DSD standards in the East Central and Rwenzori regions.

“Our strategy at the national level is to focus on quality-related issues and explore alternative channels to simplify access to treatment for recipients of care,” said Josen Kiggundu, MD, MPH, senior program officer, DSD, Uganda Ministry of Health AIDS Control Program.

Three-day meetings were held in each region, convening a total of 278 participants. “We looked at some of the treatment outcomes, including retention in care, and viral suppression among recipients of care, by analyzing the data collected with technical and financial support from CQUIN. We also looked at challenges and innovations that are coming from the implementation of models at some of the sites,” Dr. Kiggundu said.

“For this DSD performance review, there was a strong collaboration between Uganda MOH and the CQUIN team to expand the scope of data collection, which allowed for a much more in-depth view of DSD scale-up and performance over time,” said Bill Reidy, PhD, MPH CQUIN strategic information advisor.

CQUIN provided technical support to the Uganda team throughout, from the concept note development to the provision of monitoring and evaluation tools for data collection.

“I was very impressed Uganda included recipients of care in the program by having them lead a panel discussion. This approach is commendable as it allowed recipients of care to share their thoughts, needs, concerns and give guidance on the DSD model scale-up plan, an initiative that other countries can imitate,” said Rachel Mudekereza, MD, MPH, CQUIN’s new senior regional clinical advisor for West and Central Africa, who attended the review meetings.

Of the approximately 1.5 million people living with HIV in Uganda, 1.2 million are on antiretroviral therapy (ART). The DSD review meetings were an opportunity for Uganda’s health facilities and stakeholders to gain perspective on areas the country needs to focus on to continue to meet its 95-95-95 targets. Moving forward, meeting stakeholders and participants agreed to implement the performance reviews in other regions and engage health facilities at the district level instead of limiting these reviews to regional meetings. Uganda has plans to initiate six-month midterm reviews that look at implementing healthcare services and the challenges hindering the implementation of agreed services as an opportunity for cross-learning to scale-up DSD.

“Through the performance reviews, we have realized how much we have done, but we still have gaps we will continue addressing to take DSD to scale while ensuring quality implementation is attained,” Dr. Kiggundu said.

A breakout session was dedicated to a detailed overview of the DSD performance reviews (DPR) at the CQUIN fourth annual meeting. Andrea Schaaf, MPH, CQUIN strategic information specialist, reviewed the rationale for using the DPR toolkit, described the toolkit content, and explained how to implement a review meeting using the toolkit.

“We hope that other countries can build on this experience to continue to make the DSD performance reviews more valuable in providing new insights and supporting DSD implementation, resulting in improved services and outcomes for recipients of care,” Dr. Reidy said.

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