The CQUIN learning network fosters south-to-south exchange – meetings, discussions, and resource-sharing – between network countries. The goal of this exchange is to share best practices for the scale-up and spread of differentiated service delivery (DSD).
In June 2018, teams from Eswatini, Kenya, and Malawi visited Uganda on a joint south-to-south learning exchange hosted by the Uganda Ministry of Health National AIDS Control Program. The teams visited The AIDS Support Organization (TASO), a pioneer in the HIV/AIDS response in Uganda. The exchange included two field visits to observe Community Drug Distribution Points (CDDP) and Community Client-Led ART Delivery (CCLAD) models in action.
The visiting teams learned about the implementation of facility- and community-based DSD models for people living with HIV in urban and rural settings; community engagement and demand creation; and how community-based ART service delivery data flows into the national monitoring and evaluation system. Each team identified challenges and opportunities to adopt or adapt TASO’s DSD models for use by their country’s DSD program.
In June 2018, teams from Côte d’Ivoire, Malawi, Uganda, Zambia, and Zimbabwe visited Eswatini on a joint south-to-south learning exchange hosted by The Swaziland National AIDS Program (SNAP). The teams visited two government hospitals in Mbabane to learn about community-based integrated ART outreach services and observe early-morning refill models. The visit provided a unique opportunity for teams to see the implementation of client-centered services at both the facility and community levels, and use lessons learned to inform service delivery in their countries.
In addition to the model-focused site visits, teams from Malawi, Zambia, and Zimbabwe attended a facility-based demonstration of Eswatini’s existing Client Management Information System (CMIS) to observe how the system is used to manage patients on ART, as well as links to other health conditions other than HIV under other programs. An overview of current system updates intended to add functionality around M&E of DSD followed.
In August 2017, teams from Mozambique visited Eswatini and Malawi on two south-to-south learning exchanges.
Eswatini: The Mozambique Ministry of Health was interested in learning more about the how of DSD. They observed how Eswatini’s Ministry of Health planned, implemented, and sustained after-hours ART refills as well as their outreach model, where a health facility team pays monthly visits to a rural community.
Malawi: A team from Mozambique’s Ministry of Health, the Centers for Disease Control and Prevention (CDC), and other implementing partners visited Malawi’s Balaka District Hospital Teen Club and the Lighthouse Clinic’s nurse-led community ART Program (NCAP), a community-based DSD model that integrates ART and non-communicable disease drug refills. Malawi’s teen club approach is an example of innovative DSD for adolescents living with HIV.
In June 2017, Eswatini’s Ministry of Health observed that Malawi had successfully integrated antiretroviral therapy (ART) refills and viral load monitoring into their teen clubs.
The approach in Malawi is in contrast to Eswatini, where teen clubs focus primarily on providing social support and reinforcing medication adherence. Another difference is that teen clubs in Malawi include only HIV-positive adolescents, while those in Eswatini and elsewhere include both HIV-positive and negative adolescents.
Representatives from the Swaziland National AIDS Program (SNAP) visited Malawi in May 2017 to learn about best practices related to differentiated service delivery for adolescents living with HIV and the success of their teen club model. To date, more than 9,300 adolescents living with HIV have been enrolled in 135 teen clubs located in 26 of Malawi’s 28 districts.