Differentiated Service Delivery in Zambia
Percent of health facilities providing less-intensive DSD models. All 2,522 ART facilities in the country have enrolled at least 10% of eligible recipients of care into less-intensive models. Source: October 2021 CQUIN DSD Dashboard staging
% In Less-Intensive
Percent of people on ART who are enrolled in less-intensive DSD models.Among 1,172,279 recipients of care currently on ART, 457,816 have been enrolled in less-intensive models as of the end of June 2021. Source: October 2021 CQUIN data report
# of Less-Intensive
Number of less-intensive DSD models designed for people doing well on ART. Less-intensive models include: Multi-Month Scripting, Scholars Model, Before and After Hours, Fast Track, Pediatric ART Specific Day, Home ART Delivery, Mobile ART (Outreach), Community ART Access Points, Central Dispensing Unit, Peer-Led Community Adherence Groups, and Urban and Rurual Adherence Groups. Source: October 2021 CQUIN data report
Number of groups for whom less-intensive DSD models have been designed and implemented. Differentiated ART models are available for adults who are doing well on ART and eligible adolescents, adults with co-morbidities, men, and key and vulnerable populations. Source: October 2021 CQUIN DSD Dashboard staging
Differentiated Service Delivery Implementation in Zambia
Zambia joined the CQUIN learning network in 2017, as differentiated service delivery (DSD) was being integrated into Zambia’s National HIV Guidelines. DSD was first introduced in Zambia in 2013 in the form of single models and pilot projects offered by implementing partners, and has since become a fundamental service delivery mechanism for the National HIV program, growing in model diversity, increasing coverage for recipients of care, and reaching remote, rural areas of the country.
Zambia has a DSD Task Force—comprised of a National DSD Coordinator, members of the Ministry of Health, and additional stakeholders and implementing partners—which guides the implementation of DSD through the establishment of timelines, goals, and follow-up mechanisms, the creation of the National DSD Framework, and the solicitation of feedback and input from recipients of care, who are valued contributors to the Task Force’s efforts.
Currently, Zambia offers nine less-intensive DSD treatment models, including:
- Three facility-based individual models: three-month multi-month scripting and dispensing (3-MMD); six-month multi-month scripting and dispensing (6-MMD); and fast-track.
- Two facility-based group models: a teen club (Scholars / Tisamala) model; and urban adherence groups.
- Three community-based individual models: community ART distribution; the outreach model; and a unique health post model.
- One community-based group model: community ART groups (CAGs).
During a CQUIN-supported south-to-south visit to Eswatini, a team from Zambia observed the early-morning refill model, which has since been incorporated into the University Teaching Hospital Adult ART clinic in Lusaka, serving an estimated 1,000 recipients of care. Additionally, as the winner of the “shark tank” award from CQUIN in 2019—a competition in which CQUIN member countries developed TB/HIV services proposals for funding—Zambia has been implementing a DSD quality improvement (QI) project to follow-up with recipients of care receiving TB preventive therapy in less-intensive models.
Going forward, Zambia’s DSD Task Force is prioritizing improvements to DSD monitoring and evaluation. Additionally, following CQUIN’s 2019 QI workshop, the Task Force has been working on introducing DSD quality standards, further scaling-up, improving, and diversifying DSD models in Zambia.
Visit ICAP’s website for a broader portfolio of work in CQUIN network countries.