DSD for HIV prevention
According to the recent 2024 UNAIDS report, From Crisis to Opportunity, PrEP (pre-exposure prophylaxis) coverage remains below global targets (see figure below), despite considerable progress. Additionally, access to PrEP varies between different regions, highlighting disparities in availability and implementation.

The emergency response to the COVID-19 pandemic quickly leveraged differentiated service delivery (DSD) approaches that were already being used for treatment. This led to simplified, decentralized, and de-medicalized PrEP service delivery and expanded the scale of PrEP access.
In 2022, the World Health Organization (WHO) launched the technical brief, Differentiated and simplified pre-exposure prophylaxis for HIV prevention: update to WHO implementation guidance, to support the implementation of DSD for PrEP. This guidance summarizes existing evidence and recommendations to enhance the accessibility and effectiveness of PrEP services. It provides the building blocks for adaptation of DSD for PrEP in different contexts and for different population groups (table 3). WHO’s 2024 Consolidated guidelines on differentiated HIV testing services recommend the use of HIV self-testing (HIVST) to deliver PrEP, including for initiation, re-initiation and continuation.
In its 2024 Guidelines for HIV post-exposure prophylaxis (PEP), WHO recommends PEP decentralization with service delivery in community-settings as well as task-sharing, to be employed to dispense, distribute, provide and monitor PEP.
DSD can support equity in access to both PrEP and PEP – and positively impact uptake, persistence and effective use.
DSD for PrEP approach
A DSD for HIV prevention approach to PrEP adapts the building blocks for i) PrEP assessment;
ii) PrEP initiation (and re-initiation); iii) early follow-up (0-3 months); and iv) PrEP continuation with PrEP refills and clinical consultations (>3 months).

Following scientific advances in long-acting prevention commodities, it will be important to assess the role of DSD in this context. One long-acting PrEP option, CAB-LA (cabotegravir long-acting), requires more frequent clinic visits, less decentralization, and less task shifting. DSD with LEN (lenacapavir) would allow for clinic visits and injections every six months. Read more
Latest evidence: DSD for prevention – top picks
Feasibility and Impact of Community Pharmacy and Novel Pick-Up Points for Antiretroviral Therapy Pre-exposure Prophylaxis Initiation and Continuation in Low and Middle-income Countries, Lalla-Edward ST, Venter WDF, Curr HIV/AIDS Rep, Nov 2024
This literature review explores recent developments in community access to PrEP for HIV prevention in low- and middle-income countries. While community pharmacies and novel pick-up points offer promising avenues to expand access, operational complexities and regulatory frameworks present significant challenges. The authors conclude that addressing policy gaps, strengthening pharmacist training, and promoting client-centred approaches are essential for scaling up access to PrEP in low- and middle-income countries.
Preferences for Delivery of HIV Prevention Services Among Healthcare Users in South Africa: A Discrete Choice Experiment, Martin CE et al, AIDS Behav, Oct 2024
Through a discrete choice experiment, this study explored preferences for components of a PrEP service delivery package among clients accessing primary healthcare services. PrEP initiation at a pharmacy or mobile clinic was valued equally to initiating PrEP at a clinic. There was a preference for six-monthly over three-monthly follow-up. Participants preferred collecting PrEP from a pharmacy, through home delivery and from a vending machine and preferred HIV self-testing over healthcare provider testing. The authors conclude that there is a need to expand decentralized and self-led HIV prevention services.
Updated guidelines on HIV post-exposure prophylaxis: continued efforts towards increased accessibility, Allan-Blitz LT, Mayer KH, J Int AIDS Soc, 2024 Nov
PEP remains an underutilized HIV prevention tool. This commentary highlights the importance of the 2024 WHO PEP guidelines for increasing access to PEP. The guidelines strongly recommend that: (1) PEP be delivered in community settings (for example, pharmacies, police stations and online platforms); and (2) PEP delivery and monitoring be done via task sharing involving non-specialist health workers. To support implementation, the authors recommend training of the workforce and the development of detailed templates addressing heterogeneity of community settings and of the populations among whom PEP may be needed.
Differentiated Service Delivery Models for Maintaining HIV Treatment and Prevention Services During Crisis and Disease Outbreaks: Lessons from the COVID-19 Pandemic, Njuguna N et al, Curr HIV/AIDS Rep, Oct 2024
To address health system disruptions during the COVID-19 pandemic, countries adopted and scaled DSD models. Successful models employed task shifting, community-based delivery, multi-month scripting and dispensing, and telehealth for remote consultations. This review summarizes DSD models for HIV treatment and prevention that have been adapted for maintaining continuity of services. It proposes strategies for sustaining the benefits of the models now and during future health system disruptions.
Harnessing private sector strategies for family planning to deliver the Dual Prevention Pill, the first multipurpose prevention technology with pre-exposure prophylaxis, in an expanding HIV prevention landscape, Verde Hashim C et al, J Int AIDS Soc, August 2024
This qualitative study, conducted in Kenya, South Africa and Zimbabwe, explored private sector service delivery approaches for the introduction of the dual prevention pill (DPP), which combines oral PrEP with oral contraception. While noting country-specific differences, the authors found that private sector landscapes are well-suited for the introduction of the DPP, particularly via pharmacies, networked private providers and newer, technology-based channels, such as e-pharmacies and telemedicine.
Exploring adolescent girls and young women’s PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa, Rousseau E et al, J Int AIDS Soc, May 2024
The Prevention Options for Women Evaluation Research (POWER) study in Cape Town, South Africa, provided PrEP to adolescent girls and young women from four DSD platforms: mobile clinic, government facility, courier delivery, and community-based youth club. This qualitative POWER implementation study explored PrEP-user preferences, decision making, influences and habits related to PrEP. Mobile clinics were the most used PrEP delivery platform, described as acceptable and convenient. The second most popular platform was courier delivery, selected for its privacy, convenience and limited interaction needed.
Effect of differentiated direct-to-pharmacy PrEP refill visits supported with client HIV self-testing on clinic visit time and early PrEP continuation, Zewdie KB et al, J Int AIDS Soc, March 2024
This study evaluated differentiated direct-to-pharmacy PrEP refill visits. Two public health HIV clinics implemented the intervention package, which also included client HIV self-testing, client navigator, and pharmacist-led rapid risk assessment and dispensing; two other clinics served as controls. In the intervention arm, the total time spent at the clinic was reduced by 35% and PrEP continuation was higher.
Differentiated PrEP service delivery: Country policy development brief

Differentiated pre-exposure prophylaxis (PrEP) service delivery. Key considerations in developing policy guidance for differentiated PrEP service delivery (IAS) (2022)
This brief is intended to support countries to develop and include differentiated PrEP service delivery in their national HIV operational guidance.
Prevention models in action
Overcoming access barriers to HIV prevention commodities in São Paulo, Brazil
First published in IAS DSD newsletter (Dec 2024)
The STD/AIDS Coordination Office of São Paulo, Brazil, implemented initiatives that integrate HIV prevention into daily life. It has provided internal and external condoms in over 90 bus terminals and stations across the city, a compact health unit within a subway station, and the “PrEP on the Street” project, which brings services to open high-traffic areas. In addition, it has installed automated dispensing machines for PrEP, PEP and HIV self-tests at two subway stations serving more than 180,000 passengers daily.
Read here
Peer-led approaches for reaching female sex workers in Ethiopia
Presented at AIDS2020: Virtual by Dr Fethia Keder, PSI International
In Ethiopia, PrEP was piloted at drop-in centres (DICs), which provide female sex workers with comprehensive HIV care and treatment services. These service users have now become ambassadors for PrEP, working through existing peer-educator community sexual and social networks to find and reach those not yet served by the health system.
Read here
Community-led PrEP delivery for men who have sex with men and transgender people in Thailand
Presented at AIDS2020: Virtual by Nittaya Phanuphak, Institute of HIV Research and Innovation
In Thailand, key population-led health services (KPLHS) are services that are identified, designed and delivered by trained members of key populations and other lay health providers. Services include PrEP counselling, HIV and STI testing and dispensation of free PrEP.
Read here
Taking PrEP online: Project PrEP in South Africa
Presented at AIDS 2020: Virtual by Dr Saiqa Mullick, Wits Reproductive Health and HIV Institute
Project PrEP aims to strengthen demand, uptake and retention for comprehensive HIV prevention services, including oral PrEP, among adolescent girls and young women in South Africa.
Read here
DREAMS Virtual PrEP delivery for adolescent girls and young women, fisherfolk and key populations
Read about the DREAMS programme in Kenya here.
PrEP for young women in Uganda and Kenya
Pharmacist-managed OneStep PrEP in the USA
OneStep PrEP® is pharmacist-managed HIV PrEP clinic founded in 2015 and located at an independent pharmacy in Seattle, USA.
Read more about the OneStep PrEP programme here.