Angola

In 2018, the Angolan Ministry of Health, together with the National Institute for the Fight Against AIDS, published an operational guide for their test and treat strategy Projecto Piloto Luanada.  This guide specifies criteria for determining clinical stability and eligibility for three-monthly ART refills (3MMD) with annual clinical review.

Angola-TESTAR-e-TRATAR-Guia-Operacional-TeT-final_aprovado_v2-27-de-JANEIRO-2018-1

Guia Operacional da Estratégia Testar e Tartar. Projecto Piloto Luanda (2018)

An operational guide for Angola’s pilot test and treat strategy

Botswana

In 2020, the Botswana Ministry of Health and Wellness updated the national guideline for integrated community-based health services. This guide outlines a minimum package of integrated community-based health interventions and how they should be delivered to provide comprehensive care to people in their communities across a number of areas including prevention, treatment, care and support for HIV infection and tuberculosis, select noncommunicable diseases, reproductive health, and maternal and child health. It also includes a COVID-19 curriculum for community health workers. Recommended service delivery models include targeted home visits by community health workers, peer-to-peer communication, and (adherence) support groups. Through adherence groups, community health workers provide refills and distribute treatment for “stable” clients (for HIV and treatment of other chronic conditions).

ICBHS_Guidelines-v7-1-1

National guidelines for implementation of integrated community-based health services (2020)

An operational guide for Botswana’s integrated community-based health services

Burkina Faso

In 2020 the Ministry of Health in Burkina Faso published a guide for implementing six monthly ART dispensation (6MMD), known as Ravi6M. This individual treatment model can be implemented in facility or community settings.

Burkina-Faso_Guide-mise-en-oeuvre-6MMD_Feb-2020

Guide de Mise en Oeuvre de la Strategie de Ravitaillement ARV tous les six mois (Ravi6M) aux PVVIH du Burkina Faso (2020)

An operational guide for Burkina Faso’s six-monthly ART dispensing models

Burundi

In 2020 the Ministry of Public Health in Burundi and the National Programme to Combat HIV/AIDS and STIs, published national guidelines and an implementation plan for HIV treatment and prevention in Burundi. These documents outline HIV DSD treatment strategies such as multi-month ART dispensing and community ART distribution points (PODI).

Burundi-2020.10-DIRECTIVES_NATIONALES_TARV-2020-VF-PREFACEE_-09-Octobre-2020

Directives Nationales Pour la Prevention et le Traitement du VIH au Burundi (2020)

National guidelines for Burundi’s HIV treatment and prevention programme

Burundi-2020.10-PLAN-DE-MISE-EN-OEUVRE-DES-DIRECTIVES-DE-TARV-2020_VF-PREFACEE_09-Oct-2020

Plan de Mise en Œuvre des Directives Nationales Pour la Prevention et le Traitement du VIH (2020)

Implementation guide for the HIV treatment and prevention strategy

Cameroon

In 2021, The Ministry of Public Health in Cameroon released updated national guidelines on HIV care. The guidelines include a chapter on differentiated service delivery after one year on ART and detail eligibility criteria on the basis of clinical characteristics and specific populations. 

In 2017, the Ministry of Public Health in Cameroon published Operational Guidelines for the Implementation of the Test and Treat Strategy in Cameroon. These guidelines detail differentiated HIV services for “stable” clients, including three monthly ART dispensing (3MMD) and clinical monitoring.

National guidelines on HIV care

Cameroon

Operational Guidelines for the Implementation of the “Test and Treat” Strategy in Cameroon (2017)

Implementation guidelines for HIV testing, treatment and monitoring

Central African Republic (CAR)

In November 2018, the Ministry of Health in the Central African Republic (CAR) together with Médecins Sans Frontières (MSF) launched a toolkit based on experiences in programmatic implementation of Community ART Groups (CAGs) and Pharmacy Fast Track (PFT) in conflict and unstable settings in Zemio (Haut-Mbomou) and Boguila (Ouham) in CAR. The toolkit provides the knowledge and tools to implement community models of HIV care (CAGs and PFT) including; set up, follow up, monitoring and evaluation in conflict/unstable settings.

20_11_2018-CAR-CAG-and-PFT-Toolkit-Final_EG

Differentiated Models of HIV/TB Care in conflict and unstable settings: Community Antiretroviral Treatment Groups (CAGs) Pharmacy Fast track (PFT): Central African Republic (CAR)

Toolkit endorsed by the Ministry of Health

20_11_2018__CAR_CAG_and_PFT_Toolkit_Final_French

Modèles différenciés des soins VIH/TB dans les zones instables et en conflit: Groupes communautaires de traitement antirétroviral, pharmacie de dispensation rapide: République centrafricaine

Version française de la boîte à outils

Côte d’Ivoire

In June 2021, the Côte d’Ivoire Ministry of Public Health and Hygiene released a circular with updated guidance on ART for children and adolescents, including eligibility criteria for quarterly (3MMD) and semiannual (6MMD) dispensation of ART. A circular released in February 2020 provided guidance on the ‘test and treat all’ approach including recommendations for community distribution of ART for eligible clients. In 2019, the Ministry released a circular with guidelines for HIV treatment and prevention services, which allows for up to six-month ART dispensing (6MMD). An earlier circular on ‘test and treat all’ was disseminated in February 2017 and included eligibility criteria for three- to six-month ART refills for clients who are established on ART.

On 25 March 2020, the Côte d’Ivoire Ministry of Public Health and Hygiene, with the National AIDS Control Programme, published a contingency plan for the programme in the context of the COVID-19 pandemic. It details two scenarios for the continuation of the programme, depending on the stage of the pandemic.

Note Circulaire. Mise à jour des Directives Nationales du Traitement Antirétroviral (ARV) chez les enfants et adolescents infectés par le HIV (2021)

Circular on ART delivery for children and adolescents from June 2021.

Cote-dIvoire_Guidelines-for-HIV-care-in-the-context-of-COVID-19-French

Plan de Contingence PNLS Dans le Contexte de L’Epidemie COVID 19 (2020)

Contingency plan of the National HIV Programme in the context of the COVID-19 epidemic, published 25 March 2020.

Cote-dIvoire_HIV-Prevention-Treatment-Guidelines_2019

NOTE Circulaire no. 0002—3/2019/MSHP/DGS/PNLs/SST/km portant Directives techniques de Prévention du sida et de prise en charge des personnes vivant avec le VIH (2019)

Service guidelines for HIV treatment and prevention

Democratic Republic of the Congo (DRC)

In 2020, the National HIV/AIDS and STI Control Programme (PNLS) of the DRC Ministry of Health released a circular detailing changes to established service provision for people living with HIV during the COVID-19 pandemic. This notice detailed expansion of multi-month ART dispensation (MMD), including immediate MMD provision for eligible clients and broader provision of 6MMD.

In 2018, the Ministry developed both an operational plan and an operational manual to implement DSD for people living with HIV. It outlines different context- and population-specific models, including community ART distribution points, and recommends three- to six-month ART refills for “stable” clients (3-6MMD). The operational manual also includes guidance for service providers on HIV/TB service integration.

DRC-covid

Note circulaire: Mesures opérationnelles de prise en charge de PVIHs pendant cette (Operational measures for people living with HIV during COVID-19) (April 2020)

Guidance on changes to HIV service provision due to COVID-19

RDC-Plan-operationnel-soins-differencies-V-20-08-2018

Plan opérationnel d’offre des services différenciés en République Démocratique du Congo (2018)

The operational plan outlines priorities for implementing differentiated service delivery models

DRC-implementation-plan

Manuel d’operationnalisation des modeles différenciés et du guichet unique VIH/TB (2018)

This manual is aimed at HIV and tuberculosis service providers at the operational level

Dominican Republic

In 2021, the Ministry of Public Health in the Dominican Republic published an implementation strategy for differentiated service delivery for HIV treatment for adults living with HIV and an operational manual on differentiated service delivery for integrated treatment for adults living with HIV. The guidance includes DSD for HIV treatment models for key populations, people with unsuppressed viral loads and those affected by co-infections and co-morbidities. Clients considered to be established on treatment (“stable”) are now offered follow-up visits every six months and multi-month dispensing of antiretroviral therapy (ART) for a minimum of three to six months.

In 2016, the Ministry of Public Health in the Dominican Republic released a national guide for HIV care, which recommended multi-month dispensing of ART for certain “stable” client groups, up to a maximum of three months. 

Manual_Servicios-Diferenciados-de-VIH_2021

Manual de Intervencion para Modelos Diferenciados de Tratamiento Integral Dirigido a la Poblacion Adulta con VIH (2021)

Estrategia-Implementacion-Mod-Diferenciado-VIH

Estrategia para la Implementacion del Modelo de Atencion Diferenciada para la Entrega de Tratamiento Antirretroviral a la Poblacion adulta con VIH (2021)

DominicanRepublic

Guía Nacional de Atención VIH/Sida (2016)

National guide for HIV and AIDS care (Spanish)

Eswatini

In January 2022, the Ministry of Health in the Kingdom of Eswatini published Guidelines for Differentiated Service Delivery. This comprehensive document provides guidelines for HIV service differentiation across the cascade and includes guidance for the integration of other health services with DSD for ART. The Eswatini Integrated HIV Management Guidelines were also published by the Ministry in 2022 and include a dedicated section on Differentiated Service Delivery (Section 5.7).

On 22 April 2020, the Eswatini Director of Health Services published a memorandum, Guidance on Provision of Chronic Care During the COVID-19 Pandemic, which informs the management of clients with chronic conditions, including HIV and non-communicable diseases. HIV-specific guidance differentiates care for adults, children and perinatal women and includes information on contraception and viral load monitoring. In the same month, the Ministry of Health released the Community Commodity Distribution Concept Note, which proposes the use of a hybrid of its current DSD models for commodity distribution. The aim is to enable sustainable access to a broad spectrum of HIV-related treatments while reducing risk of COVID-19 exposure for people living with HIV and other health service users.

The Eswatini National AIDS Programme’s National Policy Guidelines for Community-Centred Models of ART Service Delivery (June 2016) recognizes the need for differentiation throughout the treatment pathway and provides specific guidance for management of stable clients. The guidelines are accompanied by a set of standard operating procedures (SOPs), published in 2018, including SOPs for community-centred models of HIV testing and ART service delivery for key populations.

Guidelines for Differentiated Service Delivery (2022)

This draws on an extensive review of local experience and shared experiences from other country programs and consultations with health care workers, communities and ART clients.

Eswatini Integrated HIV Management Guidelines (2022)

Memorandum-Chronic-care-during-Covid-19-22-April

Memorandum (22 April 2020)

Guidance on provision of chronic care during the COVID-19 pandemic

Community-Commodity-Distribution-Concept_21-April

Community commodity distribution concept note (April 2020)

Guidance on HIV related commodity distribution during the COVID-19 pandemic

ART-SOP-FOR-KPs-

Standard operating procedures for community centered models of HIV testing and ART service delivery for key populations (2018)

SOPs for community-centered models of HIV testing and ART delivery for key populations in Eswatini

Swaziland-Policy-Guideline-2016-1

National Policy Guidelines For Community-Centred Models of ART Service Delivery (CommART) in Swaziland (2016)

Guidelines on differentiated ART service delivery in Eswatini

Ethiopia

In February 2022, the Ethiopian Ministry of Health released updated National Guidelines for Comprehensive HIV Prevention, Care and Treatment. It includes a chapter on service delivery, detailing less intensive DSD models and more intensive DSD models, including for advanced HIV disease. The national guidelines were also published in the format of a Pocket Guide.

The Ethiopian Ministry of Health published Interim Guidance for Management of People Living with HIV (PLHIV) in the Context of COVID-19 Outbreak in Ethiopia. Second Edition in May 2020. This document includes specific facility-level guidance on differentiated services for ART provision, as well as information on mitigation of the spread of COVID-19 in communities affected by HIV. Strengthening community-based services for HIV treatment to deliver ART at community sites is among the recommended strategies to ensure continuity of care and containment of COVID-19. The Implementation Guide for Community-Based Differentiated ART Delivery Models in Ethiopia, released August 2020, provides guidance around community ART refills and peer-led community ART distribution. T

In August 2018, Ethiopia released National Consolidated Guidelines for Comprehensive HIV Prevention, Care and Treatment, with a section (5.1) on “Differentiated HIV service delivery”. The guidelines recommend an appointment spacing model (ASM) where clients are appointed every six months for clinical visit and medication refill. Clients defined as “stable” also receive additional support such as arrangements of treatment supporter home visits and adherence reminders. 

National Guidelines for Comprehensive HIV Prevention, Care and Treatment. Pocket Guide (2022)

National Guidelines for Comprehensive HIV Prevention, Care and Treatment (2022)

Implementation-Guide-for-Community-Based-ART-Delivery-July-20207

Implementation Guide for Community Based Differentiated ART Service Delivery Models in Ethiopia (August 2020)

Guidance around community ART refills and peer-led community ART distribution

ethiopia_COVID

Interim Guidance for management of People Living with HIV (PLHIV) in the context of COVID-19 Outbreak in Ethiopia Second Edition. (May 2020)

Guidance on HIV related health services during the COVID-19 pandemic

National-Comprehensive-HIV-Prevention-Care-and-Treatment-Guideline-201879

National Consolidated Guidelines for Comprehensive HIV Prevention, Care and Treatment (2018)

This guideline recommends appointment spacing and extended ART refills

Ghana

In October 2022, Ghana Health Services’ Ghana National AIDS Control Programme (NACP) released Consolidated Guidelines for HIV care in Ghana – Test, Treat & Track. This comprehensive document provides guidance for implementation of HIV care across the cascade from testing to viral suppression and is supported by Differentiated service delivery for HIV in Ghana: An Operational Manual, which was published by the NACP in September 2022. This update of the original 2017 DSD manual focusses on the “how” of HIV care and describes how services across the cascade may be differentiated according to clients’ clinical requirements, including adaptations for specific populations.  The updated manual features new considerations for integration of non-communicable disease and HIV care for children, adolescents and adults as well as DSD for individuals with advanced HIV disease. 

On 16 March 2020, the Ghana Health Service released Guidance for the Care of Persons Living with HIV (PLHIV) in the Wake of COVID-19, which details various measures to ensure smooth continuation of HIV services, including reinforcement of multi-month scripting (3 or 6 multi-month dispensation).

Differentiated service delivery for HIV in Ghana. An operational manual (2022)

This updated manual contains key considerations deemed feasible and relevant to Ghana’s context.

Consolidated guidelines for HIV care in Ghana (2022)

These updated guidelines include newly recommended HIV testing and linkage strategies, antiretroviral drug regimens, formulations and diagnostics that are appropriate to the local setting.

COVID19-Guidance-for-PLHIV_Ghana

Guidance for the Care of Persons Living with HIV (PLHIV) in the Wake of COVID-19 (2020)

Guidance on HIV health service provision during the COVID-19 pandemic

DSD-for-HIV-in-Ghana_FINAL

Differentiated service delivery for HIV in Ghana: An Operational Manual (2017) (Download)

The manual focuses on the “how” to differentiated HIV care

Guinea

In 2019, the Guinea Ministry of Health and the National HIV/AIDS and Hepatitis Programme developed an implementation guide for six-monthly (6MMD) antiretroviral therapy refills, locally known as “Rendez-vous à six mois”.

Strategie-R6M-version-finalisee-21112019.docx

Guide de mise en place. Rendez-vous à six mois: Un modèle différencié d’accès au traitement antirétroviral : L’espacement des visites pour les personnes vivant avec le VIH (2019)

Implementation guide for appointment spacing and six-monthly ART refills

Haiti

PEPFAR in Haiti, together with USAID and EQUIP, published a document detailing eligibility criteria for their six-month ART refill (6MMD) programme, with mention of integration with existing community models.

Haiti_SOP_Prolongation-de-la-Periode-de-Dispensation-des-ARVs_Final

Programme de Dispensation Prolongée des Antirétroviraux en Haïti

A document detailing Haiti’s multi-month ART refill programme

India

In 2021, the Indian Ministry of Health and Family Welfare together with the National AIDS Control Organisation released updated National Guidelines for HIV Care and Treatment.

On 23 March 2020, the Indian Ministry of Health and Family Welfare released its Guidance Note for Persons engaged in HIV/AIDS response under National AIDS Control Programme in view of the COVID-19 scenario. In addition to general COVID-19 precautions for the programme facilities, the note gives specific guidance on ART dispensation, including multi-month and community dispensing. It also mentions commodity distribution within specific vulnerable groups.

The Ministry published National Technical Guidelines on Anti Retroviral Treatment in 2018. These detail eligibility criteria for multi-month ART dispensation for different population groups.

National Guidelines for HIV Care and Treatment (2021)

Guidance-Note-COVID-19_India

Guidance Note for Persons engaged in HIV/AIDS response under National AIDS Control Programme in view of the COVID-19 scenario (March 2020)

Guidance on HIV related health services during the COVID-19 pandemic

India_HIV-Treatment-Guidelines_2018

National Technical Guidelines on Anti Retroviral Treatment (2018)

National guidelines for ART

Kenya

In 2022, the updated Kenya HIV and Prevention and Treatment Guidelines were launched. It includes guidance on DSD for clients beyond first 6 months of ART, DSD for children, adolescents and pregnant and breastfeeding women, and details on the different facility and community-based models. The previous edition, Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV in Kenya, were launched in 2018, including guidance on DSD for clients who have advanced disease and those who are clinically well. To accompany the guidelines and practical handbook, NASCOP released Differentiated Care: Operational Guide in January 2017. On 24 August 2020, the Ministry of Health released Updated Operational Guidance on Continuity of Health Services in HIV Prevention, Care and Treatment in the Context of the COVID-19 Pandemic. Included in this update is information guidance on multi-month dispensing (MMD) for PrEP, as well as updated guidance on managing MMD of ART.  Earlier COVID-19 guidance from the Ministry recommended promotion of flexible ART delivery models, such as community ART group distribution, among other measures.

Since 2016, the Kenyan Ministry of Health, through the National AIDS & STI Control Programme (NASCOP), has included provision for differentiated service delivery (DSD) in national guidelines. New Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV in Kenya were launched in 2018, including guidance on DSD for clients who have advanced disease and those who are clinically well. To accompany the guidelines and practical handbook, NASCOP released Differentiated Care: Operational Guide in January 2017. 

Kenya HIV and Prevention and Treatment Guidelines

KENYA_UPDATED-GUIDANCE-FOR-CONTINUITY-OF-HEALTHCARE-SERVICES-24.08.2020

COVID-19 Guidance on Comprehensive HIV Service Delivery (March 2020)

Guidance on HIV service delivery during the COVID-19 pandemic

ICAP_CQUIN_Kenya-ARV-Guidelines-2018-Final_20thAug2018-1

Guidelines on use of antiretroviral drugs for treating and preventing HIV in Kenya (2018)

A guideline for Kenyan health service providers on HIV prevention and treatment

Kenya_DC_Operational-Guide

Differentiated Care: Operational Guidance (2017)

A guide for healthcare workers to plan, implement, and evaluate differentiated care

Laos

A document issued in 2017 details eligibility for differentiated models of care and three to six monthly ART refills with community distribution.

Laos_2017-Final-ART-GL_English-compressed

National Guideline for the Use of Antiretroviral Therapy in Adults and Children 5th edition (2017)

National ART guidelines

Lesotho

The Sixth Edition of the National Guidelines on the Use of Antiretroviral Therapy for HIV Prevention and Treatment, launched in January 2022 by the Lesotho Ministry of Health, includes a chapter on DSD with details on MMD, fast-track, club, and outreach ART refills, decentralized drug distribution and CAGs. The guidelines also include a section on differentiating services for specific populations such as adolescents, pregnant and breastfeeding women, men, and key populations. In 2016, the Fifth Edition  of the guidelines specified eligibility criteria for three to six month dispensing of ART (3-6MMD). The guidelines further mentioned decentralization of HIV services through community adherence groups (CAGs) and integration of HIV programmes with TB, maternal and child health and sexual and reproductive health services. 

In 2020, the Ministry of Health in Lesotho released Approach to the Management of Advanced HIV Disease (AHD).  This recommends differentiation of services for “stable” clients in order to reduce clinical visit frequency and enable health facilities to focus resources on those who require more intensive clinical support.  It includes section 4.5.3 “Differentiated service delivery for AHD clients”.

On 9 July 2020, the Ministry released Coronavirus Disease – 2019 (COVID-19) Screening, Testing, Clinical Management, and Prevention of COVID-19 Guidelines for Clinicians, including a section pertaining to HIV (page 30).  This section details changes to various DSD initiatives including increased uptake of multi-month ART refills (MMD) for “stable” clients, MMD for TB preventative therapy and supporting telephonic follow-ups among people living with HIV who are not yet established on treatment. Further, the guidelines noted that additional community ART delivery models may be introduced by the Ministry. These guidelines compliment the April 2020 memo HIV program services delivery COVID 19 lock down guidance that advocated for health facilities to promote and facilitate community ART groups.

National Guidelines on the Use of Antiretroviral Therapy for HIV Prevention and Treatment

Lesotho_COVID-Guideline_Update_10-July

Coronavirus Disease – 2019 (COVID-19) Screening, Testing, Clinical Management, and Prevention of COVID-19 Guidelines for Clinicians (July 2020)

See page 30 for HIV and DSD

Lesotho_COVID-Guideline_Update_10-July-1

Approach to the Management of Advanced HIV Disease (AHD) (July 2020)

Advanced HIV disease manual that defines the AHD package of care in Lesotho.

HIV program services delivery COVID 19 lock down guidance (April 2020)

Memo on HIV services during COVID-19

Liberia

In the Liberian Ministry of Health National AIDS-STI Control Program (NACP) published Liberia Integrated Guidelines for Prevention, Care and Treatment of HIV and AIDS in fall 2022. These guidelines include section 16 on Differentiated ART Services, which mentions eligibility criteria for DSD models including facility-based individual, healthcare worker managed group, client-managed group and out-of-facility individual models.

In September 2020, the Liberian National AIDS and STI Control Program (NACP) updated a standard operating procedure (SOP) on implementation of six monthly ART dispensation (6MMD) during the COVID-19 pandemic. The document is to be used in conjunction with the Facility Assessment and Preparation Tool and details eligibility criteria for the 6MMD programme.  

On 25 March 2020, the Liberian Ministry of Health NACP published Interim Guidance for COVID-19 for all Persons with HIV, which includes recommendations for multi-month dispensation of antiretroviral therapies and telephonic feedback of viral load results.

Liberia Integrated Guidelines for Prevention, Care and Treatment of HIV and AIDS (2022)

This provides details on DSD models including facility-based individual, healthcare worker managed group, client-managed group and out-of-facility individual models

Liberia_MMD

National AIDS and STI Control Program SOP for six monthly ART dispensation (Updated September 2020)

SOP for 6MMD with eligibility criteria

Liberia_Interim-Guidance-for-COVID-19-for-all-Persons-with-HIV_March-2020

Interim Guidance for COVID-19 for all Persons with HIV (March 2020)

Guidance on HIV service delivery during the COVID-19 pandemic

Malawi

In 2022, the Ministry of Health and Population in Malawi released updated standard operating procedures and guidelines for Clinical Management of HIV in Children and Adults. Section 19 on Differentiated ART services describes eligibility criteria for multi month dispensing of ART, while integration of other health services with HIV care is covered in sections 11 (Preventive services for HIV patients) and 12 (Management of non-communicable diseases).

On 14 August 2020, the Ministry of Health issued the 4th edition of the circular, Guidance for HIV Services during COVID-19 pandemic, which provides updated guidance on safe resumption of certain HIV services, including resumption of all community HIV services.  Earlier editions of this circular included introduction of six monthly dispensing (6MMD) for certain ART regimens, among other measures.

Clinical Management of HIV in Children and Adults (2022)

Malawi Integrated Guidelines and Standard Operating Procedures for Providing HIV Services in: Antenatal Care, Maternity Care, Under 5 Clinics, Family Planning Clinics, HIV Exposed Child Follow-up, ART Clinics.

MALAWI_Guidance-for-HIV-services-during-COVID-19-pandemic_4th-edition_August-2020-11

Guidance for HIV Services during COVID-19 pandemic (4th edition) (August 2020)

Updated guidance on HIV service delivery during the COVID-19 pandemic

Malawi-Clinical-HIV-Guidelines-2019-Addendumversion-8.1

Policy Updates Addendum to the 4th Edition of the Malawi integrated Guidelines and Standard Operating Procedures for Clinical HIV Services (2019)

An addendum to Clinical Management of HIV in Children and Adults

Malawi-Clinical-HIV-Guidelines-2018-1

Guidelines on clinical management of HIV in children and adults for Malawi (2018)

An update on Malawi’s previous 2016 ART guidelines

Mali

Early in 2020, the Mali Ministry of Health published the national guidance document “Normes et Protocoles de prise en charge antirétrovirale du VIH et du Sida”.

Standards and protocols for HIV treatment (2020)

Mozambique

In March 2023, the Ministry of Health in Mozambique launched an implementation guide for DSD models in Mozambique.

In November 2020, the Directorate of Public Health in Mozambique approved a new policy supporting a maximum duration of ART for 6 months. This is currently being scaled up in Maputo City and piloted in another province.

On 27 March 2020, the Mozambique Directorate of Public Health released a circular on HIV service delivery in the context of COVID-19. This circular contains guidance on changes within HIV prevention, testing and treatment service packages, including expansion of three-monthly ART refills and adaptations of Mozambique’s community ART groups to support physical distancing.

In 2018, the Ministry of Health in Mozambique released two modules of guidance on DSD. The first focuses on differentiated prevention and testing services and the second on differentiated ART delivery, including community ART groups and family-centred approaches. This guidance complements the 2015 document on community adherence and support group strategies.

Guião Orientador sobre Modelos Diferenciados de Serviços para o HIV/SIDA em Moçambique (2023)

Dispensa-Semestral-de-ARVs-Mocambique_Nov-2020

Dispensa Semestral de ARVs Moçambique (November 2020)

New policy supporting a maximum duration of ART for 6 months

Pacote-de-Servicos-para-PVHIV-no-ambito-do-COVID19

Pacote de Serviꞔos para Populaꞔões vivendo com o HIV no âmbito da resposta ao COVID-19 (March 2020)

Guidance on HIV service delivery during the COVID-19 pandemic

Guiao-dos-Modelos-Diferenciados-de-Servicos

Guião Orientador sobre Modelos Diferenciados de Serviꞔos em Moꞔambique (2018)

Guidance from the ministry on differentiated service delivery across the HIV care cascade

CAG_Strategy_Moz-1

Estratégia de Grupos de Apoio e Adesão Communitária (2015)

A guide to implementing Community Adherence and Support Groups (CASG) and written in Portuguese

Myanmar

In 2019, the National AIDS Programme of the Ministry of Health and Sports in Myanmar released the Operational Manual on Planning and Provision of HIV services at Health Facilities. This documents details eligibility criteria for extended ART refills of three to six months (3-6MMD) delivered through a ‘fast-track’ refill approach. 

Myanmar-OM-PP-Eng-Version-2019-compressed

Operational Manual on Planning and Provision of HIV Services at Health Facilities (2019)

A manual for HIV service provision including multi month ART dispensing

Namibia

In 2019, the Ministry of Health and Social Services in Namibia released the sixth edition of their National Guidelines for Antiretroviral Therapy to align with new recommendations from the World Health Organization. Chapter 9 on ‘Differentiated Services (sic!) Delivery’ outlines various facility-based and out-of-facility models as well as ART multi-month dispensing guidelines.

Namibia_ART_guidelines

National guidelines for antiretroviral therapy 6th Edition (2019)

National ART guidelines including a chapter on DSD

Nepal

In 2020 the Government of Nepal’s Ministry of Health and Population National Centre for AIDS and STD Control published National HIV Testing and Treatment Guidelines.  This document permits up to six-month ART refills for eligible clients and details decentralized ART dispensing and community-based ART centres.

Nepal_National-HIV-Testing-Guidelines-May-10-2020-WEB-Version-1

National HIV Testing and Treatment Guidelines (2020)

Guidelines including multi-month and decentralised ART dispensation

Nigeria

In 2021, the Federal Ministry of Health’s National Aids and STIs Control Programme released the Differentiated Service Delivery Operational Manual for HIV Prevention, Treatment and Care. This comprehensive operational manual provides guidance on DSD implementation in Nigeria across the full continuum of care from testing to viral suppression, including differentiation for specific populations. It also covers DSD-specific operational considerations for laboratory services, supply chain management, programme monitoring and evaluation. The 2020 National Guidelines for HIV Prevention, Treatment and Care include a comprehensive subsection on DSD within the chapter on service delivery (Chapter 9).

Differentiated Service Delivery Operational Manual for HIV Prevention, Treatment and Care (2021)

This outlines service delivery to various sub-populations including pregnant and breastfeeding women, children, adolescents, and key populations. It also includes procurement and supply chain considerations. 

National Guidelines for HIV Prevention, Treatment and Care (2020)

Chapter Nine focuses on improving the efficiency of service delivery by using DSD models, and decentralized services. Special attention is given to DSD based on clinical characteristics and sub-groups including key populations.

Nigeria-national-guidelines-2016-

National guidelines for HIV prevention treatment and care (2016)

The national HIV guidelines from Nigeria’s Federal Ministry of Health

Papua New Guinea

In 2019, the National Department of Health in Papua New Guinea published Papua New Guinea National Guidelines for HIV Care and Treatment.  DSD is specifically included in Chapter 6 (Service Delivery), which details up to six-month ART dispensation (6MMD) and various community ART refill models.

Papua-New-Guinea_HIV-Treatment-Guidelines_2019-3

Papua New Guinea National Guidelines for HIV Care and Treatment (2019)

National guidelines for HIV service delivery

Rwanda

In 2022, the Ministry of Health in Rwanda published “Guidelines for HIV Prevention, Treatment and Care in Rwanda”. The document includes a chapter on differentiated service delivery models (2.4) and provides guidance to support clients shifting from less-intensive to more-intensive models and vice versa. In addition, it includes a flow chart for clients established/not established on ART and recommended models for enrolment, by client group.

Guidelines for HIV Prevention, Treatment and Care in Rwanda. Edition 2022

Senegal

The guide for the management of HIV in Senegal details eligibility criteria for three to six-month ART refills (3-6MMD) and endorses community dispensation models.

Senegal_Guide-PEC-VIH_4-11-18.docx

Guide pour la Prise en Charge de L’Infection par le VIH au Senegal

A guide for the management of HIV infection in Senegal detailing 3-6MMD

Sierra Leone

In May 2020, the National HIV/AIDS Control Programme published COVID-19 guidance on comprehensive HIV service delivery. It includes recommendations for same-day ART initiation and possible multi-month dispensing of ART, drug supply logistics in the event of a complete lockdown and details on suspension of outreach services.

In May 2018, the Ministry of Health and Sanitation in Sierra Leone, with support from UNAIDS, set out its country guidance on DSD in the Guide of Differentiated care model in Sierra Leone: Who feels it knows it. The guidance covers the continuum of care from HIV testing to ART delivery for “stable” clients and highlights differentiation for men, adolescents and key populations. It specifically defines a “stable” child and differentiated ART delivery models for children and adolescents. It also includes differentiated viral load testing approaches. 

Consolidated guidelines on HIV Prevention, Diagnosis, Treatment and Care in Sierra Leone (2020)

Sierra-Leone_HIV-COVID-19-Preparedness-Plan_FINAL2020

COVID-19 guidance on comprehensive HIV service delivery (May 2020)

Guidance on HIV service delivery during the COVID-19 pandemic

Guide-of-Differentiated-care-Model-Sierra-Leone-Final-Version-May-2018

Guide of differentiated care model in Sierra Leone: Who feels it knows it (2018)

Guidance from the Ministry of Health and Sanitation in Sierra Leone on differentiated service delivery

South Africa

In August 2023, the South African National Department of Health launched the “Guideline for the Prevention of Vertical Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB)”. This guideline is a component of the Maternity Care guidelines and the National Consolidated ART guidelines. Integrated visit schedules for a mother on ART and her HIV-exposed infant are aligned with the infant’s immunization schedule (including the mother’s contraception visits). It utilizes three month multi-month dispending (3MMD) to achieve this alignment (2MMD at delivery and then 3MMD from 14 weeks). Mothers on ART are eligible for less intensive DSD beyond MMD from 12 months post-delivery if receiving MCH/ART integrated care or from 6 months post-delivery, if not. In addition, integrated visit schedules for mother on PrEP are aligned with her infant’s immunization schedule. It utilizes 3MMD PrEP to achieve this alignment. It also aligns the mother’s contraception visits. 

In June 2023, the South African National Department of Health published updated “Adherence Guidelines for HIV, TB and NCDs” and “differentiated models of care standard operating procedures” to align with the “2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates”. This is the first time that the clinical and adherence guidelines revision processes were combined ensuring simultaneous consideration of both components of HIV care.

Important changes to the updated DSD for HIV treatment guidance in South Africa includes: i) reducing the number of health facility visits in the first year on treatment, ii) shifting the first treatment assessment to 3 months after initiation to support earlier adherence support for those who need it and earlier referral to DSD for models for those who are suppressed, iii) reducing the total visits for those in DSD models by supporting longer ART refills, iv) guiding multi-month dispensing for more people and v) revising the differentiated approach to support those re-engaging in care.

The department launched the updated National Strategic Plan for HIV, TB and STIs 2013-2028 on 24 March 2023. This document speaks to both differentiated HIV testing and treatment.

Guidelines that were published in 2020 in response to COVID-19 include Guidance to Implementing Partners Regarding Managing Clients on Pre-Exposure Prophylaxis (PrEP) during State of Emergency (sic) COVID-19 (26 March 2020) and Response to reduce risk among HIV and TB patients within the context of the COVID-19 pandemic: The South African response to COVID-19 (17 April 2020).

The Southern African HIV Clinicians Society published guidelines in 2017 recommending strategies to support adolescents and young adults in achieving and maintaining viral suppression. These are the first in sub-Saharan Africa to recognize the need to differentiate service delivery models for adolescents and young adults considered to be “stable” or “unstable” either in or after their first year of treatment. In the same year, the society released a supplement guideline on HIV self-testing.

Guideline for Vertical Transmission Prevention of Communicable Infections (2023)

Guideline for the Prevention of Vertical Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) 2023

2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates

Published in June 2023 by the Republic of South Africa National Department of Health

Differentiated models of care standard operating procedures. Minimum differentiated models of care package to support linkage to care, adherence, and retention in care

Updated in April 2023

National Strategic Plan for HIV, TB and STIs 2013-2028

COVID_HIV_TB_Response_v8_Final_17Apr20

Response to reduce risk among HIV and TB patients within the context of the COVID-19 pandemic: The South African response to COVID-19 (April 2020)

Guidance on HIV and TB service delivery during the COVID-19 pandemic

Final-Guidance-PrEP-COVID19-26-March-2020

Guidance to Implementing Partners Regarding Managing Clients on Pre-Exposure Prophylaxis (PrEP) during State of Emergency (sic) COVID-19 (March 2020)

Guidance on PrEP client management during the COVID-19 pandemic

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Southern African HIV Clinicians Society Guidelines: Adherence to antiretroviral therapy in adolescents and young adults (2017)

Guidelines recommending strategies to support adolescents and young adults in achieving and maintaining viral suppression

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A supplement to the National HIV Testing Services Policy 2016 (2017)

A publication of the Southern African HIV Clinicians Society on HIV self-testing

South Sudan

In April 2020, the Ministry of Health in South Sudan issued HIV programme Guidance in the context of COVID-19 Pandemic, which includes recommendations for three to six monthly ART dispensing (3-6MMD) and maximizing community-based ART distribution.

In 2017, the Ministry published Consolidated Clinical Guidelines on Use of Antiretroviral Drugs for HIV Treatment and Prevention, detailing various facility and community-based DSD models as well as guidance for up to three-month ART refills (3MMD).

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HIV programme Guidance in the context of COVID-19 Pandemic (April 2020)

Guidance on HIV programme adjustments during COVID-19

Consolidated Clinical Guidelines on Use of Antiretroviral Drugs for HIV Treatment and Prevention (2017)

National guidelines for ART

Tanzania

In 2020, the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children published the updated Interim Guidance on Provision of HIV Prevention and Care Services in the Context of COVID-19 Outbreak in Tanzania – Second Edition, which aims to ensure uninterrupted service provision for people living with HIV, while implementing standard precautions against COVID-19.

In 2019, the ministry’s National AIDS Control Programme (NACP) launched the National Accelerated Action Plan on HIV Testing Services along with the National Comprehensive Guidelines on HIV Testing Services. The latter recommends a differentiated testing approach, including special considerations for children and adolescents and pregnant and breastfeeding women, as well as key and other vulnerable populations.  The same year, the Ministry and NACP published National Guidelines for the Management of HIV and AIDS (7th Edition).  This comprehensive document includes section 2.4 on “Differentiated Service Delivery Models (DSDMs)”, which recommends using the building blocks approach to design appropriate service delivery models that take into account the needs of specific populations.  Learn more about the building blocks approach here.  

In a joint effort, the ministry and the International Training and Education Centre for Health released HIV Service Delivery Models: Mapping HIV Service Delivery Strategies in Tanzania in 2017.

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Interim Guidance on Provision of HIV Prevention and Care Services in the Context of COVID-19 Outbreak in Tanzania – Second Edition (2020)

Guidance on HIV service delivery during the COVID-19 pandemic

National Accelerated Action Plan on HIV Testing Services (2019-2020)

This plan includes a mix of HIV testing strategies, population-specific targets and accentuates on quality, efficiency, yield and linkage

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National Comprehensive Guidelines on HIV Testing Services (2019)

These guidelines provide a framework to facilitate access to safe and ethical testing services for different population groups

NATIONAL_GUIDELINES_FOR_THE_MANAGEMENT_OF_HIV_AND_AIDS_2019

National Guidelines for the Management of HIV and AIDS (7th Edition) (2019)

Comprehensive guidelines for HIV service delivery including DSD models

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HIV Service Delivery Models: Mapping HIV Service Delivery Strategies in Tanzania (2017)

A report on service delivery models currently being implemented across the HIV prevention, care and treatment cascade

Togo

In March 2020, the Ministry of Health and Public Hygiene in Togo issued an emergency order, in the context of the COVID-19 pandemic, allowing for three monthly ART dispensing (3MMD) to all people on ART.

In 2019, the Ministry released a guide to comprehensive care for people living with HIV.  This document details eligibility criteria for entry into the three to six month extended ART refill (3-6MMD) programme with six monthly clinical consultation.   

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Commande d’urgence des sites MMD (March 2020)

COVID-19 emergency order for 3MMD

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Guide de prise en charge globale des personnes vivant avec le HIV (2019)

A guide to comprehensive care for people living with HIV

Uganda

In November 2022, the Ugandan Ministry of Health published the updated “Consolidated Guidelines for the Prevention and Treatment of HIV and AIDS in Uganda“, including a chapter on Differentiated Service Delivery (p.284). In December 2022, the Ministry of Health published “Technical Guidance on Pre-Exposure Prophylaxis (PrEP) for Persons at Substantial Risk of HIV Infection in Uganda (2022)” including guidance on the implementation of DSD for PrEP in facility and community-based models (p.55).

In early 2020, the ministry published updated Consolidated guidelines for prevention and treatment of HIV in Uganda.  This comprehensive document includes section 10.1 “Differentiated Service Delivery”, which recommends using the building blocks approach to design appropriate service delivery models that take into account the needs of specific populations.  This guideline is supported by Implementation guide for Differentiated Service Delivery Models (DSDM) for HIV and TB services in Uganda (version March 2020).In Uganda, the Ministry of Health published COVID-19 Infection Prevention and Control Guidance for HIV & TB Services Delivery in April 2020. It includes recommendations to reduce congestion at health facilities and suspension of some community-based services. This document is supported by Frequently Asked Questions by Health Care Providers Regarding HIV and TB Service Delivery During COVID-19 Lockdown (April 2020), which provides practical guidance on HIV and TB service delivery issues.

Consolidated Guidelines for the Prevention and Treatment of HIV and AIDS in Uganda (November 2022)

Technical Guidance on Pre-Exposure Prophylaxis (PrEP) for Persons at Substantial Risk of HIV Infection in Uganda (2022)

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COVID-19 Infection Prevention and Control Guidance for HIV & TB Services Delivery (April 2020)

Guidance on HIV and TB service delivery during the COVID-19 pandemic

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Frequently Asked Questions by Health Care Providers Regarding HIV and TB Service Delivery During COVID-19 Lockdown (April 2020)

FAQs on COVID-19 guidance

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Implementation guide for Differentiated Service Delivery Models (DSDM) for HIV and TB services in Uganda (version March 2020)

This guide details how to implement DSD for HIV and TB

Implementation guide for Differentiated Service Delivery Models (DSDM) for HIV and TB services in Uganda (version March 2020)

This guide details how to implement DSD for HIV and TB

Uganda_Consolidated-HIV-and-AIDS-Guidelines-2020-June-30th1

Consolidated guidelines for prevention and treatment of HIV in Uganda (2020)

The Consolidated Guidelines include models for differentiated HIV testing, care and treatment

Zambia

In 2022, the Ministry of Health in Zambia published the Differentiated Service Delivery (DSD) Framework 2022-2026 which includes DSD implementation guidance for the different levels (national, provincial, district, facility, and community).

In 2020, updated Consolidated Guidelines for Treatment and Prevention of HIV Infection were released.  These reinforce the DSD for HIV treatment related recommendations of the previous 2018 guideline and extend multi month ART refills to six months (6MMD) for eligible adults.

The 2021 Guidelines for Management of Advanced HIV Disease in Zambia include a section dedicated to DSD for advanced HIV disease, which includes guidance for integration of services for non-communicable diseases. 

On 24 March 2020, the Zambian Ministry of Health published a circular, Multi-Month Dispensation and use of TLE/TLD during the COVID-19 pandemic, recommending the promotion of three or six monthly (3MMD or 6MMD) dispensation and temporary replacement of Tenofovir Lamivudine Dolutegravir (TLD) with Tenofovir Lamivudine Efavirenz (TLE) until adequate TLD stocks are available.

Differentiated Service Delivery (DSD) Framework 2022-2026 (2022)

This framework provides guidance on DSD models implementation at different levels.

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Consolidated Guidelines for Treatment and Prevention of HIV Infection (2020)

Updated HIV service guidelines included extended MMD

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Multi-Month Dispensation and use of TLE/TLD during the COVID-19 pandemic (March 2020)

Guidance on Tenofovir Lamivudine Efavirenz/Tenofovir Lamivudine Dolutegravir dispensation during the COVID-19 pandemic

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Guidelines for Management of Advanced HIV Disease in Zambia

Comprehensive guidance document for advanced HIV management, including DSD

Zimbabwe

The Zimbabwean Ministry of Health and Child Care updated its Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe, along with the Consolidated HIV and AIDS Job Aide in December 2022. Chapter 2 covers the application of DSD across the HIV cascade from testing to viral suppression.  This updated manual also includes DSD for people not yet established on treatment as well as integration of other medical needs into DSD models and DSD for different specific populations. 

In 2020, updated Consolidated Guidelines for Treatment and Prevention of HIV Infection were released.  These reinforce the DSD for HIV treatment related recommendations of the previous 2018 guideline and extend multi month ART refills to six months (6MMD) for eligible adults. The Consolidated HIV and AIDS Job Aide was developed to accompany the previous (2016) version of the manual and includes checklists, clinical algorithms and educational tools to support implementation.

The Ministry released Rapid Guidance on HIV Service Delivery in COVID-19 Context on 26 March 2020. This aims to ensure continuity of HIV services while mitigating risk for COVID-19 and includes specific guidance on multi-month antiretroviral therapy dispensation (MMD), as well as alterations to prevention services. Its job aide for healthcare workers, COVID-19 and HIV (April 2020), supports the guidance document and suggests telephonic and social messaging for treatment monitoring and psychosocial support.

Consolidated HIV and AIDS Job Aide. 2022 edition. AIDS and TB unit Zimbabwe (2022)

Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe (2022)

This updated manual provides guidance on “how” to implement differentiated service delivery across the HIV cascade.

ZIMBABWE-Rapid-guidance-on-HIV-Service-Delivery-in-COVID-19-CONTEXT-CORRECT-DOCUMENT

Rapid Guidance on HIV Service Delivery in COVID-19 Context (March 2020)

Guidance on HIV service delivery during the COVID-19 pandemic

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COVID-19 and HIV (April 2020)

COVID-19 and HIV job aide

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Operational and service delivery manual for the prevention, care and treatment of HIV in Zimbabwe (2017)

This manual gives guidance on ‘how’ to implement differentiated service delivery across the HIV cascade