AIDS 2022, the 24th International AIDS Conference took place from 29 July – 2 August in Montreal, Canada, and virtually. IAS – the International AIDS Society, through its Differentiated Service Delivery (DSD) programme, hosted a pre-conference meeting on 28 July and two satellites at AIDS 2022.

AIDS 2022 Pre-conference meeting: Differentiated service delivery for HIV treatment in 2022. Thursday, 28 July, 09:00 – 12:30 EDT, Montreal, Canada (and virtually)

In line with the AIDS 2022 conference theme “Re-engage and follow the science”, this three-hour preconference spotlighted the important role of DSD in supporting HIV treatment continuity and re-engagement in care of people living with HIV who have experienced treatment interruptions.

In this three-part pre-conference, opening presentations outlined the current state of DSD for HIV treatment in 2022 in terms of the global and country policies, evidence and implementation. Speakers highlighted the critical role that DSD for HIV treatment played in response to addressing COVID-19 challenges. Many of these COVID-19 adaptations unlocked previous barriers to DSD implementation, at least temporarily. Further, data was shared to highlight which policies to support DSD should be updated, both in terms of making COVID-19 emergency measures “the new normal” and in terms of adopting updated DSD recommendations made in the World Health Organization’s updated HIV guidelines, published in 2021.

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Session 1: DSD for HIV treatment in 2022: Building stronger HIV programme resilience

Session 2: Moving into, out of and between service delivery models: Changing needs, a changing DSD model

Session 3: DSD to support sustained re-engagement: It shouldn’t be one-size-fits all

AIDS 2022 Satellite: Expanding access to PrEP through differentiated service delivery: Lessons from COVID-19 adaptations. Saturday, 30 July, 08:00-09:00 (EDT), in Montreal, Canada (and virtually)

DSD has the potential to improve access to and uptake and effective use of pre-exposure prophylaxis (PrEP) for HIV prevention. Particularly during COVID-19, impressive adaptations were made to PrEP service delivery in many countries to ensure continued access as well as new initiations – highlighting the benefits of simplified and differentiated PrEP service delivery. This satellite showcased how a DSD approach to PrEP has expanded uptake and accelerated implementation in different contexts and populations. Building on the 2022 WHO technical brief Simplified and differentiated service delivery for PrEP, a series of case studies illustrated adaptations before and during COVID-19, such as community-based PrEP services, including at-home delivery and pharmacy pickups, HIV self-testing, and virtual interventions. Additional adaptations include multi-month dispensing of PrEP, adjustments to the clinical package of care enabling reduced frequency of clinical consultations and streamlined clinic visits, telehealth clinical check-ins and/or virtual psychosocial support, and lay provider-led service provision. The benefits and barriers to different DSD for PrEP models were considered in terms of acceptability by clients and ensuring accessibility, convenience, and quality of services.

This session convened implementers, advocates, policy makers and researchers to share their differentiated PrEP service delivery experiences towards increasing PrEP uptake, continuation, and effective use, as well as to ensure PrEP programme resilience going forward.

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AIDS 2022 Satellite: The science of differentiated service delivery: Where we are and where we’re going. Monday, 1 August, 08:00 – 09:00 (EDT), Montreal, Canada (and virtually)

Over the past decade, research on the benefits of differentiated service delivery (DSD) for HIV treatment has proliferated. Today, the World Health Organization (WHO) endorses four DSD HIV treatment models for people established on antiretroviral therapy (ART) and countries have adopted and expanded DSD implementation. During COVID-19, ART programmes were resilient, leveraging existing DSD systems to achieve scale and increase access by expanding who was eligible, extending antiretroviral therapy refills and intensifying the scale-up of community-based service delivery.

Since 2020, IAS convenes the Global DSD Research Collaborative to work collectively and efficiently to fill evidence gaps around HIV service delivery. In this satellite, this network of researchers summarized the state of the evidence for DSD for HIV treatment, including evidence gaps and key science highlights from the AIDS 2022 pre-conference DSD for HIV in 2022.  This was followed by a presentation on how best to answer the outstanding questions focusing on research methodologies appropriate in the DSD context and the role of implementation science versus traditional randomized control trials. Finally, aspirations for the future of the research space around HIV service delivery were shared. This session will be of interest to researchers and methodologists, policy makers and the broader HIV community.

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