By Emmanuel A A Teviu, Anthony Ashinyo, Kwadwo Koduah Owusu, Elizabeth Agyare, Raphael Adu-Gyamfi – National AIDS/STI Control Programme, Ministry of Health, Ghana
Ghana was an early adopter of differentiated service delivery (DSD), establishing a clear separation between clinical and refill visits for stable clients on antiretroviral therapy (ART). Building on a strong government-led supply chain, Ghana has scaled up multi-month dispensing (MMD) significantly: 38% of people living with HIV now receive six or more months of ART per dispensing visit, with a further 47% receiving three to six months, placing 85% of clients on some form of MMD. Six-monthly clinical visits are delivered by a broad task sharing cadre, including prescribers, nurses, midwives and pharmacists. Refill visits are also extended to peers and community-level providers.
Why make a change?
First and most importantly, this is about listening to people using the services. The ability to self-manage, understand their condition and live a fulfilled life is paramount for our clients. Attending a six-monthly appointment when no viral load test is due means another day away from work simply to collect a prescription. Annual clinical visits directly address this: they reduce transport costs, protect privacy, reduce stigma and free up time that clients would otherwise spend away from work or family. Central to the change is the assurance that clients can seek care at any time if they have concerns between annual reviews.
Second is the imperative to prioritize activities guided by their cost effectiveness. Reducing the number of clinical visits by half will meaningfully reduce workloads for healthcare workers, freeing capacity to focus on clients with complex needs, strengthen laboratory and diagnostic services, and enhance continuity and retention in care. These efficiency gains also improve system resilience and contribute to pandemic preparedness.
Why make the change now?
Major shifts in donor funding over the past year coincided with Ghana’s strategic sustainability planning for the HIV programme. Together, these provided a strong impetus to review clinical and service delivery guidance – drawing on retention and virological suppression data from settings that have already adopted annual visits and modelling the potential cost savings for our health system.
How are we moving from idea to policy to action?
It has been essential to build the evidence base by gathering local data and drawing on the experience of colleagues in countries that have already made this transition. Current data are encouraging, and we urge all countries and implementers making this shift to rigorously analyse and share their findings.
Engaging healthcare workers and clients revealed expected concerns: provider worries about reduced clinical oversight; client anxiety about less frequent contact; the risk of missing co-morbidities; and questions about supply chain readiness. These conversations have been largely constructive. A robust task sharing model and the assurance that clients may seek care at any time have helped build confidence in the transition, while supply chain readiness for sustained MMD has been addressed as a parallel priority.
Convening a multi-stakeholder dialogue ensured that MMD systems, including supply chains, are fully in place to support the shift. Phased implementation began in March 2026, and Ghana looks forward to sharing our experience with the global HIV community.
