A wide range of published evidence relating to differentiated service delivery is available. A summary of published evidence for differentiated ART delivery along with links to the publications is available here. The content below has been grouped thematically and includes other published literature such as commentaries, country implementation, costing studies and more.
- Limbada M, Zijlstra G, Macleod D, Ayles H, Fidler S. A systematic review of the effectiveness of non- health facility based care delivery of antiretroviral therapy for people living with HIV in sub-Saharan Africa measured by viral suppression, mortality and retention on ART. BMC Public Health. 2021 Jun 10;21(1):1110. doi: 10.1186/s12889-021-11053-8. PMID: 34112135; PMCID: PMC8194040.
- Long L, Pascoe S, Nichols B, Fox M, Cele R, Govathson C et al. Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub‐Saharan Africa: a rapid systematic review. J Int AIDS Soc. 2020; 23(11):e25640
- Ehrenkranz P, Grimsrud A, Rabkin M. Differentiated service delivery: navigating the path to scale. Current opinion in HIV and AIDS. 2019;14(1):60-5.
- Flämig K, Decroo T, van den Borne B, van de Pas R. ART adherence clubs in the Western Cape of South Africa: what does the sustainability framework tell us? A scoping literature review. J Int AIDS Soc. 2019 Mar;22(3):e25235. doi: 10.1002/jia2.25235. PMID: 30891928; PMCID: PMC6531844.
Commentaries, editorials and viewpoints
- Grimsrud, A. and Wilkinson, L. Acceleration of differentiated service delivery for HIV treatment in sub-Saharan Africa during COVID-19. J Int AIDS Soc. 2021; 24(6):e25704
- Sibanda E, Taegtmeyer M. Antiretroviral therapy dispensing for patients who are clinically stable. The Lancet Global Health. 2021;9(5):e565-e6. doi: https://doi.org/10.1016/S2214-109X(21)00104-2
- Collins LF, Colasanti JA, Nguyen ML, Moran CA, Lahiri CD, Marconi VC et al. The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the U.S. – applying lessons from high-burden settings. AIDS. 2020 Nov 5. doi: 10.1097/QAD.0000000000002746. Epub ahead of print. PMID: 33165032.
- Ehrenkranz P, Grimsrud A, Holmes CB, Preko P, Rabkin M. Expanding the vision for differentiated service delivery: a call for more inclusive and truly patient-centered care for people living with HIV. J Acquir Immune Defic Syndr. 2020 Oct 23. doi:10.1097/QAI.0000000000002549. Epub ahead of print. PMID: 33136818.
- Rosen S, Grimsrud A, Ehrenkranz P, Katz I. Models of service delivery for optimizing a patient’s first six months on antiretroviral therapy for HIV: an applied research agenda. Gates Open Res. 2020 Jul 29;4:116. doi: 10.12688/gatesopenres.13159.1. PMID: 32875281; PMCID: PMC7445417.
- Georgetown University The Policy Lab. Access During COVID-19: National Policies on Multi-month Supplies of HIV Medications.
- Wilkinson L, Grimsrud A. The time is now: expedited HIV differentiated service delivery during the COVID-19 pandemic. J Int AIDS Soc. 2020;23(5):e25503.
- Ford N, Geng E, Ellman T, Orrell C, Ehrenkranz P, Sikazwe I, et al. Emerging priorities for HIV service delivery. PLoS Med. 2020;17(2):e1003028.
- Grimsrud A, Pike C and Bekker LG. The power of peers and community in the continuum of HIV care. The Lancet Global Health. 2020; https://doi.org/10.1016/S2214-109X(19)30544-3
- Reidy WJ, Rabkin M, Syowai M, Schaaf A, El-Sadr WM. Patient-level and program-level monitoring and evaluation of differentiated service delivery for HIV: a pragmatic and parsimonious approach is needed. Aids. 2018;32(3):399-401.
- Grimsrud A, Barnabas RV, Ehrenkranz P, Ford N. Evidence for scale up: the differentiated care fresearch agenda. J Int AIDS Soc. 2017;20(Suppl 4):22024.
- Grimsrud A, Bygrave H, Doherty M, Ehrenkranz P, Ellman T, Ferris R, et al. Reimagining HIV service delivery: the role of differentiated care from prevention to suppression. J Int AIDS Soc. 2016;19(1):21484.
- Campion EW. Treating millions for HIV–the adherence clubs of Khayelitsha. N Engl J Med. 2015;372(4):301-3.
- Rousseau E, Julies RF, Madubela N and Kassim S. Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations — Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine. Curr HIV/AIDS Rep. 2021. https://doi.org/10.1007/s11904-021-00578-7
- Rousseau E, Bekker LG, Julies RF, et al. A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa. BMC Health Serv Res. 2021;21(1):888. Published 2021 Aug 28. doi:10.1186/s12913-021-06920-4
- Pollard R, Gopinath U, Reddy YA, Kumar BR, Mugundu P, Vasudevan CK et al. HIV service delivery to key populations in the time of COVID-19: experiences from India. 11th IAS Conference on HIV Science Abstract Supplement Journal of the International AIDS Society 2021, 24(S4): https://doi.org/10.1002/jia2.257551
- Barnabas RV, Szpiro AA, van Rooyen H, Asiimwe S, Pillay D, Ware NC, et al. Community-based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): a randomised trial. Lancet Glob Health. 2020;8(10):e1305-e15.
- Vrazo A, Golin R, Fernando N, Killam W, Sharifi S, Phelps B et al. Adapting HIV services for pregnant and breastfeeding women, infants, children, adolescents and families in resource-constrained settings during the COVID-19 pandemic. J Int AIDS Soc. 2020; https://doi.org/10.1002/jia2.25622
- Wilkinson L, Siberry GK, Golin R, Phelps BR, Wolf HT, Modi S, et al. Children and their families are entitled to the benefits of differentiated ART delivery. J Int AIDS Soc. 2020;23(4):e25482.
- Grimsrud AT, Pike C, Bekker LG. The power of peers and community in the continuum of HIV care. Lancet Glob Health. 2020;8(2):e167-e8.
- Grimsrud A, Bygrave H, Wilkinson L. The Case For Family-Centered Differentiated Service Delivery for HIV. J Acquir Immune Defic Syndr. 2018;78 Suppl 2:S124-s7.
- Reif LK, McNairy ML, Lamb MR, Fayorsey R, Elul B. Youth-friendly services and differentiated models of care are needed to improve outcomes for young people living with HIV. Curr Opin HIV AIDS. 2018;13(3):249-56.
- Srivastava M, Sullivan D, Phelps BR, Modi S, Broyles LN. Boosting ART uptake and retention among HIV-infected pregnant and breastfeeding women and their infants: the promise of innovative service delivery models. J Int AIDS Soc. 2018;21(1).
- Macdonald V, Verster A, Baggaley R. A call for differentiated approaches to delivering HIV services to key populations. J Int AIDS Soc. 2017;20(Suppl 4):21658.
- Mirkovic KR, Rivadeneira ED, Broyles LN. Children and alternative service delivery models: a case for inclusion. Aids. 30. England2016. p. 2569-70.
- Liu L, Christie S, Munsamy M, Roberts P, Pillay M, Shenoi SV, et al. Title: Expansion of a national differentiated service delivery model to support people living with HIV and other chronic conditions in South Africa: a descriptive analysis. BMC Health Services Research. 2021;21:463. doi: 10.1186/s12913-021-06450-z. PubMed PMID: PMC8127180.
- Roberts T, Sahu S, Malar J, Abdullaev T, Vandevelde W, Pillay YG, et al. Turning threats into opportunities: how to implement and advance quality TB services for people with HIV during the COVID-19 pandemic and beyond. Journal of the International AIDS Society. 2021;24(4):e25696.
- Tisdale RL, Cazabon D, Moran AE, Rabkin M, Bygrave H, Cohn J. Patient-Centered, Sustainable Hypertension Care: The Case for Adopting a Differentiated Service Delivery Model for Hypertension Services in Low- and Middle-Income Countries. Glob Heart. 2021 Sep 2;16(1):59. doi: 10.5334/gh.978. PMID: 34692383; PMCID: PMC8415184.
- Boyd AT, Moore B, Shah M, Tran C, Kirking H, Cavanaugh JSet al. Implementing TB preventive treatment within differentiated HIV service delivery models in global programs. Public Health Action. 2020 Sep 21;10(3):104-110. doi: 10.5588/pha.20.0014. PMID: 33134124; PMCID: PMC7577005.
- Bygrave H, Golob L, Wilkinson L, Roberts T, Grimsrud A. Let’s talk chronic disease: can differentiated service delivery address the syndemics of HIV, hypertension and diabetes? Curr Opin HIV AIDS. 2020;15(4):256-60.
- Pathmanathan I, Pevzner E, Cavanaugh J, Nelson L. Addressing tuberculosis in differentiated care provision for people living with HIV. Bull World Health Organ. 952017. p. 3.
- Tram KH, Mwangwa F, Atukunda M, Owaraganise A, Ayieko J, Plenty A, et al. Isoniazid Preventive Therapy Completion in the Era of Differentiated HIV Care. J Acquir Immune Defic Syndr. 2017;76(5):e115-e7.
- Geldsetzer P, Ortblad K, Bärnighausen T. The efficiency of chronic disease care in sub-Saharan Africa. BMC Med. 142016. p. 127.
Country implementation evaluations and considerations
- Gilbert HN, Wyatt MA, Pisarski EE, et al. How community ART delivery may improve HIV treatment outcomes: Qualitative inquiry into mechanisms of effect in a randomized trial of community-based ART initiation, monitoring and re-supply (DO ART) in South Africa and Uganda. J Int AIDS Soc. 2021;24(10):e25821. doi:10.1002/jia2.25821
- Hoke T, Bateganya M, Toyo O, Francis C, Shrestha B, Philakone P, et al. How Home Delivery of Antiretroviral Drugs Ensured Uninterrupted HIV Treatment During COVID-19: Experiences From Indonesia, Laos, Nepal, and Nigeria. Global Health: Science and Practice. 2021; 8(3) doi: 10.9745/GHSP-D-21-00168
- Yang X, Zeng C, Tam CC, Qiao S, Li X, Shen Z, Zhou Y. HIV Service Interruptions During the COVID-19 Pandemic in China: The Role of COVID-19 Challenges and Institutional Response from Healthcare Professional’s Perspective. AIDS Behav. 2021 Oct 6:1–9. doi: 10.1007/s10461-021-03484-6. Epub ahead of print. PMID: 34613522; PMCID: PMC8493360.
- Boyd AT, Jahun I, Dirlikov E, et al. Expanding access to HIV services during the COVID-19 pandemic-Nigeria, 2020. AIDS Res Ther. 2021;18(1):62. Published 2021 Sep 19. doi:10.1186/s12981-021-00385-5
- Kintu, T.M., Ssewanyana, A.M., Kyagambiddwa, T. et al. Exploring drivers and barriers to the utilization of community client-led ART delivery model in South-Western Uganda: patients’ and health workers’ experiences. 2021. BMC Health Serv Res. 1129. https://doi.org/10.1186/s12913-021-07105-9
- Claassen CW, Mumba D, Njelesani M, et al. Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up. BMJ Open. 2021;11(7):e047017. doi:10.1136/bmjopen-2020-047017
- Parrish C, Basu A, Fishman P, et al. Estimating the effect of increasing dispensing intervals on retention in care for people with HIV in Haiti. EClinicalMedicine. 2021;38:101039. doi:10.1016/j.eclinm.2021.101039
- Ferreyra C, Moretó-Planas L, Wagbo Temessadouno F, et al. Evaluation of a community-based HIV test and start program in a conflict affected rural area of Yambio County, South Sudan. PLoS One. 2021 Jul 12;16(7):e0254331. doi: 10.1371/journal.pone.0254331. PMID: 34252129; PMCID: PMC8274874.
- Zakumumpa H, Makobu K, Ntawiha W, Maniple E. A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda. PLoS One. 2021;16(7):e0254214. doi:10.1371/journal.pone.0254214
- Zakumumpa H, Tumwine C, Milliam K, Spicer N. Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda. BMC Health Serv Res. 2021;21(1):692. doi:10.1186/s12913-021-06607-w
- Goodrich S, Siika A, Mwangi A, et al. Development, Assessment, and Outcomes of a Community-Based Model of Antiretroviral Care in Western Kenya Through a Cluster-Randomized Control Trial. J Acquir Immune Defic Syndr. 2021;87(2):e198-e206. doi:10.1097/QAI.0000000000002634
- Eshun-Wilson I, Awotiwon AA, Germann A, et al. Effects of community-based antiretroviral therapy initiation models on HIV treatment outcomes: A systematic review and meta-analysis. PLoS Med. 2021;18(5):e1003646. doi:10.1371/journal.pmed.1003646
- Lujintanon S, Amatavete S, Sungsing T, et al. Client and provider preferences for HIV care: Implications for implementing differentiated service delivery in Thailand. Journal of the International AIDS Society. 2021;24(4):e25693-e.
- Christ B, van Dijk J, Ballif M, Nyandoro T, Reichmuth ML, Mukondwa WR, et al. Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges. OSF Preprints2020.
- Zakumumpa H, Rujumba J, Kwiringira J, Katureebe C, Spicer N. Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda. BMC Health Serv Res. 2020;20(1):222.
- Kun KE, Couto A, Jobarteh K, Zulliger R, Pedro E, Malimane I, et al. Mozambique’s Community Antiretroviral Therapy Support Group Program: The Role of Social Relationships in Facilitating HIV/AIDS Treatment Retention. AIDS Behav. 2019;23(9):2477-85.
- Reif LK, Rivera VR, Bertrand R, Belizaire ME, Joseph JB, Louis B, Joseph B, Anglade B, Seo G, Severe P, Rouzier V, Pape JW, Fitzgerald DW, McNairy ML. “FANMI”: A Promising Differentiated Model of HIV Care for Adolescents in Haiti. J Acquir Immune Defic Syndr. 2019 Sep 1;82(1):e11-e13. doi: 10.1097/QAI.0000000000002088. PMID: 31107305; PMCID: PMC6692183.
- Zakumumpa H, Bennett S, Ssengooba F. Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study. Implementation science : IS. 2017;12(1):45-.
Costing and cost-effectiveness
Note: Costing studies for specific differentiated models of ART delivery are included within the evidence summaries here. Below are general costing studies related to differentiated service delivery.
- Rosen S, Nichols B, Guthrie T et al. Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019 [version 1; peer review: Awaiting peer review] Gates Open Research 2021, 5:177
- Okere, N. E., Corball, L., Kereto, D., Hermans, S., Naniche, D., Rinke de Wit, T. F. and Gomez, G. B. Patient-incurred costs in a differentiated service delivery club intervention compared to standard clinical care in Northwest Tanzania. J Int AIDS Soc. 2021; 24( 6):e25760
- Hoffman RM, Moyo C, Balakasi KT, Siwale Z, Hubbard J, Bardon A, et al. Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a cluster-randomised, non-blinded, non-inferiority trial. The Lancet Global Health. 2021;9(5):e628-e38.
- Nichols BE, Cele R, Lekodeba N, Tukei B, Ngorima-Mabhena N, Tiam A, et al. Economic evaluation of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients. Journal of the International AIDS Society. 2021;24(4):e25692.
- Nichols BE, Cele R, Jamieson L, Long LC, Siwale Z, Banda P et al. Community-based delivery of HIV treatment in Zambia: costs and outcomes. AIDS. 2020 Nov 5. doi: 10.1097/QAD.0000000000002737. Epub ahead of print. PMID: 33170578.
- Larson BA, Pascoe SJ, Huber A, Long LC, Murphy J, Miot J, et al. Will differentiated care for stable HIV patients reduce healthcare systems costs? J Int AIDS Soc. 2020;23(7):e25541.
- Roberts DA, Tan N, Limaye N, Irungu E, Barnabas RV. Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review. J Acquir Immune Defic Syndr. 2019;82 Suppl 3(Suppl 3):S339-s47.
- Forsythe S, Lee B, Tarimo K, Silvan B, Balampama M, Chitty J, et al. HIV treatment support services in Tanzania: a cost and efficiency analysis at facility and community levels. Afr J AIDS Res. 2019;18(4):306-14.
- Shade SB, Osmand T, Luo A, Aine R, Assurah E, Mwebaza B, et al. Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the SEARCH Studys. AIDS. 2018 Sep 24;32(15):2179-2188. doi: 10.1097/QAD.0000000000001958. PMID: 30134294; PMCID: PMC6143350.
- Barker C, Dutta A, Klein K. Can differentiated care models solve the crisis in HIV treatment financing? Analysis of prospects for 38 countries in sub-Saharan Africa. J Int AIDS Soc. 2017;20(Suppl 4):21648.
- Vaikath M, Khan S, Mafara E, Dlamini N, Dlamini P, Ndzinisa N, et al. Patient out of pocket expenditures for ART in Swaziland. CROI2017; Seattle, USA2017.
- Phillips AN, Cambiano V, Nakagawa F, Bansi-Matharu L, Sow PS, Ehrenkranz P, et al. Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. PLoS One. 2016;11(12):e0167654.
- Phillips A, Shroufi A, Vojnov L, Cohn J, Roberts T, Ellman T, et al. Sustainable HIV treatment in Africa through viral-load-informed differentiated care. Nature. 2015;528(7580):S68-76.
Other publications including pre-prints (not peer-reviewed) and protocols (studies underway)
- Ross J, Murenzi G, Hill S, Remera E, Ingabire C, Umwiza F, et al. Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study. BMJ open. 2021;11(4):e047443-e. doi: 10.1136/bmjopen-2020-047443. PubMed PMID: 33895720.
- Amstutz A, Lejone TI, Khesa L, Kopo M, Kao M, Muhairwe J, Bresser M, et al. Offering ART Refill Through Community Health Workers Versus Clinic-Based Follow-Up After Home-Based Same-Day ART Initiation: The VIBRA Cluster-Randomised Clinical Trial. 2021. Available at SSRN: https://ssrn.com/abstract=3824772 or http://dx.doi.org/10.2139/ssrn.3824772
- Huber A, Pascoe S, Nichols BE, Long L, Kuchukhidze S, Phiri B, et al. Differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: A landscape analysis. medRxiv. 2020:2020.08.25.20181818.
- Ssempijja V, Nason M, Nakigozi G, Ndyanabo A, Gray R, Wawer M, et al. Adaptive Viral Load Monitoring Frequency to Facilitate Differentiated Care: A Modeling Study From Rakai, Uganda. Clin Infect Dis. 2020;71(4):1017-21.
- Amstutz A, Lejone TI, Khesa L, Muhairwe J, Nsakala BL, Tlali K, et al. VIBRA trial – Effect of village-based refill of ART following home-based same-day ART initiation vs clinic-based ART refill on viral suppression among individuals living with HIV: protocol of a cluster-randomized clinical trial in rural Lesotho. Trials. 2019;20(1):522.
- Hoffman R, Bardon A, Rosen S, Fox M, Kalua T, Xulu T, et al. Varying intervals of antiretroviral medication dispensing to improve outcomes for HIV patients (The INTERVAL Study): study protocol for a randomized controlled trial. Trials. 2017;18(1):476
- Mutasa-Apollo T, Ford N, Wiens M, Socias ME, Negussie E, Wu P, et al. Effect of frequency of clinic visits and medication pick-up on antiretroviral treatment outcomes: a systematic literature review and meta-analysis. J Int AIDS Soc. 2017;20(Suppl 4):21647
- Ssonko C, Gonzalez L, Mesic A, da Fonseca MS, Achar J, Safar N, et al. Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs. J Int AIDS Soc. 2017;20(Suppl 4):21654.