By Khumbo Niyrenda, Partners in Hope, Malawi:
AIDS 2024 provided a critical platform for extensive discussions on the evolution of DSD, including its expansion beyond HIV-specific care towards a broader, person-centred healthcare model. The pre-conference “Differentiated service delivery beyond HIV treatment: Learnings from and for NCDs and family planning towards integrated DSD” set the stage for these discussions. Throughout the conference, presentations acknowledged health needs beyond HIV and explored the potential application of DSD principles to chronic care services for the general population.
A case study from Malawi showcased the integration of DSD principles with family planning services, highlighting the success of community-based distribution of contraceptives and the introduction of self-injectable options.
A satellite session organized by the IAS and WHO dug deep into the issues surrounding disengagement from HIV services and the role of DSD in facilitating continuous engagement in care. This session kicked off with the launch of the WHO policy brief on supporting re-engagement in HIV treatment services, emphasizing the “revolving door” nature of HIV care.
Zimbabwe’s presentation on its updated Operational and Service Delivery Manual highlighted the importance of taking differentiated, person-centred approaches to re-engagement. South Africa shared its experience in developing a re-engagement algorithm that differentiates care based on the duration of disengagement and clinical factors. Malawi offered a comprehensive look at the reasons for disengagement and re-engagement in HIV care, emphasizing the role of health system challenges, interpersonal factors and clinical reasons in treatment interruptions. Trials from Malawi demonstrated the critical role of positive healthcare worker-client interactions in supporting re-engagement.
A session on new strategies for optimizing person-centred care brought together several innovative approaches to HIV prevention and treatment. One abstract presented findings on less frequent PrEP monitoring (six vs. three monthly), suggesting that this approach could reduce total clinic visits without increasing sexually transmitted infection rates, potentially improving the efficiency of PrEP programmes. A study from Mozambique showed high rates of viral suppression (98%) and retention in care (98%) with six-month antiretroviral dispensing, providing strong support for wider implementation of this approach. The introduction of injectable PrEP (CAB-LA) was a hot topic, with a study from Zambia showing that it achieved similar one-month continuation rates (75.1%) to oral PrEP (74.5%) and could be successfully integrated into existing PrEP services.
This aligns with the conference’s emphasis on making long-acting injectables more available in high-burden regions, particularly in low- and middle-income countries, as a potential solution to address stigma-related barriers in HIV treatment.
Key enablers of DSD for HIV treatment were highlighted, including non-toxic regimens, simplified clinical guidance, reliable adherence measures (such as viral load monitoring) and cohort monitoring. These enablers not only support the success of DSD in HIV care, but also point to its potential adaptability to other health domains.
AIDS 2024 clearly showed that DSD has moved beyond its origins in HIV care to become a versatile approach for improving healthcare delivery across domains. The emphasis on flexible, non-judgemental and tailored approaches to care, whether in HIV or other health services, reflects a growing recognition of the need for person-centred models that can adapt to individual and community needs. As DSD continues to evolve, it promises to play a crucial role in improving access to care and health outcomes across a wide range of services and populations.
