Ruanne Barnabas, Associate Professor in Global Health and Medicine at the University of Washington
Differentiated care was highlighted at the 9th IAS Conference on HIV Science (IAS 2017), not only in specific sessions but also throughout the meeting. This is as HIV care moves from a crisis response to sustainable client-centred treatment for life. Two highlights for me were: 1) seeing differentiated care innovations responsive to communities and clients’ expectations; and 2) implementation science studies that will provide evidence on differentiated service delivery strategies that work.
The Journal of the International AIDS Society supplement on Differentiated Care & HIV, released at IAS 2017, featured studies that introduced differentiated care strategies to reach people living with HIV at every step of the HIV care continuum – from increasing testing coverage through community health extension workers in Uganda to models of care for post-partum women in Cape Town which sustain ART adherence after delivery.
Dr Wafaa El Sadr’s plenary highlighted the evolution of differentiated care from initial broad strokes to improve care for all, such as multi-month delivery, to precision public health. New interventions address the expectations and needs of clients, such as integrating opioid substitution therapy with ART initiation, monitoring, and resupply, and fast-tracking paediatric clients to improve health outcomes.
Innovation was evident at the Differentiated Service Delivery and Care: Key Considerations for Successful Scale-up Symposium which highlighted the World Health Organization’s guidance on streamlining services, decentralization and task shifting to reach key populations. How to measure impact took centre stage at the Implementation Science: NIH Priorities and Funded Examples Workshop where presenters discussed how measuring the impact on health and the cost of interventions could become routine using improved data systems for health records with clear plans for data analysis.
Closing the gap from evaluation to implementation is key to maintain the momentum towards the UNAIDS 90-90-90 goals. Key gaps for differentiated service delivery include strategies to reach key populations for HIV care, the effectiveness of accelerated ART initiation, the impact of integrated services on health outcomes, strategies to re-engage clients lost-to-follow-up and the economic outcomes of new health interventions. For the 22nd International AIDS Conference (AIDS 2018) and 10th International AIDS Society Conference on HIV Science (IAS 2019), I’m excited that we’ll hear more about how we assess the impact of differentiated care, re-engineer services and meet the expectations of clients – science at its best.
