Reflections on IAS 2025 from a DSD perspective (Sept 2025)
By Emmah Owidi, Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
The science presented at IAS 2025, the 13th IAS Conference on HIV Science, underscored the central role of DSD in achieving more person-centred, efficient and sustainable HIV programmes.
A major takeaway was that DSD presents a timely opportunity to sustain HIV service delivery while promoting health system resilience in the rapidly changing global funding environment. Discussions emphasized that tailoring services to client needs – whether for people living with HIV, key populations or people seeking HIV prevention – should now be the default.
The IAS-organized satellite, “Building forward: Differentiated service delivery as a catalyst for sustained and integrated HIV services amid funding uncertainty”, emphasized the urgency for governments to embed DSD principles into national programmes and guidelines, and scale them up across communities in response to declining donor support. Presenters from the ministries of health in Zambia, Uganda and Malawi shared the impact of funding cuts on HIV programming and lessons learnt from defining a minimum package of care.
The session launching the JIAS supplement, “Differentiated service delivery – beyond HIV treatment for integration and other health needs”, highlighted the need for expansion of DSD models beyond HIV treatment. Other sessions showcased service integration models, including HIV self-testing in PrEP, HIV diagnosis and treatment. Zambia’s experience in decentralizing viral load testing through community collection points was presented as a DSD model for improving service access while maintaining quality. Sessions looked at growing evidence for integrating HIV treatment and prevention into services for other health conditions including sexual and reproductive health, tuberculosis, mental health and diabetes care to reduce access barriers.
Sessions also focused on expanding PrEP choice through implementing and scaling up new long-acting prevention tools and adapting DSD strategies for priority populations. Innovative community-led approaches showed promise in promoting equity by reaching populations often missed by traditional clinic-based services. Among these presented approaches were HIV stigma reduction and enhancing prevention and care, community-led monitoring, adherence groups for men in Kenya, and mobile outreach in refugee camps in Uganda (watch session).
Artificial intelligence and other digital health tools, such as mobile platforms for appointment reminders, digital TB diagnostics and adherence monitoring, and online PrEP delivery, were further showcased as essential for supporting self-care, service continuation and quality, and medication adherence. However, equity concerns, including ethics and access for people without smartphones, were noted as key barriers to digital rollouts. Policy makers were urged to institutionalize DSD models within universal health coverage frameworks to ensure sustainability beyond donor funding cycles.
The message from IAS 2025 is clear: DSD is a key pillar of healthcare that prioritizes choice, convenience and quality for clients while maximizing health system efficiency. The current challenge is to accelerate implementation, close equity gaps and ensure that every person benefits from truly differentiated, person-centred care.
