Differentiated Service Delivery (DSD)

MISSION: To increase the scale up of differentiated service delivery to improve access to and quality of prevention, testing, treatment and care services for people living with and vulnerable to HIV.

Current models of providing HIV services for prevention, testing, care and treatment are being stretched to the limit. To reach the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets by 2020 and 95-95-95 targets by 2030, differentiated approaches are needed to meet the diverse needs and expectations of all people living with HIV (PLHIV). Differentiated service delivery (DSD has been defined as “a client-centred approach that simplifies and adapts HIV services across the cascade, in ways that both serve the needs of PLHIV better and reduce unnecessary burdens on the health system”. The IAS Differentiated Service Delivery initiative, previously called the Differentiated Care initiative, is committed to supporting the scale up of DSD through catalysing country and community advocacy and amplifying global best practices, tools and evidence to effectively reach the 37 million people worldwide in need of high-quality life-saving HIV care.

A key component of this work is www.differentiatedservicedelivery.org – the “go-to” resource for implementing quality client-centred care. To highlight latest research, new innovative tools and upcoming events, the initiative publishes a regular www.differentiatedcare.org newsletter. Click here to sign up.

Learn more about the Differentiated Service Delivery Technical Working Group, the Technical Working Group on Differentiated HIV Testing Services and the Technical Working Group on Differentiated Service Delivery for Key Populations.

 


POLICY

Extending the platform to support enabling policies for differentiated service delivery

The IAS DSD initiative is committed to developing resources to support implementation and scale up in countries. To support this vision, the initiative works with stakeholders to develop a range of thematic decision frameworks. The first decision framework focused on differentiated ART delivery, particularly for clinically stable adults. The second decision framework drew purposeful attention to children, adolescents and pregnant and breastfeeding women and differentiated ART delivery. The third decision framework set out a comprehensive understanding of differentiated ART delivery for key populations including men who have sex with men, people who inject drugs, sex workers and transgender people.  The fourth decision framework highlighted how the principles of DSD may support a systematic approach to reaching the remaining people living with HIV who do not know their status considering the core components of mobilizing, testing and linking to prevention and/or treatment.

Collaborating with decision makers

The DSD initiative collaborates with a diverse range of partners in the global AIDS response to advance the incorporation of DSD models into HIV programming. This includes co-convening international, regional and in-country consultations. The initiative convenes a series of global Technical Working Groups with members from normative agencies, donors, networks of people living with HIV and implementers.

Supporting national guidelines and guidance

The DSD initiative works with countries to incorporate enabling policies for DSD into their national guidance. Recent collaborations include working with ministries of health in Zimbabwe, Swaziland and Tanzania. The initiative’s work has also been referenced in guidance and informational documents from PEPFAR, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and USAID.

Featured work:

Launching Differentiated service delivery for HIV: A decision framework for differentiated ART delivery for key populations
A decision framework for differentiated ART delivery for key populations advocates that key populations including men who have sex with men, people who inject drugs, sex workers and transgender people can also benefit from access to differentiated ART delivery. This is the third in the Decision Framework series.

Read more in EN | FR | POR

Producing Differentiated service delivery for HIV: A decision framework for HIV testing services.
A decision framework for HIV testing services highlights how the principles of DSD may support a systematic approach to reaching the remaining people living with HIV who do not know their status considering the core components of mobilizing, testing and linking to prevention and/or treatment. This is the fourth of the Decision Framework series.

Read more in EN | FR | POR


RESEARCH

Promoting latest best practice

The DSD initiative advocates for research that evaluates promising service delivery models, strategies to facilitate increased uptake of services, and implementation science. To promote access to the latest best practices and other key publications in the field, the initiative has developed www.differentiatedservicedelivery.org – the “go-to” resource for implementers as they work to provide quality client-centred care.

Amplifying evidence

To support the rapid adoption and implementation of research on DSD, a summary of published evidence from both peer-reviewed journals and conference proceedings is curated and available at www.differentiatedservicedelivery.org

Featured work:

Raising the profile of DSD
Launched at AIDS 2018, the IAS-Lancet Commission presented key recommendations on advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals and emphasized the role of DSD for both HIV and other diseases.

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Advocating for family-centred DSD
This commentary, published as part of a supplement in Journal of Acquired Immune Deficiency Syndrome (JAIDS), makes the case for family-centred DSD for HIV.

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STRUCTURAL BARRIERS

Enabling community mobilization and demand creation

Empowering people living with, affected by and at risk of acquiring HIV is critical to achieving and sustaining high-quality services. To that end, the IAS has partnered with the AIDS Rights Alliance of Southern Africa (ARASA) and the International Treatment Preparedness Coalition (ITPC) to initiate a series of efforts to support community monitoring and mobilization and demand creation. This has included work in five countries in sub-Saharan Africa and resulted in the developmen of a toolkit to support demand creation.

Building Youth Champions

Young people living with HIV face a number of unique challenges in effectively accessing and utilizing HIV services, including treatment. To develop a better understanding of how treatment for young people can be best delivered, the IAS appointed five Differentiated Care Youth Champions, one in each of the following countries: Kenya, Malawi, South Africa, Tanzania and Zimbabwe. Each Youth Champion worked within an organization that provides HIV care services, including civil society and networks of people living with HIV.

Featured work:

Supporting demand creation within communities
With support from the IAS, the International Treatment Preparedness Coalition (ITPC) and the AIDS and Rights Alliance for Southern Africa (ARASA) partnered to produce “What works for me: Activist toolkit on differentiated service delivery”. Launched at the 19th International Conference on AIDS and STIs in Africa (ICASA 2017) in Abidjan, Côte d’Ivoire, the toolkit is aimed at strengthening the engagement of people living with HIV and demand for differentiated ART delivery.

Download the chapter What Works for Us – Youth-led Advocacy for DSD
Download the toolkit, available in EN | FR

Engaging broad support to include children and adolescents
As part of a series of briefs prepared by the Child Survival Working Group, this brief advocates for an accelerated scale-up of differentiated service delivery for children and adolescents.

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Listening to what young people want
The five Differentiated Care Youth Champions worked with their organizations to engage a diverse group of young people living with HIV and to listen to their experiences, needs and expectations for receiving care. The key areas for action were summarized in a policy brief.

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