Differentiated Service Delivery in HIV Care
Summary
Differentiated Service Delivery (DSD) in HIV care encompasses a suite of client-centred approaches that adapt the location, frequency and cadre of service provision to the needs and clinical status of people living with HIV. Moving beyond a one-size-fits-all model, DSD stratifies patients into groups such as newly initiating, clinically stable or unstable, and those with co-morbidities. Stable patients may access multi-month prescriptions, fast-track refills or peer-led community groups, reducing clinic congestion and patient travel costs. Vulnerable or key populations benefit from outreach delivery, safe-space clinics and peer navigation. Integration of HIV services with non-communicable disease care or maternal health services offers streamlined monitoring and medication delivery. By aligning health-system resources with patient demand, DSD strengthens retention, promotes sustained viral suppression and addresses disparities in access—particularly among men, rural populations and marginalised groups. Implementation requires robust supply chains, routine monitoring of outcomes, supportive policy frameworks and community engagement. As countries strive towards universal treatment coverage and epidemic control, DSD models are instrumental in enhancing the quality, efficiency and resilience of HIV programmes worldwide.
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Differentiated Service Delivery in HIV Care publication trend
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Technical terms
Differentiated Service Delivery (DSD): A patient-centred framework that tailors HIV service intensity, location and frequency to clinical status and individual needs.
Antiretroviral Therapy (ART): The combination of medicines used to suppress HIV replication and maintain immune function.
Viral suppression: Reduction of HIV RNA in the blood to levels undetectable by standard tests, indicating effective ART.
Key populations: Groups at elevated risk of HIV infection (for example, sex workers, men who have sex with men, people who inject drugs) who may face stigma or legal barriers to care.
Decentralised drug distribution: The provision of medications outside traditional clinical settings, often through community pickup points or mobile outreach.
References
- The cyclical cascade of HIV care: Temporal care engagement trends within a population-wide cohort. PLOS Medicine (2024).
- Person‐centred, integrated non‐communicable disease and HIV decentralized drug distribution in Eswatini and South Africa: outcomes and challenges. Journal of the International AIDS Society (2023).
- Community-based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): a randomised trial. The Lancet Global Health (2020).
- Multi‐month prescriptions, fast‐track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals. Journal of the International AIDS Society (2017).
- A call for differentiated approaches to delivering HIV services to key populations. Journal of the International AIDS Society (2017).
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