Coverage of differentiated service delivery antiretroviral therapy models among people living with HIV currently on antiretroviral therapy
Export Indicator
This indicator measures the rollout and implementation of DSD models of antiretroviral therapy during the reporting period.
WHO recommends DSD models of care for eligible people, including those established on antiretroviral therapy, to ensure care meets the diversity of needs of people living with HIV. This indicator measures the proportion of people on treatment receiving DSD antiretroviral therapy models of care—and, if feasible, whether people eligible for DSD antiretroviral therapy are receiving such services.
DSD for HIV treatment aims to improve retention in care and viral suppression by optimizing models of treatment and care delivery to improve client experience and health outcomes and leverage resources towards improving programmatic efficiency.
DSD models for HIV treatment can be broadly classified into four categories: group models managed by health-care workers; group models managed by clients; individual models based at facilities; and individual models not based at facilities. Within these four categories, many adaptations can be made to provide person-centred services to meet the distinct and evolving needs of people from specific populations, such as people receiving second- or third-line regimens, people with controlled comorbidities, people from key populations, pregnant women, children and adolescents.
Examples of DSD antiretroviral therapy models include multimonth dispensing of antiretroviral medicines, fast-track antiretroviral medicine refills, facility adherence groups, community antiretroviral therapy distribution points, client antiretroviral therapy groups, antiretroviral therapy groups led by community health workers or peer educators, and advanced HIV disease care packages.
A wide range of DSD antiretroviral therapy models have been developed by countries adapted to different contexts and populations. A multitude of DSD models are being implemented within this evolving programme area. Regardless of which DSD antiretroviral therapy models are adopted, it is important to assess coverage to scale up services and strengthen implementation.
Number of people living with HIV enrolled in DSD antiretroviral therapy models during the reporting period.
A. Number of people living with HIV receiving antiretroviral therapy at the end of the reporting period.
B. Number of people living with HIV on antiretroviral therapy eligible for DSD antiretroviral therapy models (for countries that are able to report).(Eligibility for DSD of antiretroviral therapy as defined in national guidelines)
Numerator / denominator A
Numerator / denominator B (for countries that are able to report)
Patient monitoring tools (electronic or paper), such as antiretroviral therapy registers or electronic medical records.
Coverage measures all people living with HIV currently enrolled in DSD antiretroviral therapy models, including those newly enrolled and those enrolled in previous reporting periods.
DSD is a person-centred approach that simplifies and adapts HIV services across the cascade in ways that serve the needs of people living with or vulnerable to HIV and optimize available resources in the health system.
DSD for HIV treatment should consider clinical needs and adapt services for people with advanced HIV disease and high viral load, for specific populations and for contextual settings. DSD for HIV treatment is based on four building blocks: when (frequency), where (location), what (type/package) and who (provider). In any given DSD model for HIV treatment, the building blocks should be defined separately for clinical consultations, antiretroviral therapy refills and psychosocial support.
Multimonth dispensing of antiretroviral medicines refers to the provision of multiple months’ supply of antiretroviral medicines or other medicines at a single time point. Multimonth dispensing is frequently offered as a component of differentiated service delivery. WHO recommends that people who are established on antiretroviral therapy should be offered antiretroviral medicine refills lasting 3–6 months (preferably 6 months).
The criteria for determining that a person is successfully established on antiretroviral therapy are:
- Receiving antiretroviral therapy for at least 6 months.
- No current illness (not including well-controlled chronic health conditions).
- Good understanding of lifelong adherence, with adequate adherence counselling provided.
- Evidence of treatment success, with at least one suppressed viral load result within the past 6 months (if viral load is not available, CD4 count >200 cells/mm3 for adults or >350 cells/mm3 for children aged 3–5 years, weight gain, and absence of symptoms and concurrent infections).
The definition of being established on antiretroviral therapy should be applied to people from all populations, including people receiving second- and third-line regimens, people with controlled comorbidities, children, adolescents, pregnant or breastfeeding women, and people from key populations.
Annually.
- Gender (female, male, other) (“Other” includes transgender and gender-diverse people who choose an identity other than male or female)
- Age (0–14 years, ≥15 years).
Please include any information on sustained changes in national guidance on dispensing frequency that is related to COVID-19 in the narrative report.
This indicator monitors trends in the coverage of DSD of HIV treatment in a standardized and comparable way across countries and over time. It does not measure the quality of services, impact on treatment outcomes such as retention or viral suppression, or programmatic efficiencies such as reduced clinic visits or staff time.
The accuracy of the number of people enrolled in DSD antiretroviral therapy models will depend on the quality of the underlying reporting system and its ability to identify clients enrolled in DSD antiretroviral therapy models. Data quality challenges may lead to underreporting due to missing data or delays in reporting of facility data to the national level, or overreporting if clients are reported by both facilities and community or private settings.
Issues with linkages and flow of data between health facilities and community-delivered services may lead to delays in data transmission and underreporting. Countries should adapt monitoring tools such as antiretroviral therapy registers or electronic medical records to track and monitor clients enrolled in DSD antiretroviral therapy models at the service delivery and national levels.
Consolidated guidelines on person centred HIV strategic information: strengthening routine data for impact. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240055315, accessed 7 November 2023).
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/9789240031593, accessed 7 November 2023).