Consultation on HIV differentiated service delivery models for specific populations and settings: Pregnant and breastfeeding women, children, adolescents and key populations

Meeting report - 16–18 November 2016
Geneva, Switzerland


There is growing support for differentiated service delivery (DSD) of HIV care as a way to increase service efficiencies and impact. DSD is a client-centred approach that simplifies and adapts HIV services across the cascade to reflect the preferences and expectations of various groups of people living with HIV (PLHIV) while reducing unnecessary burdens on the health system. DSD is promoted by the latest World Health Organization (WHO) guidelines for preventing and treating HIV infection [1].

In addition, a number of countries in sub-Saharan Africa have incorporated DSD into their national guidelines; these include South Africa, Swaziland and Zimbabwe. Major donors, including the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund, have promoted the adoption of DSD models in a number of countries, in particular through targeted support to roll out reduced frequency of clinic visits and longer antiretroviral therapy (ART) refills (multi-month prescribing).

Most evidence in support of DSD to date comes from pilot programmes for delivering ART to stable, non-pregnant adults in high-burden countries in sub-Saharan Africa. WHO guidelines do not limit recommendations relating to DSD to this group.

However, experience in implementation of recommendations of task shifting and decentralization suggests that additional guidance and attention is required for specific populations and settings. Specifically, the needs of certain populations must be considered to ensure they also benefit from service adaptations; among these populations are pregnant and breastfeeding women, adolescents and children, and key populations, including men who have sex with men (MSM), sex workers, people who inject drugs, transgender (TG) people and people in prisons and other closed settings.

[1]: World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. WHO, Geneva: 2nd Edition. 2016.