The CQUIN Learning Network

WHO Key Considerations &

the Decision Framework: DSD for adolescents

Anna Grimsrud, PhDInternational AIDS Society

October 25, 2017

Johannesburg, South Africa

It’s not about everybody getting the same thing, It’s about everybody

getting what they need in order to improve the quality of their situation.” C.Parker

Image : “Interaction Institute for Social Change | Artist: Angus Maguire.”

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Differentiated care,or differentiated service delivery (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.

Differentiated care is applicable across the HIV care continuum

Diversity of care needs for PLHIV

WHO 2016 Consolidated Guidelines.

The building blocks

Task shifting & task sharing

WHO 2016 guidelines6.11 Delivering HIV services to adolescents

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Elements of care are for ART refills, clinical consultations and psychosocial support

Doherty, M. IAS 2017. Symposia – Differentiated Service Delivery and Care.

Determining Stability(Annex 1)

Building blocks for adolescents (10-19 years)(Annex 4)

Clinical consultations ART refills Psycosocial support

WHEN Every 3-6 months Every 3-6 months 1-6 months

WHERE Primary careOutreach from primary health care

Primary careOut of facility

Primary careOut of facilityVirtual environment

WHO Nurses MidwivesClinical officersDoctors

Lay providers Lay providersPeers

WHAT Adolescent clinical consultation Mental health assessmentLaboratory testsRescript

ART Referral checkAdherence checkDisclosure process check-in

Peer group environmentReferral checkOnward disclosure support

Decision Framework

Health care worker-managed group

Youth Clubs, Youth Care Clubs in South Africa Community ART groups (CAGs)

Client-managed group

Fast track ART refill collection at facilitye.g. Teen Clubs in Malawi

Facility-based individual

• Mobile outreach• Fixed community ART refill distribution

• Home ART delivery

Out-of-facility individual

5-step approach to differentiated ART delivery

The three elements

The Decision Framework for ART delivery www.differentiatedcare.org

5-step approach to differentiated ART delivery

Adaption existing differentiated model:South Africa adult adherence club model

Adaption case studies:South Africa adult adherence club model

Adapt existing peer support/psychosocial intervention:Zimbabwe adolescent refill groups

• An example of a health care worker-managed group

• Leverages existing model of psychosocial support *More frequent psychosocial support provided as required

5-step approach to differentiated ART delivery

Example: When building block

1. 2017 WHO Key Considerations:

2. What to plan:

3. Specific considerations for each population

Description

Building blocks

Elements

90 90 90 targets

81% 73%

Current status –How are we doing

http://www.unaids.org/en/resources/infographics/measures-progress-909090

Current status –How are we ACTUALLY doing

http://www.unaids.org/en/resources/infographics/measures-progress-909090

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Online knowledge repository

www.differentiatedcare.org• Global and country guidance

• ART delivery model examples & tools • Published evidence & resources

Resource hyperlinks

• www.differentiatedcare.org• Key considerations for differentiated antiretroviral therapy delivery for

specific populations: Children, adolescents, pregnant and breastfeeding women and key populations

• Differentiated care for HIV: A Decision Framework for ART delivery for children, adolescents and pregnant and breastfeeding women– English / French / Portuguese

• Policy brief – Young lives, new solutions – English / French

• #IASYouthVoices Differentiated Care films– What is differentiated care?– The power of peers– The difference is in delivery– The need for youth engagement

• Email differentiatedcare@iasociety.org for more details

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