Reframing HIV Care: Putting People at the Centre of Antiretroviral Delivery

The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. 

Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. 

The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programs expand treatment eligibility, many people entering care will not be ‘patients’ but healthy, active and productive members of society ¹. 

To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation.

Problem statements
1. The scale-up of ART in low- and middle-income countries has led to overburdened health systems
•HIV clinics are overcrowded and waiting times are long
•Many countries lack sufficient clinical personnel to treat the increasing numbers of patients eligible for ART
•Health systems are geared to acute disease response rather than to providing chronic care
2. The needs of people who are stable on and adherent to ART are different to those of people who are unwell or non-adherent
•Current models of care are not patient-centered
•People with widely divergent needs have only one access point to the clinic to receive care
•Stable people do not need regular contact with the healthcare facility
3. Alternative care models implemented in resource-limited settings have not been taken to scale
•There are limited robust measures of impact and outcomes of alternative delivery frameworks

Below:  Four levers to tailor or adapt care to people’s needs (service frequency, location, intensity and cadre)

Below:  Categories of care models

Full article at:   http://goo.gl/5LxyOE

By:   Chris Duncombe,1 Scott Rosenblum,1 Nicholas Hellmann,2 Charles Holmes,3 Lynne Wilkinson,4 Marc Biot,4 Helen Bygrave,4 David Hoos,5 and Geoff Garnett1

¹The Bill and Melinda Gates Foundation, Seattle, WA, USA

²Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C, USA

³Centre for Infectious Disease Research in Zambia, Lusaka, Zambia

⁴Medecins Sans Frontieres Operational Centre, Brussels, Belgium

⁵Mailman School of Public Health, Columbia University, New York, NY, USA

Corresponding Author Chris James Duncombe, Bill and Melinda Gates Foundation, 440 5th Ave North, Seattle, Washington, 98109. E-mail:gro.noitadnuofsetag@ebmocnuD.sirhC

 

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