Differentiated Service Delivery (DSD)

MISSION: To increase the scale up of differentiated service delivery to improve access to and quality of prevention, testing, treatment and care services for people living with and vulnerable to HIV.

Current models of providing HIV services for prevention, testing, care and treatment are being stretched to the limit. To reach the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets by 2020 and 95-95-95 targets by 2030, differentiated approaches are needed to meet the diverse needs and expectations of all people living with HIV (PLHIV). Differentiated service delivery (DSD has been defined as “a client-centred approach that simplifies and adapts HIV services across the cascade, in ways that both serve the needs of PLHIV better and reduce unnecessary burdens on the health system”. The IAS Differentiated Service Delivery initiative, previously called the Differentiated Care initiative, is committed to supporting the scale up of DSD through catalysing country and community advocacy and amplifying global best practices, tools and evidence to effectively reach the 37 million people worldwide in need of high-quality life-saving HIV care.

A key component of this work is www.differentiatedservicedelivery.org – the “go-to” resource for implementing quality client-centred care. To highlight latest research, new innovative tools and upcoming events, the initiative publishes a regular www.differentiatedcare.org newsletter. Click here to sign up.

Learn more about the Differentiated Service Delivery Technical Working Group, the Technical Working Group on Differentiated HIV Testing Services and the Technical Working Group on Differentiated Service Delivery for Key Populations.



Extending the platform to support enabling policies for differentiated service delivery

The IAS DSD initiative is committed to developing resources to support implementation and scale up in countries. To support this vision, the initiative works with stakeholders to develop a range of thematic decision frameworks. The first decision framework focused on differentiated ART delivery, particularly for clinically stable adults. The second decision framework drew purposeful attention to children, adolescents and pregnant and breastfeeding women and differentiated ART delivery. The third decision framework set out a comprehensive understanding of differentiated ART delivery for key populations including men who have sex with men, people who inject drugs, sex workers and transgender people.  The fourth decision framework highlighted how the principles of DSD may support a systematic approach to reaching the remaining people living with HIV who do not know their status considering the core components of mobilizing, testing and linking to prevention and/or treatment.

To support differentiated ART delivery in West and Central Africa, the IAS DSD initiative launched two documents in May 2019. The first is a supplement to the first Decision Framework, outlining how to prioritize differentiated ART delivery scale up in West and Central and with examples from the region. The second document is a brief, outlining five priority actions for differentiated ART delivery in West and Central Africa.

Collaborating with decision makers

The DSD initiative collaborates with a diverse range of partners in the global AIDS response to advance the incorporation of DSD models into HIV programming. This includes co-convening international, regional and in-country consultations. The initiative convenes a series of global Technical Working Groups with members from normative agencies, donors, networks of people living with HIV and implementers.

Supporting national guidelines and guidance

The DSD initiative works with countries to incorporate enabling policies for DSD into their national guidance. Recent collaborations include working with ministries of health in Zimbabwe, Swaziland and Tanzania. The initiative’s work has also been referenced in guidance and informational documents from PEPFAR, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and USAID.

Featured work:

Launching Prioritizing differentiated ART delivery for clinically stable clients in West and Central Africa: A supplement to A Decision Framework for antiretroviral therapy delivery
This supplement highlights how to implement differentiated ART delivery in West and Central Africa. It provides an overview of the principles of differentiated service delivery, guidance on how to prioritize differentiated ART delivery in West and Central Africa and case studies from the region, illustrating differentiated ART delivery in action.

Read more in EN | FR

Advocating for differentiated ART delivery in West and Central Africa
In May 2019, a brief titled Prioritizing differentiated ART delivery to fast track reaching HIV targets in West and Central Africa was launched at INTEREST 2019, outlining five priority actions for differentiated ART delivery in West and Central Africa.

Read more in EN | FR


Promoting latest best practice

The DSD initiative advocates for research that evaluates promising service delivery models, strategies to facilitate increased uptake of services, and implementation science. To promote access to the latest best practices and other key publications in the field, the initiative has developed www.differentiatedservicedelivery.org – the “go-to” resource for implementers as they work to provide quality client-centred care.

Amplifying evidence

To support the rapid adoption and implementation of research on DSD, a summary of published evidence from both peer-reviewed journals and conference proceedings is curated and available at www.differentiatedservicedelivery.org

Featured work:

Outlining the priority research agenda for differentiated service delivery
In March 2019, the IAS convened a one-day think tank discussion, bringing together 30 global health leaders to consider and determine the critical unanswered questions around HIV differentiated service delivery.

Read the think tank report

Technical consultation on HIV linkage - Meeting report
This meeting report summarizes the key outcomes from a one-day technical consultation on HIV linkage, convened by the International AIDS Society in Seattle, USA, on 3 March 2019.

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Enabling community mobilization and demand creation

Empowering people living with, affected by and at risk of acquiring HIV is critical to achieving and sustaining high-quality services. To that end, the IAS has partnered with the AIDS Rights Alliance of Southern Africa (ARASA) and the International Treatment Preparedness Coalition (ITPC) to initiate a series of efforts to support community monitoring and mobilization and demand creation. This has included work in five countries in sub-Saharan Africa and resulted in the developmen of a toolkit to support demand creation.

Building Youth Champions

Young people living with HIV face a number of unique challenges in effectively accessing and utilizing HIV services, including treatment. To develop a better understanding of how treatment for young people can be best delivered, the IAS appointed five Differentiated Care Youth Champions, one in each of the following countries: Kenya, Malawi, South Africa, Tanzania and Zimbabwe. Each Youth Champion worked within an organization that provides HIV care services, including civil society and networks of people living with HIV.

Featured work:

Supporting demand creation within communitities and for adolescents and young people
With support from the IAS, ITPC and ARASA have launched a new chapter of the Activist Toolkit on Differentiated Service Delivery “What works for us – Youth-led advocacy for DSD”. Launched at the PATA 2018 Youth Summit in Dar es Salaam, Tanzania, the chapter builds on the toolkit on demand creation launched in 2017 and focusses on successful advocacy strategies to empower adolescents and young people to ask for what works for them.

Download the chapter What Works for Us – Youth-led Advocacy for DSD EN | FR
Download the toolkit, available in EN | FR

Engaging broad support to include children and adolescents
As part of a series of briefs prepared by the Child Survival Working Group, this brief advocates for an accelerated scale-up of differentiated service delivery for children and adolescents.

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Listening to what young people want
The five Differentiated Care Youth Champions worked with their organizations to engage a diverse group of young people living with HIV and to listen to their experiences, needs and expectations for receiving care. The key areas for action were summarized in a policy brief.

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