While most countries have embraced efforts to end AIDS by 2020 through achievement of the global 90-90-90 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS), implementing the most effective strategies is challenging and places a significant burden on health systems. Although nations and their development partners are scaling up efforts to end HIV and AIDS, international and domestic funding is not increasing proportionately. Innovative strategies must be created and used to sustain health systems, support clients and ensure that clients stay in treatment over the long term.

One such strategy is known as differentiated models of care — service delivery that is tailored to the unique needs of client subgroups across the continuum of prevention, care and treatment. This approach fosters efficiency at the health facility and community levels, allowing quality of care to be maintained with existing human and financial resources. It also makes obtaining services easier and more convenient for clients, which promotes their uptake of and retention in those services.

FHI 360 is applying the differentiated models of care approach to its programs in Africa to improve service delivery to specific groups of people, including key populations (men who have sex with men, sex workers, transgender people and people who inject drugs), pregnant women, orphans and vulnerable children, and youth.

Differentiated models of care provide people with options around each of these four client-centered building blocks (see infographic):

• When medication is collected or delivered
• Where care and treatment are obtained
• Who delivers the services
• Which services are needed

FHI 360 programs build on these four blocks and take a holistic approach to management of HIV care. Our approach addresses all aspects of service delivery along the continuum of care, such as antiretroviral therapy (ART) refills and laboratory services, to better meet the needs of clients. FHI 360 has conducted formative research with key stakeholders, including clients, policymakers and health care providers, to plan and implement tailored differentiated models of care for subgroups of clients.

The subgroups fall into these clinical characteristics: new clients who are in the “transition pool,” those who are stable on ART, those who are not stable on ART, those who are adherent and those who are not adherent. The transition pool refers to individuals who require preparation before initiating ART to facilitate their rapid transition into care. Special populations, such as children and adolescents, are important subgroups that also require tailored interventions.

The following examples show how FHI 360 is implementing differentiated models of care to address the needs of specific client subgroups.

In Nigeria, FHI 360 developed an innovative adherence support calendar for new clients in the transition pool. Trained staff use the calendar to call or visit new clients to provide assistance and adherence reinforcement. We found that this type of intensified adherence support, carried out at the facility and community level by lay workers, pharmacists and adherence counselors, is necessary for clients in the first month on ART. Preliminary results show that the first month retention rate increased from 58 percent to 97 percent after the introduction of the intensified adherence support.

At the Moatize Health Center in Mozambique, nearly one-third of clients who are stable on ART receive the rapid flow package of services. Rapid flow allows each client in this subgroup to get a six-month prescription of ART, with monthly refills. The clients are required to visit the clinic only for consultation and laboratory monitoring every six months. They can get their refills from community pharmacies and need to attend consultation only twice a year, which reduces the burden on clients and facilitates retention in treatment.

In Kenya’s Rift Valley region, FHI 360 uses differentiated models of care to better reach and serve adolescents with HIV. Facility-based, tailored services are delivered to this subgroup, including the establishment of youth-friendly centers, the dedication of specific clinic days for adolescents, the employment of specially trained health care workers and the creation of adolescent spaces within clinics. In addition, weekend adolescent clinics provide refills, separate group counseling sessions for parents and adolescents, and other services that address adolescents’ clinical or psychosocial needs.

Differentiated models of care are yielding promising results, and FHI 360’s experience demonstrates that existing structures and resources can be leveraged to provide population-specific care and support. More remains to be done, but consistent sharing of best practices and lessons learned will be critical to achieving the 90-90-90 targets.

For more on differentiated models of care, visit FHI 360’s online synopsis.

---

Photo credit: Jessica Scranton/FHI 360