Differentiated ART services

Clinical description

• Different patient groups need different HIV services. Adapt the interval and range of services

to suit current needs of each patient.

• DSD can reduce the burden of unnecessary clinical visits, allowing health workers to spend

more time with unstable patients who need thorough review and management.

• DSD must be safe, feasible, cost-effective and have a clear benefit for patients and the health

system.

• A stable patient is defined as meeting all the following criteria:

o On the current ART regimen for 6 months+ without any significant side effects o No opportunistic infections o Latest VL was within the last 12 months and was suppressed (see Table 20 on page 92)

o Not pregnant or breastfeeding

• Offer approved MoH DSD models to all eligible patients but ensure they are returned to regular

clinical services if they become unstable.

o 3- or 6-months ART dispensing (See eligibility criteria below)

o Teen Clubs (see section 18.9.1 on page 89 for eligibility criteria)

o Outreach and mobile clinics delivered by a certified ART-provider o Drop-in-Centres for key and marginalised populations

• Unstable patients are defined as presence of any of the following:

o Latest VL result: low-level viraemia or viraemia 1000+ o Current WHO clinical stage 3 and 4 conditions o CD4 count of 200 and below in the last 6 months

• See sections 8.1 (page 22) and 18.10 (page 90) for management of patients at risk / with advanced

illness. Patient with advanced illness must be managed within the clinic settings.