WHO Key Considerations & the Decision Framework: DSD for...
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The CQUIN Learning Network
WHO Key Considerations &
the Decision Framework: DSD for adolescents
Anna Grimsrud, PhDInternational AIDS Society
October 25, 2017
Johannesburg, South Africa
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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.
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Differentiated care is applicable across the HIV care continuum
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Diversity of care needs for PLHIV
WHO 2016 Consolidated Guidelines.
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The building blocks
Task shifting & task sharing
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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.
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Determining Stability(Annex 1)
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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
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Decision Framework
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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
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5-step approach to differentiated ART delivery
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The three elements
The Decision Framework for ART delivery www.differentiatedcare.org
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5-step approach to differentiated ART delivery
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Adaption existing differentiated model:South Africa adult adherence club model
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Adaption case studies:South Africa adult adherence club model
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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
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5-step approach to differentiated ART delivery
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Example: When building block
1. 2017 WHO Key Considerations:
2. What to plan:
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3. Specific considerations for each population
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Description
Building blocks
Elements
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90 90 90 targets
81% 73%
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Current status –How are we doing
http://www.unaids.org/en/resources/infographics/measures-progress-909090
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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
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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 [email protected] for more details
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