HIV is a major public health problem in Zambia. HIV treatment became available in 2004 in the public sector, while the last decade has seen successful scaling-up of antiretroviral therapy (ART) services resulting in over 700,000 adults and children accessing HIV care and treatment services in Zambia. However, this scale-up has caused a strain on the health system, threatening the quality of care and crowding out other services.
To help address this challenge, the World Health Organization (WHO) developed guidelines in 2015 highlighting the need for Differentiated Care Frameworks with variations in service frequency, health worker cadre, service location and service intensity across countries and populations. In Zambia, the Ministry of Health has contextualized this and authorized implementing partners such as CIDRZ to pilot different models of community-based ART service delivery.
With support from the Bill & Melinda Gates Foundation, CIDRZ has been implementing four Differentiated Service Delivery (DSD) models: Community Adherence Groups (CAGs), Urban Adherence Groups (UAGs), FastTrack and Streamline ART Initiation (START), under the Community ART for Retention in Zambia study.
The objectives of the Community ART study were:
- To determine the acceptability, appropriateness, and feasibility of a differentiated care system in Zambia
- To evaluate the effectiveness, efficiency, and healthcare quality of a differentiated care system that includes targeted models of care
- To develop a “methodologic” toolkit for assessment of local needs and preferences and for implementation during scale-up of differentiated care models in this and in other contexts
To share lessons learnt and recommendations from implementing these models, CIDRZ conducted a five-day meeting with other organisations that have been implementing similar models. Among them, the University of Maryland gave an update on the Community HIV Epidemic Control (CHEC) model. Other organisations that participated are the Zambian Ministry of Health, Zambart, National AIDS Council, and the USAID EQUIP Project.
The meeting was aimed at learning lessons about the most applicable model in the Zambian context and how such a model will inform the revision to the National HIV Policy to include community-based ART service delivery as a major component of service delivery for stable HIV-infected patients in Zambia.
CIDRZ provided an outline of an Online Toolkit being developed which will capture the CIDRZ experience of implementing DSD and provide resources to assist future implementers as well as how to assess DSD models.
During the meeting, participants analyzed the different models presented and discussed the advantages, disadvantages and provided recommendations for adaptation for possible scale-up. The meeting also looked at the required indicators for reporting by partners implementing DSD and for tracking by the Ministry of Health.
Participants agreed to incorporate DSD into the National HIV policy and , and drafted a road map to manage takeholder expectations, communicate plans and coordinate the consolidated HIV treatment guidelines, and finalized the monthly reporting tool for DSD Indicators for implementers.