Helen Bygrave1, Lina Golob1, Lynne Wilkinson2,3, Teri Roberts1, Anna Grimsrud2,4. 1. International AIDS Society, Geneva, Switzerland. 2. International AIDS Society. 3. Department of Public Health Medicine, School of Public Health and Family Medicine. 4. Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
Abstract
PURPOSE OF REVIEW: Differentiated service delivery (DSD) for HIV provides an approach to scaling services that are client-centred and aims to address client challenges whilst reducing the burden on health systems. With access to antiretroviral therapy, people living with HIV are living longer and increasingly present with comorbid conditions, such as hypertension and diabetes. This review presents the syndemic burden of HIV, hypertension and diabetes and highlights opportunities and challenges to leveraging DSD across diseases. RECENT FINDINGS: Prevalence of hypertension and diabetes in the eight highest HIV prevalence countries ranges between 20-24% (31.9% in those >50 years old) and 4-10%, respectively. Service delivery models addressing the concurrent syndemics focus primarily on integration of services. Two DSD examples were found where people living with HIV and other comorbidities had their care and treatment supported in healthcare worker-led facility-based adherence clubs. SUMMARY: Key enablers that have supported DSD for HIV such as simplified algorithms, optimized formulations, secure drug supply, and strengthened monitoring and evaluation systems are lacking for hypertension and diabetes and thus pose a major challenge to leveraging DSD models for people with syndemic conditions. However, the DSD approach may also catalyse opportunities to provide person-centred care for these syndemics and more implementation research in this area is warranted.
PURPOSE OF REVIEW: Differentiated service delivery (DSD) for HIV provides an approach to scaling services that are client-centred and aims to address client challenges whilst reducing the burden on health systems. With access to antiretroviral therapy, people living with HIV are living longer and increasingly present with comorbid conditions, such as hypertension and diabetes. This review presents the syndemic burden of HIV, hypertension and diabetes and highlights opportunities and challenges to leveraging DSD across diseases. RECENT FINDINGS: Prevalence of hypertension and diabetes in the eight highest HIV prevalence countries ranges between 20-24% (31.9% in those >50 years old) and 4-10%, respectively. Service delivery models addressing the concurrent syndemics focus primarily on integration of services. Two DSD examples were found where people living with HIV and other comorbidities had their care and treatment supported in healthcare worker-led facility-based adherence clubs. SUMMARY: Key enablers that have supported DSD for HIV such as simplified algorithms, optimized formulations, secure drug supply, and strengthened monitoring and evaluation systems are lacking for hypertension and diabetes and thus pose a major challenge to leveraging DSD models for people with syndemic conditions. However, the DSD approach may also catalyse opportunities to provide person-centred care for these syndemics and more implementation research in this area is warranted.
Authors: Anne L Stangl; Triantafyllos Pliakas; Jose Antonio Izazola-Licea; George Ayala; Tara S Beattie; Laura Ferguson; Luisa Orza; Sanyukta Mathur; Julie Pulerwitz; Alexandrina Iovita; Victoria Bendaud Journal: PLoS One Date: 2022-02-22 Impact factor: 3.240
Authors: Marya K Plotkin; Katie M Williams; Absolom Mbinda; Vivaldo Nunes Oficiano; Benard Nyauchi; Patrick Walugembe; Emily Keyes; Barbara Rawlins; Donna McCarraher; Otto N Chabikuli Journal: BMC Public Health Date: 2022-03-23 Impact factor: 3.295