Antiretroviral therapy (ART) services are often provided in standard, yet inefficient ways, making long-term it difficult for patients to stay on treatment long-term. Differentiated Models of Care (DMOC) reduce the cost for patients to stay on ART, can provide tailored ART support, reduce congestion in ART facilities and provide the foundation for patient-centered chronic disease wellness systems. The PEPFAR-supported Centers for Infectious Disease Research in Zambia (CIDRZ) has developed and is implementing Community-based Adherence Groups (CAGs). CAGs provide routine ART management to patients, decongest high-volume facilities, and minimize difficulties in accessing ART sites.
In many PEPFAR countries, most funding for the national HIV program comes from the host country. Local public resources to support the KP response have remained underused due to a shortage of social contracting systems, limited social health insurance (SHI) capacity, and undefined policy frameworks. In both Vietnam and Thailand, U.S. Agency for International Development (USAID) mission teams developed work plans with their partners to build the capacity for SHI programs to cover HIV services.
The Western Cape Government Department of Health adopted the adherence club (AC) differentiated-care model for the Cape Metro district in January 2011. The antiretroviral treatment (ART) AC model provides patient-friendly access to ART for clinically stable patients, ART distribution, and care and support to groups of stable patients. ACs meet either at a health care facility or at a community-based venue for symptom screening, group discussions, ART distribution, and care and support to groups of stable patients. The program was successfully implemented and scaled up across the district.
Through community-based testing, HIV-infected clients are provided baseline clinical care and a comprehensive package of peer-delivered linkage services recommended by the WHO and the CDC. CommLink mobile clinical and linkage services initiated at the point of HIV diagnosis are designed to help community clients “link” to a local facility for lifetime HIV, care, treatment, and support.