Differentiated service delivery for people with HIV and non-communicable diseases: South African policy enabler for integration

BACKGROUND: Non-communicable diseases (NCDs), are undoubtedly leading cause of mortality and disabilities in the world accounting for about half of global disease burden. NCDs are increasingly causing health threats for people living with HIV. Whilst South Africa has the largest ART programme worldwide with over 5.5 Million people on ART. The rising burden of NCDs is placing considerable strain and presenting challenges of maintaining high-quality public health care services. The overall prevalence of hypertension was 14.3% in 2017, while the overall prevalence of diabetes was 3.2% in 2017. As South Africa scale-up differentiated service delivery (DSD), this optimization presents an opportunity to integrate HIV and management of NCDs into DSD models.
DESCRIPTION: DSD is the framework of the Adherence Guidelines (AGL) for HIV, TB and NCDs adopted in March 2020. It aims to strengthen linkage, adherence, and retention in care using a patient-centered approach throughout the treatment cascade for both HIV, TB, and NCDs patients. It makes provision for the three DMoCs (Facility Pick Up Points (FAC PuP), External Pick-Up Points (EX-PuP), and Adherence Clubs (AC) both at facility and community based) for those who are established in ART care and living with hypertension and/or diabetes.
LESSONS LEARNED: FAC-PuP model allows for direct and quick access to the pharmacy for healthy and stable clients on treatment. AC is facility and community-based and allows stable patients to be grouped, voluntarily for routine check-ups. EX-PuP model takes various forms, but all involve the patient collecting their treatment supply individually outside of the facility or from an automated system; thus, including from private pharmacies, lockers, etc. As of the end of October 2021, data by DSD and type of patient showed a significant number of clients decanted (2 901 452). EX-PuP showed a high proportion of 60% (1 486 684) followed by FAC-PuP 25% (658 671) and lastly, the AC at 15% (500 590).
CONCLUSIONS: DSD policy on HIV and NCDs provides the opportunity to optimize 90% of people on ART including the Integration of NCDs, TB/HIV services into less-intensive. Conduct the comprehensive review of AGL Policy to inform on options to strengthen the HIV and NCDs integration.