The World Health Organization (WHO)
The WHO provides guidelines, recommendations and key considerations to support differentiated service delivery across the HIV care continuum.
In March 2021, the WHO released Updated recommendations on service delivery for the treatment and care of people living with HIV and Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring. These new recommendations are an update to the 2016 WHO Consolidated Guidelines on the use of ARV drugs for treating and preventing HIV infection (see below). WHO now recommends that people on antiretroviral therapy (ART) for at least 6 months and responding well, should be offered clinical visits every 3 to 6 months, preferably every 6 months, and should be offered refills of ART lasting 3 to 6 months, preferably 6 months.
In June 2020, WHO published Maintaining essential health services: operational guidance for the COVID-19 context. On page 39-42, specific modifications for HIV service delivery in periods of COVID-19 related disruption are detailed, along with recommendations for transition towards restoration of activities as restrictions are relaxed.
In March 2020, WHO released the WHO operational handbook on tuberculosis. Module 1: Prevention. Tuberculosis preventive treatment, an implementation guide for the simultaneously released updated tuberculosis (TB) guidelines. The operational handbook recommends integrating intensified TB case finding and TB preventive therapy (TPT) within differentiated antiretroviral therapy delivery models. Client visits should be scheduled such that they can pick up antiretrovirals and TPT drugs at the same time.
In December 2019, WHO published a technical brief to define and clarify the key elements of adolescent-friendly health services, summarize existing guidance on adolescent-friendly health services and differentiated service delivery for adolescents living with HIV while showcasing best-practice case studies based on country experience in implementing these services.
In 2018, the HIV self-testing strategic framework: a guide for planning, introducing and scaling up was released to support uptake of HIV self-testing including the six-step approach to differentiated HIV testing. In July 2017, WHO prequalified the first HIV self-test. WHO has recommended HIV self-testing since November 2016 when they released a supplement guideline on HIV self-testing and partner notification. This supplement was to the 2015 Consolidated guidelines on HIV testing services.
The 2017 Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy also includes differentiated service delivery. This guideline adds recommendations for appropriate packages of care for clients presenting or returning to care with either advanced HIV disease or when clinically well.
The 2017 Key considerations for differentiated antiretroviral therapy delivery for specific populations: children, adolescents, pregnant and breastfeeding women and key populations outlines the rationale for and features of differentiated ART delivery for clinically stable clients in these populations. The document complements A Decision Framework for differentiated antiretroviral therapy delivery for children, adolescents and pregnant and breastfeeding women (see, DSD decision frameworks).
WHO first recommended a differentiated care approach in the 2016 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations and Consolidated guidelines on person-centred HIV patient monitoring and case surveillance were published in the same year.