The World Health Organization (WHO)
The World Health Organization (WHO) provides guidance, recommendations and key considerations to support differentiated service delivery across the HIV care continuum.
In July 2021, WHO published Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring as an update of the previous (2016) edition of the consolidated guidelines on HIV. The guidelines feature an expanded chapter on service delivery (Chapter 7, pages 339-470) that was published first in April 2021 (Updated recommendations on service delivery for the treatment and care of people living with HIV). This chapter emphasizes the need for differentiated service delivery for HIV treatment with a revised definition of established on treatment and outlines the four categories of DSD for HIV models. It also includes the recommendation for supporting HIV treatment initiation in the community. The revised consolidated guidelines also include the March 2021 update on treatment monitoring (Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring), with revised timing of routine viral load monitoring to ensure that it is more accessible, focused and triggers clinical action.
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 July 2017, the WHO prequalified the first HIV self-test and 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.
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).
The 2022 technical brief Differentiated and simplified pre-exposure prophylaxis for HIV prevention: update to WHO implementation guidance, recommends multiple pre-exposure prophylaxis (PrEP) options as part of combination prevention approaches and there has been a global uptake of PrEP into national guidelines and widespread implementation of PrEP services, although projects and programmes are still commonly small-scale. In many countries, services have been demedicalized, simplified, differentiated, digitalized, and integrated to increase uptake and effective use of PrEP.