"I do understand why counselling is poor in the facilities because the nurses are overwhelmed. Effective counselling is not about numbers – I'm not a number, I'm a human being. The focus should be on the quality of service I receive. If we can shift the stable clients, it means there will be enough time for counselling the person who is unwell."

Vusi Matsebula, PLHIV, Swaziland
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Stable client models

Recent innovations in ART delivery, or differentiated models of ART delivery for stable clients, can be categorized into four models. Within these models, all clients continue to have clinical consultations as part of their package of care. Multiple models can work in parallel so that a client can move between them during the course of their lifetime. Further, the models are flexible to accommodate clients who may want to or require up referral. By being up referred, the intensity of care is increased to reflect the increased clinical needs of the client.

Health care worker-managed groups

Clients receive their ART refills in a group and either a professional or a lay health care staff member manages this group. The groups meet within and/or outside of health care facilities.
Client-managed groups

Clients receive their ART refills in a group but this group is managed and run by clients themselves. Generally, client-managed groups meet outside of health care facilities.
Facility-based individual models

ART refill visits are separated from clinical consultations. When clients have an ART refill visit, they bypass any clinical staff or adherence support and proceed directly to receive their medication.
Out-of-facility individual models

ART refills and, in some cases, clinical consultations are provided to individuals outside of health care facilities.