Nsanzimana Sabin, Remera Eric, Ribakare Muhayimpundu, Burns Tracy, Dludlu Sibongile, Mills Edward J, Condo Jeanine, Bucher Heiner C, Ford Nathan
Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda.
Basel Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):21635. doi: 10.7448/IAS.20.5.21635.
In 2016, Rwanda implemented "Treat All," requiring the national HIV programme to increase antiretroviral (ART) treatment coverage to all people living with HIV. Approximately half of the 164,262 patients on ART have been on treatment for more than five years, and long-term retention of patients in care is an increasing concern. To address these challenges, the Ministry of Health has introduced a differentiated service delivery approach to reduce the frequency of clinical visits and medication dispensing for eligible patients. This article draws on key policy documents and the views of technical experts involved in policy development to describe the process of implementation of differentiated service delivery in Rwanda.
Implementation of differentiated service delivery followed a phased approach to ensure that all steps are clearly defined and agreed by all partners. Key steps included: definition of scope, including defining which patients were eligible for transition to the new model; definition of the key model components; preparation for patient enrolment; considerations for special patient groups; engagement of implementing partners; securing political and financial support; forecasting drug supply; revision, dissemination and implementation of ART guidelines; and monitoring and evaluation.
Based on the outcomes of the evaluation of the new service delivery model, the Ministry of Health will review and strategically reduce costs to the national HIV program and to the patient by exploring and implementing adjustments to the service delivery model.
2016年，卢旺达实施了“全面治疗”政策，要求国家艾滋病防治项目将抗逆转录病毒治疗（ART）覆盖范围扩大到所有艾滋病毒感染者。在接受抗逆转录病毒治疗的164262名患者中，约有一半已接受治疗超过五年，患者长期坚持治疗的问题日益受到关注。为应对这些挑战，卫生部引入了差异化服务提供模式，以减少符合条件患者的临床就诊和配药频率。本文借鉴关键政策文件以及参与政策制定的技术专家的观点，描述卢旺达差异化服务提供模式的实施过程。
差异化服务提供模式的实施采用了分阶段方法，以确保所有步骤都明确界定并得到所有合作伙伴的认可。关键步骤包括：确定范围，包括确定哪些患者有资格过渡到新模式；定义关键模式组成部分；为患者登记做准备；考虑特殊患者群体；让实施伙伴参与；获得政治和财政支持；预测药品供应；修订、传播和实施抗逆转录病毒治疗指南；以及监测和评估。
根据新服务提供模式的评估结果，卫生部将通过探索和实施对服务提供模式的调整，审查并从战略上降低国家艾滋病防治项目和患者的成本。
