Global Development, Bill & Melinda Gates Foundation, Seattle, WA, USA.
Department of HIV and Hepatitis, WHO, Geneva, Switzerland.
J Int AIDS Soc. 2018 Mar;21(3). doi: 10.1002/jia2.25080.
The World Health Organization's (WHO) recommendation of "Treat All" has accelerated the call for differentiated antiretroviral therapy (ART) delivery, a method of care that efficiently uses limited resources to increase access to HIV treatment. WHO has further recommended that stable individuals on ART receive refills every 3 to 6 months and attend clinical visits every 3 to 6 months. However, there is not yet consensus on how to ensure that the quality of services is maintained as countries strive to meet these standards. This commentary responds to this gap by defining a pragmatic approach to the monitoring and evaluation (M&E) of the scale up of differentiated ART delivery for global and national stakeholders.
Programme managers need to demonstrate that the scale up of differentiated ART delivery is achieving the desired effectiveness and efficiency outcomes to justify continued support by national and global stakeholders. To achieve this goal, the two existing global WHO HIV treatment indicators of ART retention and viral suppression should be augmented with two broad aggregate measures. The addition of indicators measuring the frequency of (1) clinical and (2) refill visits by PLHIV per year will allow evaluation of the pace of scale up while monitoring its overall effect on the quality and efficiency of services. The combination of these four routinely collected aggregate indicators will also facilitate the comparison of outcomes among facilities, regions or countries implementing different models of ART delivery. Enhanced monitoring or additional assessments will be required to answer other critical questions on the process of implementation, acceptability, effectiveness and efficiency.
These proposed outcomes are useful markers for the effectiveness and efficiency of the health system's attempts to deliver quality treatment to those who need it-and still reserve as much of the available resource pool as possible for other key elements of the HIV response.
世界卫生组织（WHO）提出的“全面治疗”建议加速了差异化抗逆转录病毒疗法（ART）的推广，这是一种高效利用有限资源来增加艾滋病毒治疗机会的护理方法。WHO 进一步建议，接受 ART 治疗且病情稳定的个体每 3 至 6 个月进行一次药物续配，每 3 至 6 个月进行一次临床访视。然而，在各国努力达到这些标准的同时，如何确保服务质量得以维持，尚未达成共识。本评论通过定义一种实用方法，以满足全球和国家利益相关者对差异化 ART 推广的监测和评估（M&E）需求，来应对这一差距。
项目管理人员需要证明差异化 ART 推广的规模扩大正在实现预期的效果和效率结果，以证明国家和全球利益相关者继续提供支持的合理性。为了实现这一目标，应在现有的全球 WHO 艾滋病毒治疗指标中，即 ART 保留率和病毒抑制率的基础上，增加两个广泛的综合指标。增加每年测量 PLHIV 临床和药物续配访视频率的指标，将允许评估扩大规模的速度，同时监测其对服务质量和效率的总体影响。这些四项常规收集的综合指标的结合，也将有助于比较实施不同 ART 交付模式的设施、地区或国家的结果。需要进行更强化的监测或额外的评估，以回答有关实施过程、可接受性、有效性和效率的其他关键问题。
这些提出的结果是衡量卫生系统向有需要的人提供高质量治疗的有效性和效率的有用指标，同时为艾滋病毒应对措施的其他关键要素保留尽可能多的可用资源池。
