HIV Programmes and Advocacy, International AIDS Society (IAS), Geneva, Switzlerand.
Southern Africa Medical Unit, Medécins Sans Frontières.
J Acquir Immune Defic Syndr. 2018 Aug 15;78 Suppl 2:S124-S127. doi: 10.1097/QAI.0000000000001733.
Differentiated care, or differentiated service delivery (DSD), is increasingly being promoted as one of the possible ways to address and improve access, quality, and efficiency of HIV prevention, care, and treatment. Family-centered care has long been promoted within the provision of HIV services, but the full benefits have not necessarily been realized. In this article, we bring together these two approaches and make the case for how family-centered DSD can offer benefits to both people affected by HIV and the health system. Family-centered DSD approaches are presented for HIV testing and antiretroviral therapy (ART) delivery, referencing policies, best practice examples, and evidence from the field. With differentiated family-centered ART delivery, the potential efficiencies gained by extending ART refills can both benefit clients by reducing the frequency and intensity of contact with the health service and lead to health system gains by not requiring multiple providers to care for one family. A family-centered DSD approach should also be leveraged along the HIV care cascade in the provision of prevention technologies and mobilizing family members to receive regular HIV testing. Furthermore, a family-centered lens should be applied wherever DSD is implemented to ensure that, for example, adolescents who are pregnant receive an adapted package of quality care.
差异化护理或差异化服务提供（DSD）越来越被视为解决和改善艾滋病毒预防、护理和治疗的可选择途径之一，以提高可及性、质量和效率。在艾滋病毒服务提供方面，以家庭为中心的护理早已得到大力提倡，但未必能充分实现其全部效益。在本文中，我们将这两种方法结合起来，并提出以家庭为中心的差异化服务提供如何能为受艾滋病毒影响的个人和卫生系统带来益处。本文提出了以家庭为中心的差异化服务提供方法，用于艾滋病毒检测和抗逆转录病毒疗法（ART）的提供，引用了政策、最佳实践示例以及来自实地的证据。通过差异化的、以家庭为中心的 ART 提供方法，延长 ART 续药时间所带来的效率提高，不仅可以通过减少客户与卫生服务的接触频率和强度为客户带来好处，而且还可以通过减少多个提供者照顾一个家庭来为卫生系统带来好处。以家庭为中心的差异化服务提供方法还应在艾滋病毒护理服务提供过程中利用预防技术，并动员家庭成员定期接受艾滋病毒检测。此外，无论何时实施差异化服务提供，都应采用以家庭为中心的视角，以确保例如，为怀孕的青少年提供一套适应的优质护理包。
