Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Fam Med Community Health. 2020 Sep;8(3). doi: 10.1136/fmch-2020-000393.
Differentiated service delivery (DSD) models for HIV often exclude children and adolescents. Given that children and adolescents have lower rates of HIV diagnosis, treatment and viral load suppression, there is a need to use DSD to meet the needs of children and adolescents living with HIV. This commentary reviews the concept of DSD, examines the application of DSD to the care of children and adolescents living with HIV, and describes national guidance on use of DSD for children and adolescents and implementation of DSD for HIV care and treatment in children and adolescents in Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)-supported programmes in seven sub-Saharan countries between 2017 and 2019. Programme descriptions include eligibility criteria, location and frequency of care delivery, healthcare cadre delivering the care, as well as the number of EGPAF-supported facilities supporting each type of DSD model. A range of DSD models were identified. While facility-based models predominate, several countries support community-based models. Despite significant uptake of various DSD models for children and adolescents, there was variable coverage within countries and variability in age criteria for each model. While the recent uptake of DSD models for children and adolescents suggests feasibility, more can be done to optimise and extend the use of DSD models for children and adolescents living with HIV. Barriers to further DSD uptake are described and solutions proposed. DSD models for children and adolescents are a critical tool that can be optimised to improve the quality of HIV care and outcomes for children and adolescents.
差异化服务交付（DSD）模式通常将艾滋病毒感染者中的儿童和青少年排除在外。鉴于儿童和青少年的艾滋病毒诊断率、治疗率和病毒载量抑制率较低，因此需要利用 DSD 来满足艾滋病毒感染者中的儿童和青少年的需求。本评论审查了 DSD 的概念，考察了 DSD 在儿童和青少年艾滋病毒感染者护理中的应用，并描述了国家关于 DSD 用于儿童和青少年的指导意见，以及在 2017 年至 2019 年间，伊丽莎白·格拉泽儿科艾滋病基金会（EGPAF）在七个撒哈拉以南非洲国家支持的方案中，为儿童和青少年实施 DSD 用于艾滋病毒护理和治疗的情况。方案描述包括资格标准、护理提供的地点和频率、提供护理的医疗保健人员，以及支持每种 DSD 模式的 EGPAF 支持的设施数量。确定了一系列 DSD 模式。尽管以机构为基础的模式占主导地位，但有几个国家支持以社区为基础的模式。尽管儿童和青少年广泛采用了各种 DSD 模式，但各国之间的覆盖率存在差异，每个模式的年龄标准也存在差异。尽管最近儿童和青少年 DSD 模式的采用表明了其可行性，但仍有更多工作需要优化和扩大 DSD 模式在艾滋病毒感染者中的应用。描述了进一步采用 DSD 的障碍，并提出了解决方案。儿童和青少年 DSD 模式是一种关键工具，可以对其进行优化，以提高儿童和青少年艾滋病毒护理的质量和结果。
