Gift Adelaja Modupe, Akinsolu Folahanmi Tomiwa, Abodunrin Olunike Rebecca, Lukwa Akim Tafadzwa, Olagunju Mobolaji Timothy, Akinpelu Adekemi, Mary Ogunwale Mercy, Mary Ola Oluwabukola, Raji Dolapo Omotayo, Ezechi Lilian Ogochukwu, Gambari Aisha Oluwaseun, Ezechi Oliver Chukwujekwu
Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan, Nigeria.
Center for Reproduction and Population Health Studies, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
BMC Health Serv Res. 2025 Aug 21;25(1):1119. doi: 10.1186/s12913-025-13283-7.
Differentiated Service Delivery (DSD) models have been introduced to optimise HIV care by adapting services to client needs while reducing the burden on healthcare systems. In Nigeria, where HIV prevalence remains high. Understanding provider perspectives is critical to improving and sustaining DSD implementation. This study explored the experiences, challenges, and recommendations of healthcare providers involved in DSD delivery in Ibadan North, Oyo State.
A qualitative descriptive study was conducted between July and September 2024, involving 11 key informant interviews and two focus group discussions across three DSD-implementing facilities. Participants included clinicians, ART counsellors, HTS providers, retention officers, and program managers. Data were analysed thematically using NVivo 12 software, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.
Five core themes emerged: perceived benefits of DSD models, implementation challenges, eligibility and suitability of clients, human resource capacity and training, and strategic recommendations for sustainability. Providers reported that DSD models improved accessibility, reduced clinic congestion, and enhanced patient retention and viral suppression. However, challenges such as inaccurate client data, dependency on community models, systemic inefficiencies, and inadequate training impeded effective implementation. Participants emphasised the need for policy alignment, community engagement, capacity building, and stronger monitoring systems.
DSD models hold promise for improving HIV service delivery in Nigeria. However, their success depends on addressing structural and operational challenges, tailoring approaches to local contexts, and strengthening health workforce capacity. These findings provide critical insights to inform national policy, support program scale-up, and contribute to achieving the UNAIDS 95-95-95 and SDG 3.3 targets.
差异化服务提供(DSD)模式已被引入,旨在通过使服务适应客户需求来优化艾滋病毒护理,同时减轻医疗系统的负担。在艾滋病毒流行率仍然很高的尼日利亚,了解提供者的观点对于改进和维持DSD的实施至关重要。本研究探讨了参与奥约州伊巴丹北部DSD服务提供的医疗保健提供者的经验、挑战和建议。
2024年7月至9月进行了一项定性描述性研究,涉及对三个实施DSD的设施进行11次关键信息访谈和两次焦点小组讨论。参与者包括临床医生、抗逆转录病毒治疗顾问、艾滋病毒检测服务提供者、留存官员和项目经理。数据按照定性研究报告统一标准(COREQ)指南,使用NVivo 12软件进行主题分析。
出现了五个核心主题:DSD模式的感知益处、实施挑战、客户的资格和适用性、人力资源能力和培训以及可持续性的战略建议。提供者报告说,DSD模式提高了可及性,减少了诊所拥堵,并提高了患者留存率和病毒抑制率。然而,诸如客户数据不准确、依赖社区模式、系统效率低下和培训不足等挑战阻碍了有效实施。参与者强调需要政策协调、社区参与、能力建设和更强大的监测系统。
DSD模式有望改善尼日利亚的艾滋病毒服务提供。然而,其成功取决于应对结构和运营挑战、根据当地情况调整方法以及加强卫生人力能力。这些发现为国家政策提供了关键见解,支持项目扩大规模,并有助于实现联合国艾滋病规划署95-95-95目标和可持续发展目标3.3。