The importance of the “how”: the case for differentiated service delivery of long‐acting and extended delivery regimens for HIV prevention and treatment

Author:

Grimsrud Anna1ORCID,Wilkinson Lynne12,Delany‐Moretlwe Sinead3ORCID,Ehrenkranz Peter4ORCID,Green Kimberly56,Murenga Maureen7,Ngure Kenneth89ORCID,Otwoma Nelson J.10,Phanuphak Nittaya11ORCID,Vandevelde Wim12,Vitoria Marco13,Bygrave Helen14

Affiliation:

1. HIV Programmes and Advocacy IAS – the International AIDS Society Cape Town South Africa

2. Centre for Infectious Disease Epidemiology and Research University of Cape Town Cape Town South Africa

3. Wits RHI University of the Witwatersrand Johannesburg South Africa

4. Global Health Bill & Melinda Gates Foundation Seattle Washington USA

5. Primary Health Care PATH Seattle Washington USA

6. Primary Health Care PATH Hanoi Vietnam

7. Lean on Me Foundation Nairobi Kenya

8. School of Public Health Jomo Kenyatta University of Agriculture and Technology Nairobi Kenya

9. Department of Global Health University of Washington Seattle Washington USA

10. National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK) Nairobi Kenya

11. The Thai Red Cross AIDS Research Centre – PREVENTION Bangkok Thailand

12. Global Network of People Living with HIV (GNP+) Cape Town South Africa

13. Global HIV, Hepatitis, and Sexually Transmitted Infections Programmes World Health Organization Geneva Switzerland

14. IAS ‐ International AIDS Society Geneva Switzerland

Abstract

AbstractIntroductionLong‐acting and extended delivery (LAED) regimens for HIV treatment and prevention offer unique benefits to expand uptake, effective use and adherence. To date, research has focused on basic and clinical science around the safety and efficacy of these products. This commentary outlines opportunities in HIV prevention and treatment programmes, both for the health system and clients, that could be addressed through the inclusion of LAED regimens and the vital role of differentiated service delivery (DSD) in ensuring efficient and equitable access.DiscussionThe realities and challenges within HIV treatment and prevention programmes are different. Globally, more than 28 million people are accessing HIV treatment—the vast majority on a daily fixed‐dose combination oral pill that is largely available, affordable and well‐tolerated. Many people collect extended refills outside of health facilities with clinical consultations once or twice a year. Conversely, uptake of daily oral pre‐exposure prophylaxis (PrEP) has consistently missed global targets due to limited access with high individual cost and lack of choice contributing to substantial unmet PrEP need. Recent trends in demedicalization, simplification, additional method options and DSD for PrEP have led to accelerated uptake as its availability has become more aligned with user preferences. How people currently receive HIV treatment and prevention services and their barriers to adherence must be considered for the introduction of LAED regimens to achieve the expected improvements in access and outcomes. Important considerations include the building blocks of DSD: who (provider), where (location), when (frequency) and what (package of services). Ideally, all LAED regimens will leverage DSD models that emphasize access at the community level and self‐management. For treatment, LAED regimens may address challenges with adherence but their delivery should provide clear advantages over existing oral products to be scaled. For prevention, LAED regimens expand a potential PrEP user's choice of methods, but like other methods, need to be delivered in a manner that can facilitate frequent re‐initiation.ConclusionsTo ensure that innovative LAED HIV treatment and prevention products reach those who most stand to benefit, service delivery and client considerations during development, trial and early implementation are critical.

Funder

Bill and Melinda Gates Foundation

Publisher

Wiley

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health

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