Dr Helen Bygrave: Differentiated HIV Service Delivery Is a Client-Centered Approach

Providers need to put themselves in their patients' shoes and think about how they would like to receive services, emphasized Helen Bygrave, MD, chronic diseases advisor for the Médecins Sans Frontières’ (Doctors Without Borders) Access Campaign.

Providers need to put themselves in their patients' shoes and think about how they would like to receive services, while remembering that people with HIV need more than antiretroviral therapy (ART), emphasized Helen Bygrave, MD, chronic diseases advisor for the Médecins Sans Frontières (Doctors Without Borders) Access Campaign.

Bygrave co-introduced, "Don't Wait - Integrate! How COVID-19 Has Highlighted the Need for HIV Services to Be Person-Centered,” along with Nomthandazo Lukhele, MD, MCBC, of the World Health Organization on day 1 of IAS 2021, this year's virtual annual meeting of the International AIDS Society, which took place July 18-21.


Can you tell us about yourself and your work?

My name is Helen Bygrave. I'm a physician based in London and the UK. I have been working in supporting HIV programs, many across Sub-Saharan Africa for about 15 years now, and more recently, I've been working as a consultant with the International AIDS Society, really supporting the differentiated service delivery initiative.

What is differentiated service delivery, and how can it improve outcomes for those living with HIV?

So, the real kind of key principles of differentiated service delivery is that this is a client-centered approach. We're designing services around the needs of the client. So, it's simplifying and adapting services across the cascade of care. So we do think about differentiated testing, differentiated prevention now. These concepts are also being used in PrEP [pre-exposure prophylaxis] rollout as well. It's about serving the needs of people living with HIV, whilst at the same time reducing the burden on the health system—and we hope kind of being cost-efficient.

But the primary goal is that we're thinking about, “How would I, if I was attending these services, like to receive my care?” I think with this session, we were also thinking, people with HIV just don't just need ART; they have other health needs. Women, mainly of childbearing age, might need contraception. As our cohorts get older, many people will need care for diabetes and cardiovascular disease. So, thinking about putting the person at the center and how do we design our service delivery models to really address those needs.

In COVID, what we've really seen is a number of the principles that we've been talking about in this differentiated service delivery community for a number of years now, really accelerated. One of the key things we've pushed over the years is to try and extend ART refills, extend the duration of time, so people don't have to come so often. And COVID has really accelerated that. We've seen scale up. PEPFAR [US President's Emergency Plan for AIDS Relief] has nice data on this really kind of scale up of providing 6 months of refills. In PEPFAR programs, that's gone from 9% to 21% over the year, in terms of the portion of people that that can now get 6 months of drugs.

We also saw during COVID that eligibility was broadened. We see longer refills being given more readily to children, which was guidelines before but often countries were not implementing that. And that, again, has been scaled up during COVID.

And also thinking about eligibility. So, pregnant women were often excluded, [but] that's now changed in the new guidelines that WHO has released this week, and also allowing people to have longer refills earlier. So not waiting for 1 year, but really kind of thinking about how we can simplify care for people earlier on in their treatment story.

There's been some really nice examples presented at this conference.Some great work from Ethiopia, demonstrating, in particular, this increase in eligibility to other populations.

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