Streamlining AHD care: Zimbabwe's blueprint for integrating STOP AIDS training with differentiated service delivery
- THRIVE
- Sep 8
- 3 min read
The Imperative for Integrated AHD Care
Advanced HIV disease (AHD) continues to pose a significant challenge in the global HIV response, contributing to preventable morbidity and mortality. Early diagnosis and comprehensive management are critical to improving outcomes for individuals with AHD. Differentiated Service Delivery (DSD) models, which tailor HIV services to the diverse needs of people living with HIV (PLHIV), offer a client-centered approach to care. In Zimbabwe, the THRIVE project demonstrates how integrating the comprehensive STOP AIDS training package within DSD models can enhance AHD service delivery. Embedding specialized AHD care into existing DSD models makes services more accessible, particularly for vulnerable populations, and more patient-focused, moving beyond the traditional one-size-fits-all approach. This signifies a fundamental reorientation of AHD care from reactive treatment in specialized clinics to proactive, patient-centered services.
Foundational Work: Mapping and Collaboration
The development of an effective DSD model for AHD in Zimbabwe began with meticulous foundational work, rooted in a data-driven and collaborative approach. A key first step was mapping existing DSD models to identify opportunities for integrating STOP AIDS elements. The findings were subsequently reviewed in partnership with community members from AFROCAB, guiding the design of a community-facility service delivery model that is both innovative and responsive to the needs of PLHIV with AHD. Involving community stakeholders from the outset ensured that the model reflected local realities and patient needs, which were necessary for successful uptake and sustained impact.
To further solidify the collaborative framework, a bootcamp brought together the Ministry of Health and Child Care (MoHCC) and PEPFAR implementing partners (IPs) to develop an AHD DSD model tailored to Zimbabwe’s local context. This high level of partnership underscores a shared commitment to developing a model that was not imposed but co-created with key national and implementing partners, ensuring its practicality and relevance. This co-design process minimized potential implementation bottlenecks and guaranteed the model would be technically sound, operationally feasible, and acceptable to both communities and the healthcare providers who would implement it. This approach built early ownership and aligned expectations, boosting the chances of successful adoption and sustainable scale-up.
The Five Pillars of Zimbabwe's AHD DSD Model
Following extensive engagement, community advisory board (CAB) members, the MoHCC, and CHAI reached a consensus on a model targeting five key areas across the STOP AIDS package of care. These pillars form a comprehensive strategy for addressing AHD:
Enhanced diagnostics for AHD identification: Ensuring timely and accurate diagnosis.
Integrated nutritional screening and treatment: Recognizing the role of nutrition in AHD management.
Facility-based AHD prophylaxis and pre-emptive treatment: Providing essential preventive and early interventions.
Enhanced adherence: Supporting patients to maintain their treatment regimens.
Defaulter tracking: Establishing systems to find and re-engage patients lost to follow-up.
These five pillars collectively demonstrate a holistic approach, systematically addressing the AHD care cascade from initial diagnosis through to long-term adherence and retention in care.
Initial Training on the New Model
With a robust DSD model in place, the focus shifted to effective implementation through targeted training and capacity building to equip providers with the skills needed to deliver high-quality AHD care. Facilities were trained on the practical implementation of the newly designed DSD model. This training also focused on monitoring and evaluation (M&E) systems to track and assess program performance. This step towards operationalization laid the groundwork for effective service delivery.
Key Lessons and Future Outlook
Zimbabwe's journey in integrating STOP AIDS training with DSD models for AHD offers key lessons for other countries aiming to enhance client-centered AHD care. First, co-design is essential: the success of the model hinged on robust collaboration involving the MoHCC, implementing partners, and community representatives. Second, iterative capacity building, through initial and refresher trainings, enabled deeper integration of complex guidance and mastery of new service delivery approaches. Third, the comprehensive five-pillar approach of the DSD model addresses critical facets of AHD care, from diagnosis to adherence.
Looking ahead, the commitment to continuous improvement is evident. A key priority for 2025 includes the "continuous monitoring of DSD models for AHD implementation". This focus on ongoing monitoring and quality improvement will be essential for adapting the models as needed and ensuring sustained impact. This experience in Zimbabwe provides a promising blueprint for other settings seeking to make AHD care more client-centered, accessible, and effective through innovative DSD approaches.
Through the generous support of Unitaid, the Clinton Health Access Initiative (CHAI)-led THRIVE Project is enabling access to critical prevention, screening, and treatment commodities for advanced HIV disease to dramatically reduce mortality among adults and children living with HIV. The THRIVE project is conducted in partnership with Afrocab and Penta.
Disclaimer: The views expressed are those of CHAI and do not necessarily reflect those of Unitaid or other partners.
