![]() As of December 2022, more than four million USAID-supported clients were receiving at least 3MMD. USAID worked closely with Ministries of Health, ARV supply chain partners, and health facilities to scale up the provision of MMD to all eligible clients. During the COVID-19 pandemic response, MMD became a tool for decongesting health facilities and supporting the uninterrupted provision of ART to people living with HIV. MMD policy and implementation vary across the 40-plus countries with a USAID-supported treatment program. Traditionally, clients return to the health facility or alternative dispensing locations on a monthly basis to obtain 30-day supplies of ARVs eligible clients enrolled on MMD can often receive three to six months’ worth of ARVs at a time, eliminating trips to the clinic. MMD eases the strain on over-burdened health facilities by providing eligible patients with three- and six-month MMD (3MMD and 6MMD) growing literature on MMD shows good continuity of treatment and viral load suppression outcomes, as well as cost savings to both the healthcare system and patients. MMD provides numerous benefits to ART patients and the health system. MMD and DDD directly contribute to client-centered care, increased access to services, and resilience of country health systems. Decentralizing ARV refill services outside of public facilities can maintain patient access to medications while minimizing their contact with the health system, where they are at risk of obtaining or transmitting COVID-19. Manufacturing and shipping disruptions have also caused delays in shipments of ARVs to PEPFAR-supported countries and complicated efforts to dispense multiple-month supplies of drugs to patients. As many governments worldwide instituted curfews, border closures, and transportation stoppages throughout 2020, patients faced challenges traveling to access antiretroviral therapy (ART) in facilities. Recently, COVID-19 has increased the urgency to differentiate care as shutdowns and overburdened facilities have created additional barriers to access to life saving HIV treatment. Together these strategies help minimize the burden on clients and the healthcare system by reducing the frequency of visits to health facilities and allowing clients to pick up drugs closer to their homes. DSD can include individual or group models that meet at the health facility or outside the facility in the community or at a client’s home, and most DSD models include options for multi-month drug dispensing (MMD) of ARVs and decentralized drug distribution (DDD). ![]() In order to minimize these barriers and improve retention in care, USAID provides differentiated service delivery (DSD), which seeks to tailor service delivery approaches to meet the unique needs of population groups and increase client-centered care. In addition to routine clinical visits, clients often make frequent visits to health facilities to pick up their monthly supply of life-saving HIV treatment, including antiretroviral medicine (ARVs), which further burdens clients and often contributes to poor clinical outcomes and high rates of interruption in treatment. Public hospitals often manage high volumes of clients with inadequate staffing, resulting in long wait times, overworked staff, poor client satisfaction, and weak retention. In many low- and middle-income countries where PEPFAR works, long lines at public facilities, distance to facilities, stigma, and lack of transportation money are common barriers to retention in HIV care. Photographer/affiliation: Stella Muyano/PATH Overview The USAID-funded, PATH-led Project in Haut-Katanga has been partnering with alternative medicine centers to extend the reach of HIV testing and decentralize HIV treatment and care services outside of health facilities. ![]()
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