1. CQUIN Call to Action Peter Preko MB, ChB Project Director, CQUIN
ICAP at Columbia University
21 July 2019

2. The CQUIN Learning Network
Outline
Differentiated Service Delivery
The CQUIN network
The ‘call to action’
The CQUIN Learning Network

3. The CQUIN Learning Network
Differentiated Service Delivery is a client-centred approach that simplifies and adapts HIV services across the cascade to reflect the preferences and expectations of various groups of people living with HIV while reducing unnecessary burdens on the health system
The CQUIN Learning Network

4. How can we improve outcomes?
Change the package of care (the “what”)
Change the way we deliver care (the “how”)
The CQUIN Learning Network

5. Differentiated Service Delivery is about the “how” not the “what”
Service Intensity
Service Frequency
Service Location
Service Provider
The CQUIN Learning Network

6. Optimizing Care To Achieve Impact
The CQUIN Learning Network

7. DSD is not just for stable patients
Countries are making great strides scaling up less-intensive DSD models for stable patients
But DSD also includes more- intensive models for people who need specialized or frequent services
The CQUIN Learning Network

8. The CQUIN Learning Network
Outline
Differentiated Service Delivery
The CQUIN network
The ‘call to action’
The CQUIN Learning Network

9. The CQUIN Learning Network
The CQUIN Network
The HIV Coverage, Quality, and Impact Network (CQUIN) is a south-to-south learning network designed to foster the scale up of differentiated service delivery as a means to HIV epidemic control
Priority activities include:
facilitating country-to-country knowledge exchange
providing demand-driven technical assistance
supporting catalytic projects and knowledge generation
Funded by the Bill and Melinda Gates Foundation
Convened by ICAP at Columbia University
The CQUIN Learning Network

10. The CQUIN Learning Network
CQUIN Network
Member Countries
The CQUIN Learning Network

11. CQUIN Communities of Practice
Ad hoc technical working groups designed to co- create resources and tools in priority domains:
Differentiated M&E
DSD for people at high risk of disease progression
TB/HIV and DSD
Quality improvement and DSD
Community engagement and DSD
The CQUIN Learning Network

12. Newly Initiating ART or on ART for < 1 year
What do we mean by
PLHIV
Newly Initiating ART or on ART for < 1 year
Early Disease
Advanced Disease
On ART for ≥ 1 year
Stable
Unstable
The CQUIN Learning Network

13. The CQUIN Learning Network
CQUIN: DSD for
Many countries have guidelines and systems related to the package of care (the “what”)
However, national guidelines and systems related to the way in which care is delivered (the “how”) are scarce
The CQUIN Learning Network

14. Programmatic Challenges
The CQUIN Learning Network

15. Illustrative Programmatic Challenges
How can we swiftly identify patients at high risk of HIV disease progression and “flag” them for rapid and prioritized services?
How can we provide services that are both intensified and patient-centered?
The CQUIN Learning Network

16. Illustrative DSD models for P@HR
SERVICE FREQUENCY
SERVICE INTENSITY
Weekly or Biweekly visits
Monthly Visits
Interim mHealth contacts
Enhanced Prophylaxis
Enhanced Counseling
Baseline CD4 at ART initiation
Reflex Lab Testing (e.g Crag for those with low CD4)
SERVICE LOCATION
SERVICE PROVIDERS
Specialty Clinics
Intermediate care facilities
Housing near facility (like maternity waiting homes)
mHealth enabled home-based care
NIMART “plus”
Super mentors (e.g. in Kenya)
Telemedicine
Oversight committees for 3rd line ART
The CQUIN Learning Network

17. The SIPOC Model from Kenya (“Severely Immunosuppressed Package of Care”)

18. Kwazulu Natal’s Viral Load Priority Clinic
What:
Adherence Counseling
Psychosocial support
ART
CD4
OI Screening and Diagnosis
Management of OI
Repeat VL
When:
Monthly
Friday
Where:
Health Facility
Who:
Medical Officer
Counselor
Social Worker

19. Priority Research Questions
To what extent can care for be decentralized and delivered outside of the hospital setting?
Would community-based DSD models of care work for unstable patients?
Can non-physician clinicians be trained to provide care for unstable patients?
The CQUIN Learning Network

20. The CQUIN Learning Network
Outline
Differentiated Service Delivery
The CQUIN network
The ‘call to action’
The CQUIN Learning Network

21. The CQUIN Learning Network
CQUIN’s Call to Action
Developed by the CQUIN community of practice on
Summarizes the published and grey literature on DSD
Calls for programs and policy- makers to prioritize innovative service delivery models for
The CQUIN Learning Network

22. The CQUIN Learning Network
Summary
An evidence-based package of services has been identified for but coverage of these services is low
We are not getting the right care to the right people at the right time
Similarly, not much progress has been made in developing innovative differentiated service delivery models for
Innovative program designs and implementation research are needed to improve the coverage, quality, and impact of services for as we strive to reduce HIV-associated mortality and achieve epidemic control
The CQUIN Learning Network

23. The CQUIN Learning Network
Acknowledgements
Beckman Coulter Foundation
The Bill & Melinda Gates Foundation
ICAP colleagues
CQUIN network participants
The CQUIN Learning Network