Changing models of care to improve progression through the HIV treatment cascade in different populations

With global guidelines recommending earlier treatment for HIV infection, there will be increased demand for care and treatment services. Although health systems delivering HIV care globally have made advances in decentralizing to lower level health centers and enabling nurse-based delivery of antiretroviral treatment, they remain largely clinic based. Innovators have recently developed newer community-based care delivery models that could extend the capacity of stretched health systems to accommodate further increases in patient volumes. This review will focus on the programme outcomes from new care models and consider their ability to have an impact at scale.

Numerous patient-centered models of care have been developed to target patients stable on treatment and minimize clinic utilization. In rural areas, these models are aimed at reducing travel times and related costs, whereas models in urban and semi-urban areas focus on decreasing clinic congestion and patient wait times. Each of these models benefits from a focus on community support, and they demonstrate excellent retention in the care cascade for patients self-selecting into them.

Care models including nontraditional community-oriented care for well patients, largely delivered through nonmedical providers have demonstrated outstanding outcomes, and need to be further tested and scaled.