Patient-level and program-level monitoring and evaluation of differentiated service delivery for HIV: a pragmatic and parsimonious approach is needed

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Achieving the ambitious global HIV treatment goals will require a marked expansion of antiretroviral therapy (ART) coverage and close attention to HIV service quality [1]. In response, a growing body of evidence supports the use of differentiated ART services (DARTS) for subgroups of HIV-positive individuals [2–14]. Although differentiated services can support diverse patient groups, most current DARTS initiatives target stable adult patients, that is, those demonstrating ART adherence and viral suppression or viral suppression alone [15]. Both community-based and facility-based DARTS can reduce the burdens associated with frequent and lengthy clinic visits for both patients and health providers. Ultimately, these models aim to enhance retention, ART adherence, viral suppression, and quality of life [16].
The implementation of such novel approaches involves fundamental changes to delivery systems. This can make monitoring services more challenging, requiring new approaches to ensure that data are available to inform the care of individuals engaged in DARTS and enable programmatic evaluation of diverse DARTS models.
Important lessons have been learned regarding HIV program monitoring and evaluation (M&E). These include the critical importance of parsimony and pragmatism, focusing on information that is feasible to collect and essential for patient and program management [17]. These principles are particularly important as existing M&E systems evolve in response to increasingly diverse DARTS models.
This article highlights common gaps in M&E systems with respect to DARTS. We outline elements of an integrated, streamlined approach that provides robust information to guide patient and program management, while minimizing the burden of data collection and aggregation. Lastly, we note that additional information is needed for assessment and strategic planning at the health system level; this may require additional data collection and/or special studies.

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