Evaluating the impact of differentiated service delivery (DSD) on retention in care and HIV viral suppression in South Africa: A target trial emulation using routine healthcare data, Huber AN et al, PLoS Med, August 2025

This study compared HIV treatment outcomes for a large cohort of clients in South Africa enrolled in DSD models with those eligible but not enrolled. Using a target trial emulation approach, it assessed retention in care and viral suppression over 12, 24 and 36 months. DSD enrolment was associated with slightly higher retention and similar viral suppression compared with non-DSD clients. The findings suggest that DSD models maintain clinical effectiveness while offering non-clinical benefits, such as saving provider and client time.

Cost and effectiveness of differentiated ART service delivery strategies in Zambia: a modelling analysis using routine data, Lekodeba NA et al, J Int AIDS Soc, July 2025

This study used a mathematical modelling approach to evaluate the cost effectiveness of different DSD models for HIV treatment in Zambia. Using retention and viral suppression data from a national client cohort between 2018 and 2022, the analysis compared 125 scenarios of nine DSD models. Six scenarios were assessed as cost effective, with 6MMD-only being cost saving, improving retention and viral suppression while lowering client costs. The authors suggest that nationwide scale up of 6MMD to all eligible clients is likely cost saving, with further health gains possible through tailored combinations of other DSD models for specific sub-populations.

Seizing the moment: the potential of PrEP choice and innovation to transform HIV prevention, Schmidt HA et al, J Int AIDS Soc, July 2025

This commentary highlights how expanding PrEP options and service delivery innovations could strengthen global HIV prevention. While limited rollout of oral PrEP and challenges with PrEP persistence restrict its impact, long-acting injectables have the potential to overcome these challenges. Providing PrEP choices through DSD models can improve access, uptake and client satisfaction. However, overcoming programmatic challenges, including costs, monitoring and policy support, will be critical to fully realizing the potential of PrEP.

Home-Based Care for Hypertension in Rural South Africa, Siedner MJ et al, N Engl J Med, Epub ahead of print, Sept 2025

This randomized controlled trial in South Africa tested home-based hypertension care led by community health workers (CHWs) against standard clinic-based care. At six months, both CHW-led models significantly reduced systolic blood pressure compared with standard care, with the enhanced CHW group achieving the greatest improvements. Hypertension control rates were also substantially higher in both CHW groups, and benefits persisted at 12 months. Findings suggest that home-based care is an effective strategy for improving hypertension management.

Effectiveness and experiences with differentiated service delivery of HIV care in Kisumu County, Kenya: A mixed methods study, 2014–2021, Odhiambo F et al, PLOS Glob Public Health, August 2025

This mixed-methods study evaluated the impact of DSD models for HIV care in Kisumu County, Kenya, following WHO’s 2015 test and treat policy. A pre-post analysis of clinically “stable” adult clients showed significant improvements in retention, increasing from 86.4% pre-DSD to over 98% at 12 and 24 months, with sustained viral suppression. Focus group discussions indicated high satisfaction among both clients and healthcare workers, citing greater efficiency, improved staff attitudes and reduced clinic workload. Many clients preferred facility-based DSD models over community-based options due to concerns about stigma and privacy.

“If your CD4 count lowers, that is when you are similar to a person that is non-existent” A qualitative exploration of perceptions around advanced HIV disease in South Africa, Pita TP et al, BMC Public Health, July 2025

This qualitative study explored perceptions and influencing factors of advanced HIV disease (AHD) in South Africa. Interviews and focus group discussions with people living with HIV, nurses and policy makers indicated that most clients were unfamiliar with the term, AHD, and often confused CD4 counts with viral load testing. Key contributors to AHD included poor adherence, clinic avoidance, structural barriers to care, mental health challenges, reliance on traditional medicine and stigma. The findings underscore the need for improved community education, better integration of mental health support and re-engagement strategies.

A research framework to support re-engagement and continuous engagement in HIV care, Lavoie MC et al, Lancet HIV, Sept 2025

This viewpoint argues that disengagement from HIV care is a critical weakness in the HIV response, and calls for clearer distinctions between concepts such as loss to follow up and unknown care status, and for flexible data harmonization to generate stronger, comparable evidence across studies. The authors emphasize that effective re-engagement requires not just tracing clients, but also addressing systemic barriers, adopting client-centred models and testing interventions tailored to diverse populations. They conclude that a global research agenda, supported by methodological guidance, is needed to advance sustainable strategies for continuous engagement and re-engagement in HIV care.