By Emmanuel A A Teviu, Anthony Ashinyo, Kwadwo Koduah Owusu, Elizabeth Agyare, Raphael Adu-Gyamfi – National AIDS/STI Control Programme, Ministry of Health, Ghana
Ghana was an early adopter of DSD, establishing a clear separation between clinical and refill visits for stable clients on antiretroviral therapy (ART). Building on a strong government-led supply chain, Ghana has scaled up multi-month dispensing (MMD) significantly: 38% of people living with HIV now receive six or more months of ART per dispensing visit, with a further 47% receiving three to six months, placing 85% of clients on some form of MMD.
Why make the change now?
Major shifts in donor funding over the past year coincided with Ghana’s strategic sustainability planning for the HIV programme. Together, these provided a strong impetus to review clinical and service delivery guidance – drawing on retention and virological suppression data from settings that have already adopted annual visits and modelling the potential cost savings for our health system.
How are we moving from idea to policy to action?
It has been essential to build the evidence base by gathering local data and drawing on the experience of colleagues in countries that have already made this transition. Current data are encouraging, and we urge all countries and implementers making this shift to rigorously analyse and share their findings.
We spoke with the Ministry
of Health and Child Care in Zimbabwe about the country’s implementation
experience.
How did
Zimbabwe transition to annual clinical visits?
Zimbabwe adopted the
annual clinical visit guidance for people living with HIV on ART in 2015
through the Operational and Service Delivery Guidance. This coincided with the
country’s transition towards routine viral load (VL) monitoring. To support
implementation, the Ministry conducted guideline dissemination, healthcare
worker training, and on-the-job mentorship to strengthen understanding and
build confidence among service providers.
What are
your key takeaways from implementing annual clinical visits?
The alignment of annual VL testing with annual clinical visits facilitated
improved cohort management and enabled clearer identification and follow-up of
recipients of care who were missing VL tests. Between 2015 and 2025, national
VL testing coverage increased substantially from 15% to 85%, while VL
suppression rates improved from 86% to 96%. Despite these encouraging trends,
the direct impact of annual clinic visits on recipient of care-level outcomes
has not yet been formally evaluated.
Why annual clinical visits for stable people living with HIV are important, IAS, July 2026
Read the new policy brief developed by the IAS and find out why stable people living with HIV should have annual clinical visits. The brief covers key evidence for annual clinical visits, explains why this matters for national HIV programmes, and shares country experiences of adopting policies that support annual visits.
