The “TIER Tool – Tool for Intervention, Evaluation and Ranking”

The TIER Excel tool, developed by the IAS, is designed to support countries in their planning and prioritization of HIV programme elements in the context of funding shifts. This tool provides a structured framework to prioritize HIV programme components – across testing, treatment and prevention – based on epidemiological context and progress toward the 95-95-95 targets.

Explore “The PATHS – Planning and Action Toolbox for HIV Sustainability”

This toolbox, developed by the IAS and partners, is a rapidly deployable resource to support national governments in responding to unexpected reductions in HIV funding by enabling swift reassessment and reorganization of HIV systems and services.

The changing cost-effectiveness of primary HIV prevention: simple calculations of direct effects, Garnett GP et al, J Int AIDS Soc, May 2025

This commentary explores the changing cost effectiveness of HIV prevention tools amid declining HIV incidence, particularly in central, eastern, southern and western Africa. The authors propose simplified equations to estimate cost effectiveness, budget impact and epidemiological benefit, highlighting how these are influenced by such factors as incidence, intervention efficacy and coverage. The commentary concludes that decreasing HIV incidence reduces the value of broad prevention efforts and that existing tools and efforts to identify people with increased vulnerability to HIV acquisition do not allow for substantial efficiency gains.

Testing different models of pharmacy-based HIV pre- and post-exposure prophylaxis initiation and management in Kenya: protocol for a cluster-randomized controlled trial, Kareithi T et al, Res Sq [Preprint], March 2025

This protocol outlines a four-arm (3+1 control arm) cluster-randomized controlled trial to evaluate whether private pharmacies in Central and Western Kenya can effectively deliver HIV PrEP and post-exposure prophylaxis (PEP) compared with the current standard (screening and referral). The four delivery models vary in who pays for the service (clients or providers) and whether additional counselling is provided. Primary outcomes include PrEP initiation and continuation at 60 days. Secondary outcomes include PEP initiation, PEP-to-PrEP transition, repeat PEP use, PrEP/PEP initiation and PrEP/PEP continuation at 60 and 270 days. Acceptability, feasibility and cost will be assessed from client and provider perspectives.

HIV post-exposure prophylaxis in community settings and by lay health workers or through task sharing: a systematic review of effectiveness, case studies, values and preferences, and costs, Kennedy CE et al, J Int AIDS Soc, May 2025

This systematic review informed the updated WHO guidelines on the provision of PEP through decentralization and with task sharing. The data suggest that community-based provision and involvement of trained lay providers or pharmacists can improve PEP uptake and adherence and possibly reduce HIV acquisition. There is broad acceptance among healthcare workers across countries of these models, and one study indicated the cost effectiveness of these models on the African continent. The authors conclude that PEP programmes should be expanded to include community delivery and task sharing. 

This publication is part of the JIAS supplement "PEP in Africa: prospects, opportunities and challenges".

Stakeholders' perspectives on the status of family planning integration into differentiated antiretroviral therapy service delivery models in Uganda: A qualitative assessment, Matovu JKB et al, PLoS One, May 2025

This qualitative study explored the status of, as well as stakeholders’ perspectives about, the integration of family planning (FP) services into self-care-oriented DSD models for female clients living with HIV in Uganda. It found two types of FP integration, with only a few health facilities offering fully integrated “one-stop” services, and most providing collaboration/referrals, leading to increased time and effort for clients. Stakeholders preferred the one-stop model for its convenience, but identified such barriers as staff shortages, FP supply stock-outs, lack of space and inadequate record-keeping systems. This highlights the need for stronger policy support and system improvements to effectively integrate FP into self-care-oriented DSD models.

Effect of differentiated service delivery models for HIV treatment on healthcare providers' job satisfaction and workloads in sub-Saharan Africa: a mixed methods study from Malawi, Zambia, and South Africa, Ntjikelane V et al, Hum Resour Health, May 2025

This mixed-methods study assessed job satisfaction and perceived changes in job satisfaction among HIV care providers in Malawi, South Africa and Zambia after the adoption of DSD models. While overall job satisfaction was high, providers in Malawi were more likely to report dissatisfaction, especially if they felt DSD models made their jobs harder or brought no change. Qualitative findings suggested that DSD models improved working conditions through easing clinic congestion and allowing more focus on meaningful tasks. This emphasizes the value of DSD in enhancing providers’ quality of professional life.

Association between changes in script renewal periods and HIV viral non-suppression: a cohort study of a South African private-sector HIV program, Patten G et al, J Acquir Immune Defic Syndr, [Epub ahead of print] May 2025

This study aimed to evaluate the impact of extending ART prescription renewal periods from six to 12 months on viral non-suppression in South Africa’s private health sector during COVID-19. Using routine claims data and an interrupted time-series analysis, the study compared viral non-suppression trends across three periods: pre-extension; during 12-month renewals; and post-reversion to six-month renewals. Findings include that viral non-suppression decreased more rapidly during the 12-month renewal period and increased again when the six-month interval was reinstated. The authors conclude that extending prescription renewal periods was not associated with worse virologic outcomes among privately insured people living with HIV.

Retention and viral suppression with differentiated time or space for adolescent and young adult HIV care: a systematic review and meta-analysis, Setia Wirawan GB et al, J Acquir Immune Defic Syndr, [Epub ahead of print] April 2025

This systematic review and meta-analysis examined the impact of DSD models offering dedicated time or space for adolescents and young adults living with HIV on their treatment outcomes. Using PRISMA guidelines, the authors included 11 studies (10 from resource-limited African settings) that compared DSD models with standard care. The analysis found that tailored care models significantly improved retention in care and viral suppression, despite moderate heterogeneity, compared with the standard of care. The study concludes that differentiated time or space for adolescent and young adult HIV care can significantly improve treatment outcomes for this population.