Background: The adoption of the ''Test and Start'' strategy to accelerate the achievement of the 90-90-90 goals has increased the number of PLHIV receiving ART. Stable ART clients often do not require the same level of clinical oversight and could receive services through alternative models, allowing limited HRH to see those clients who require regular monitoring.
Service providers have identified differentiated service delivery (DSD) models of care for clinically stable ART clients as a way to provide services more efficiently. Estimating and optimizing available or required human resources becomes the next requirement. To aid in decision-making for implementation and resource allocation, the HRH2030 program, funded by USAID, through PEPFAR, developed a simple, client-focused tool that guides users for standardizing estimation of HRH needs.
Methods: From August to December 2017, data were collected from 20 experienced ART clinics and community-based service points in Uganda (see table) that manage about 62,000 clients. The information obtained was used to benchmark client-service provider contact time for critical tasks performed along the HIV service delivery continuum under different DSD models. Key data collected included: annual ART client caseloads (new and current); client classifications (stable, unstable) as well as by sub-population; DSD models implemented; service provider types, numbers, task distribution and level of effort.
Client flows for 395 ART recipients were observed for a total of 1,720 critical task observations over a period of over 64,000 minutes. Using these data, a prototype tool that estimates HRH need based on the users'' client load and workforce was developed and piloted in Cameroon and Uganda. Expert stakeholder interviews were also utilized to fine-tune the tool.
Results: The tool contains algorithms that enable users to estimate HRH needs from the annual ART client caseload and allows the building of scenarios for workforce mix and task- sharing/shifting for optimizing resource allocations. Results from a pilot in Cameroon suggest it helps facility staff make more informed HRH decisions.
Conclusions: Use of DSD models globally is rapidly expanding. Two country pilots have shown promising value for this tool. Implementation in additional settings will gauge further utility, accuracy, areas for additional refinement, and options for country-specific contextualization.



[Details of Data Collection from Uganda]

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