Background: There are over 420,645 people living with HIV on antiretroviral therapy (ART) in Ethiopia. This number is expected to increase by 30% with the adoption of Test and Treat by the Federal Ministry of Health (FMOH) in 2016. This poses a challenge to the Ethiopian health system, where shortage of clinical staff is a recurring problem.
Description: To address this issue, ICAP, in collaboration with the FMOH and the Centers for Disease Control and Prevention conducted a pilot of a differentiated service delivery (DSD) six-month appointment spacing model (ASM). ICAP established a technical working group on DSD and developed supplemental guidelines, monitoring framework, provider support tools, and training curriculum for regional and facility service providers. Six high-volume health facilities were included in an ASM pilot, which began in April 2017. Eligible non-pregnant adult patients (stable per World Health Organization criteria) were enrolled in the pilot, which included six- months medication supply, biannual clinical visit, annual viral load testing, psychosocial support, counseling, and encouragement to participate in peer support groups.
Lessons learned: Of the 24,657 clients that were currently on ART at the 6 pilot facilities, 12,649 clients (51%) were eligible for ASM, of whom 49% were enrolled by the 6th month of the pilot. Among the 51% who declined participation, the major reasons cited for refusal to participate in the ASM were fear of inadvertent disclosure due to having a large volume of medication and concerns regarding safety and storage of medication for prolonged periods at home. ASM has been scaled-up to 765 facilities, with 57,000 clients enrolled as of November 2017.
Conclusions/Next steps: Implementation of the ASM in the Ethiopian context demonstrated rapid enrollment of a large number of clients within a short period, and acceptance of the model by clients and service providers. Future work is needed to increase acceptance of ASM model and address common concerns cited by those who declined to take part in pilot. Additionally, work will be needed to evaluate retention on ART and healthcare worker and client satisfaction at 1.5 years on ASM.

Cummulative ASM enrollment at the six pilot hospitals, Apr-Nov, 2017
[Cummulative ASM enrollment at the six pilot hospitals, Apr-Nov, 2017]