By Jessica Posner
The global HIV community is increasingly supporting person-centered care, demanding further de-medicalization of the HIV response and shifting the focus of control to the person. During last week’s International AIDS Conference, delegates openly acknowledged that traditional service delivery models will not be enough to achieve the UNAIDS 95–95–95 goals.
While current antiretroviral and care approaches can suppress HIV, achieving optimal quality of life requires a wider consideration of a person’s well-being, the complexity of individuals’ lives, and the social determinants of health.
A key theme emerged during the course of the conference: people must not only survive but thrive! Achieving viral suppression is a necessary but insufficient goal. The COVID-19 pandemic transformed the usual order of business, clearly demonstrating that delivering health care services and medications closer to home and in more flexible, convenient ways, is feasible. In fact, these differentiated service delivery approaches lead to comparable, if not better outcomes for all people.
JSI is at the forefront of this transformation, shifting the global paradigm of health systems and service delivery. We are disrupting traditional medical (and often paternalistic) norms that expect people to fit the system. Instead, we are focusing on how systems and services can meet people where they are and give them what they need.
To inspire a global discussion on person-centered care (PCC) within HIV at AIDS 2022 in Montreal last week, JSI convened stakeholders from the WHO, USAID, PATH, the Institute of HIV Research and Innovation, and mothers2mothers in a session titled Beyond theory: People, providers, and policymakers share practical perspectives on delivering responsive, person-centered HIV primary health care.
Held just before the conference opening plenary, the session included a series of presentations, video testimonials, and a lively panel discussion that highlighted several key points:
- Innovations born of the COVID-19 pandemic should be sustained for the long-term. For example, panelists discuss mainstreaming community-based service provision, expanding telehealth and mental health care services, and providing people with longer-term medication supplies and home-based diagnostic tools to reduce the frequency of costly health facility visits.
- The new WHO 2021 Service Delivery Guidelines support PCC. It is incumbent upon global implementers and practitioners to roll out and scale-up these guidelines, ensuring that they reach different types of people with the right type of service, in the right time and place, delivered by highly skilled, friendly providers.
- PCC frameworks can inform future strategies and interventions to improve care for people living with HIV and seeking treatment, service providers, and families and communities.
- We must partner with ministries of health to define public sector integrated service packages that are person-centered.
In the session, and throughout the conference, we learned about evidence-based PCC approaches including:
- Human-centered design and community-led monitoring have a critical role in operationalizing and strengthening person-centered service delivery models.
- One-stop shop models increase diagnosis and treatment access and can offer a variety of services tailored to key and priority populations who have been marginalized by the traditional health system.
- PCC interventions are not only for HIV treatment; they can be implemented across the care continuum, through user-informed, customized case identification approaches; personalized linkage to treatment; differentiated service delivery for ART; and optimizing viral load suppression and early infant diagnosis.
- Civil society organizations have a critical role in making PCC a reality, for instance, by mobilizing communities; strengthening the legal environment to mitigate sexual and gender-based violence and gender inequality; and improving accountability through community-led monitoring approaches.
- Programs need to focus on HIV and aging. People living with HIV are at a six-fold risk of developing non-communicable diseases such as diabetes, hypertension, cervical cancer, and depression, making integrated service delivery a critical part of their care.
At the close of the session, JSI’s Kate Onyejekwe challenged all delegates to take the following actions to advance PCC:
Donors and funders: Integrating person-centered HIV services will require resources. Let’s move away from our vertical funding silos and consider adjacent or more integrated programs and realign our performance metrics to measure this.
Policymakers: Many times, we develop aspirational, high-quality policies but fail to operationalize them through guidelines, circulars, training, tools, and indicators. We need political will to transform this vision into a reality in our health centers and communities.
Implementers: In our zeal to deliver services and achieve targets, we may lose sight of our true end goal: supporting people to live high-quality and meaningful lives. Let’s move away from vertical, disease-specific interventions as the only way to achieve targets and maintain epidemic control. People prefer integrated programs, which are often more cost-efficient in the long run.
People: We are all individual users of health services in our communities. We can continue to provide feedback and demand that services be provided in the manner and method we prefer. Let’s keep pressure on our service providers, policymakers, and officials to transform the way health care is delivered, putting us at the center.
JSI’s Center for HIV & Infectious Diseases and its new Behavior Initiative are sharing promising practices with donors, partners, divisions, projects, and staff. In doing so, we are transforming how we design, equip, implement, and monitor our programs. We remain committed to shifting the global paradigm of health service delivery, putting person-centered care at the core of our work.