Table 1.

Ideal differentiated service delivery models with future long‐acting extended delivery antiretrovirals for HIV treatment and prevention

	HIV antiretroviral treatment			HIV antiretroviral prevention
Building blocks of service delivery	Current DSD model with daily oral tablets	DSD with current LAED a	Ideal with future LAEDs (including oral tablets, injections, implants and patches)	Current DSD model with daily oral tablets	DSD with current LAED b	Ideal with future LAEDs (including oral tablets, injections, implants and patches)
WHEN Service frequency (frequency of refills and clinical consultations)	3‐ to 6‐monthly drug pickup 6‐ to 12‐monthly clinical visits	1‐ to 2‐monthly IM injections with 6‐ to 12‐monthly clinical visits, c 6‐monthly SC injection with 6‐ to 12‐monthly clinical review d	6‐ to 12‐monthly delivery system (LA oral tablets, longer IM injections, SC self‐injections, implants and patches) 6‐ to 12‐monthly clinical visits Alignment with visits for other medical needs	3‐monthly PrEP refills (moving towards 6 monthly) 3‐ to 6‐monthly clinical visits	2‐monthly IM injections and clinical visits	6‐ to 12‐monthly delivery system (LA oral tablets, longer IM injections, SC self‐injections, implants and patches) 6‐ to 12‐monthly clinical visits Alignment with visits for other medical needs
WHERE Service location	ART refills through fast‐track in PHC or decentralized to community settings Clinical visits at primary healthcare	PHC/hospital (with infrastructure for IM injection, cold chain for RPV, management of syringes and needles)	Decentralized—fast track collection at facilities or outside of PHC and hospitals and into communities (e.g. pharmacies, community‐based organizations, mobile vans, home delivery, etc.)	PrEP refills decentralized to community settings Clinical visits at primary healthcare or via telemedicine	PHC/hospital (with infrastructure for IM injection, management of syringes and needles)	Decentralized—fast track delivery at facilities or outside of PHC and into communities (e.g. pharmacies, community‐based organizations, mobile vans, etc.) supported by telemedicine
WHO Service provider (e.g. clinician, nurse, pharmacist, HCW, CHW and peer)	ART refills distributed by lay providers, including peers, pharmacists, CHWs Clinical visits by trained nurses	Trained HCW for IM injections and ART prescribing	Treatment options supporting self‐management: choice of, for example, 6‐ to 12‐month implant; 6 × monthly oral tablets; 6–12 months of a self‐managed SC self‐injection or patch Trained nurse for prescription, implant insertion and monitoring	PrEP refills distributed by lay providers, peers, pharmacists, CHWs and courier Clinical visits by trained HCWs or lay providers supported by clinicians (prescriptions by clinicians)	Trained HCW for IM injections and PrEP prescribing and monitoring	Treatment options supporting self‐management: choice of, for example, 6‐ to 12‐month implant; 6 × monthly oral tablets; 6–12 months of a self‐managed SC or patch Clinical visits by trained HCWs or lay providers supported by clinicians (prescriptions by clinicians)
WHAT Package of services provided	ART refills (& psychosocial support) And at clinical consultations prescriptions, clinical and lab monitoring, OI and other management	Same as current DSD	Same as current DSD + site for implant insertion + product and service integration for other health needs, including STIs, contraception, NCDs and GAHT	PrEP refills, other prevention commodities, HIV self‐test kits, HIV risk and PrEP effective use counselling, PrEP clinical management and monitoring	Same as current DSD	Stipulated minimum package of services (supporting demedicalization) + product and service integration for other health needs, including STIs, contraception, NCDs and GAHT

Abbreviations: ART, antiretroviral therapy; CAB, cabotegravir; CAB/RPV, cabotegravir/rilpivirine; CHW, community‐health worker; DSD, differentiated service delivery; GAHT, gender‐affirming hormonal therapy; HCW, healthcare worker; IM, intramuscular injection; LA, long‐acting; NCDs, non‐communicable diseases; OI, opportunistic infection; PHC, primary health centre; SC, subcutaneous.

^a CAB/RPV, lenacapvir.

^b CAB‐LA.

^c Oral lead in and specifics on loading doses also to be considered.

^d Could also consider 6‐monthly SC injection with 6‐ to 12‐monthly clinical review for the treatment of HIV‐1 infection in heavily treatment‐experienced adults with multidrug resistant HIV‐1 infection and not currently available in low‐ and middle‐income countries (initiation oral dosing also to be considered).