Table 2.

Strengths and constraints of HIV health service delivery in improving HIV case detection and retention in care

	Strengths	Constraints
Availability	- Outreach peer educators in more than half of districts [D,R]	- Less than one-third of districts offering VCT/ART at district level in middle/low HIV burden provinces [D,R]
	- Two-thirds of districts offering VCT/ART at district level in high HIV burden provinces [D,R]	- Lack of physically accessible VCT/ART in remote areas in high/middle burden provinces [D,R]
Connectedness
Hub & Heart	- Coordination mechanism between administrative detention centers and HIV outpatient clinics emerging [R]	- No coordination mechanism between districts with VCT/ART and those without [D,R]
	- HIV outpatient clinic ‘plus’ at district level expanded in high and middle burden provinces [D,R]	- Clinical services only in government funded HIV outpatient clinic at provincial level [D,R]
		- No system to monitor expansion of outpatient clinic ‘plus’ [D,R]
Chronological	- Chronic care based ART case management established for IDU and non-IDU [R]	- Limited capacity to address the needs of PLHIV on ART for many years [R]
	- Palliative care initiated integrated with cancer care [R]	- Pre-ART care under-developed [R]
		- Linkage from VCT to pre-ART care under-developed [R]
Horizontal	- HIV testing and counseling integrated into TB and antenatal care in donor funded districts with ART/VCT in high (and middle) burden provinces [D]	- Lack of linkage for HIV-TB and HIV-MCH in non-donor funded districts without VCT/ART in middle/low burden provinces [D]
	- Referral system between administrative detention centers and HIV outpatient clinics being developed [R]	- HIV service register not designed to facilitate TB/HIV and PMTCT [R]
Vertical	- Extensive mobilization of peer educators to facilitate MARPs to access VCT [D]	- Access to HIV testing and care and treatment in advanced stage of HIV infection [D,R]
	- Alternative approaches to reach hidden MARPs emerging [D]	- Health workers commonly providing verbal advice only to patients for referral across different levels of health facilities [R]
	- CHBC models mobilizing a wide range of stakeholders [R]	- No system to monitor referral services [R]

Remark:

[D] stands for a strength or constraint that is related to HIV case detection.

[R] stands for a strength or constraint that is related to retention in care.