{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:00:27Z","timestamp":1791385227691,"version":"4.3.3"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:00:00Z","timestamp":1678752000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In 2018, Mozambique's Ministry of Health launched a guideline for a nationwide implementation of eight differentiated service delivery models to optimize HIV service delivery and achieve universal coverage of HIV care and treatment. The models were (1) Fast\u2010track, (2) Three\u2010month Antiretrovirals Dispensing, (3) Community Antiretroviral Therapy Groups, (4) Adherence Clubs, (5) Family\u2010approach, and three one\u2010stop shop models for (6) Tuberculosis, (7) Maternal and Child Health, and (8) Adolescent\u2010friendly Health Services. This study identified drivers of implementation success and failure across these differentiated service delivery models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty in\u2010depth individual interviews were conducted with managers and providers from the Ministry of Health and implementing partners from all levels of the health system between July and September 2021. National\u2010level participants were based in the capital city of Maputo, and participants at provincial, district and health facility levels were from Sofala province, a purposively selected setting. The Consolidated Framework for Implementation Research (CFIR) guided data collection and thematic analysis. Deductively selected constructs were assessed while allowing for additional themes to emerge inductively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The CFIR constructs of Relative Advantage, Complexity, Patient Needs and Resources, and Reflecting and Evaluating were identified as drivers of implementation, whereas Available Resources and Access to Knowledge and Information were identified as barriers. Fast\u2010track and Three\u2010month Antiretrovirals Dispensing models were deemed easier to implement and more effective in reducing workload. Adherence Clubs and Community Antiretroviral Therapy Groups were believed to be less preferred by clients in urban settings. COVID\u201019 (an inductive theme) improved acceptance and uptake of individual differentiated service delivery models that reduced client visits, but it temporarily interrupted the implementation of group models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study described important determinants to be addressed or leveraged for the successful implementation of differentiated service delivery models in Mozambique. The models were considered advantageous overall for the health system and clients when compared with the standard of care. However, successful implementation requires resources and ongoing training for frontline providers. COVID\u201019 expedited individual models by loosening the inclusion criteria; this experience can be leveraged to optimize the design and implementation of differentiated service delivery models in Mozambique and other countries.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26076","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T07:27:46Z","timestamp":1678778866000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Managers\u2019 and providers\u2019 perspectives on barriers and facilitators for the implementation of differentiated service delivery models for HIV treatment in Mozambique: a qualitative study"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2531-6402","authenticated-orcid":false,"given":"Dorlim","family":"Moiana Uetela","sequence":"first","affiliation":[{"name":"Instituto Nacional de Sa\u00fade  Maputo Mozambique"},{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gimbel","sequence":"additional","affiliation":[{"name":"Department of Child, Family and Population Health Nursing University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celso","family":"Inguane","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onei","family":"Uetela","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneth","family":"Dinis","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"National Directorate of Public Health Ministry of Health  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleny","family":"Couto","sequence":"additional","affiliation":[{"name":"National STI\u2010HIV\/AIDS Program Ministry of Health  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ir\u00e9nio","family":"Gaspar","sequence":"additional","affiliation":[{"name":"National STI\u2010HIV\/AIDS Program Ministry of Health  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo S.","family":"Gudo","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9rgio","family":"Chicumbe","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Gaveta","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orvalho","family":"Augusto","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Universidade Eduardo Mondlane  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Sherr","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"},{"name":"Department of Industrial &amp; Systems Engineering University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,14]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001137"},{"key":"e_1_2_12_3_1","unstructured":"MISAU.Relat\u00f3rio Anual das Actividades Relacionadas ao HIV\/SIDA.2021."},{"key":"e_1_2_12_4_1","unstructured":"UNAIDS. 90\u201090\u201090: an ambitious treatment target to help end the AIDS epidemic.2014."},{"key":"e_1_2_12_5_1","volume-title":"Guideline on when to start antiretroviral therapy and on pre\u2010exposure prophylaxis for HIV","author":"World Health Organization","year":"2015"},{"key":"e_1_2_12_6_1","unstructured":"Minist\u00e9rio da Sa\u00fade.Direc\u00e7\u00e3o Nacional De Sa\u00fade P\u00fablica \u2010 Programa Nacional De Controlo Das its\/Hiv E Sida. 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