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We describe the scale of DSD implementation among HIV facilities in low\u2010 and middle\u2010income countries (LMICs) in Latin America, Africa and the Asia\u2010Pacific before the COVID\u201019 pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed facility\u2010level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi\u2010month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 175 facilities in the Asia\u2010Pacific (<jats:italic>n<\/jats:italic> = 30), Latin America (<jats:italic>n<\/jats:italic> = 8), Central Africa (<jats:italic>n<\/jats:italic> = 21), East Africa (<jats:italic>n<\/jats:italic> = 74), Southern Africa (<jats:italic>n<\/jats:italic> = 28) and West Africa (<jats:italic>n<\/jats:italic> = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility\u2010based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client\u2010managed group models (60%). Out\u2010of\u2010facility individual models were available at 48% of facilities. Facility\u2010based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility\u2010based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long\u2010term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre\u2010COVID\u201019 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client\u2010centred care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26477","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:29:34Z","timestamp":1751884174000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Scale of differentiated service delivery implementation in HIV care facilities in low\u2010 and middle\u2010income countries: a global facility survey"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7560-5256","authenticated-orcid":false,"given":"Nathalie Ver\u00f3nica","family":"Fern\u00e1ndez Villalobos","sequence":"first","affiliation":[{"name":"Institute of Social and Preventive Medicine University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Helfenstein","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine University of Bern Bern Switzerland"},{"name":"Department of Clinical Research University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vohith","family":"Khol","sequence":"additional","affiliation":[{"name":"National Center for HIV\/AIDS, Dermatology &amp; STDs Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1102-5564","authenticated-orcid":false,"given":"Christella","family":"Twizere","sequence":"additional","affiliation":[{"name":"Centre National de R\u00e9f\u00e9rence en mati\u00e8re de VIH\/SIDA (CNR) Bujumbura Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayara","family":"Secco","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Infectologia Evandro Chagas (INI) Funda\u00e7\u00e3o Oswaldo Cruz Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Castelnuovo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, College of Health Sciences Makerere University Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Huwa","sequence":"additional","affiliation":[{"name":"Lighthouse Trust Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9393-9732","authenticated-orcid":false,"given":"Thierry","family":"Tiendredbeogo","sequence":"additional","affiliation":[{"name":"University of Bordeaux National Institute for Health and Medical Research (INSERM) UMR 1219 Research Institute for Sustainable Development (IRD) EMR 271 Bordeaux Population Health Research Centre Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8375-3926","authenticated-orcid":false,"given":"C. 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