{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:42:38Z","timestamp":1790145758998,"version":"4.0.1"},"reference-count":17,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2017,7,21]],"date-time":"2017-07-21T00:00:00Z","timestamp":1500595200000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Introduction<\/jats:bold>: Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. M\u00e9decins Sans Fronti\u00e8res (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF\u2010supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC).<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: Services included provision of general health care, with out\u2010patient care (range between countries 43,343 and 287,163 consultations\/year in 2015) and in\u2010patient care (range 1076\u201316,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12\u2013255 patients\/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi\u2010month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and peer support activities.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>: The principles of differentiated HIV care for high\u2010quality ART delivery can successfully be applied in challenging operating environments. However, success heavily depends on specific adaptations to each setting.<\/jats:p>","DOI":"10.7448\/ias.20.5.21654","type":"journal-article","created":{"date-parts":[[2017,5,27]],"date-time":"2017-05-27T06:44:16Z","timestamp":1495867456000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs"],"prefix":"10.1002","volume":"20","author":[{"given":"Charles","family":"Ssonko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Mesic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio Silveira","family":"da Fonseca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Achar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Safar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidney","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther C.","family":"Casas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30087-X"},{"key":"e_1_2_8_3_1","unstructured":"Fact sheet 2016 |UNAIDS [Internet]. [cited 2016 Nov 8]. Available from:http:\/\/www.unaids.org\/en\/resources\/fact\u2010sheet"},{"key":"e_1_2_8_4_1","unstructured":"Fast\u2010track. Ending the HIV epidemic by 2030[Internet]. [cited 2016 Sep 7]. Available from:http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/JC2686_WAD2014report_en.pdf"},{"key":"e_1_2_8_5_1","unstructured":"On the fast track to ending the AIDS epidemic \u2010 20160423_SGreport_HLM_en.pdf[Internet]. [cited 2016 Sep 7]. Available from:http:\/\/sgreport.unaids.org\/pdf\/20160423_SGreport_HLM_en.pdf"},{"key":"e_1_2_8_6_1","unstructured":"New toolkit for differentiated care in HIV and TB programs [Internet]. The Global Fund to fight AIDS Tuberculosis and Malaria. [cited 2016 Oct 19]. Available from:http:\/\/www.theglobalfund.org\/en\/news\/2015\u201012\u201004_New_Toolkit_for_Differentiated_Care_in_HIV_and_TB_Programs\/"},{"key":"e_1_2_8_7_1","unstructured":"Out of focus. How millions of people in west and central africa are being left out of the global HIV response. [Internet]. [cited 2016 Sep 7]. Available from:http:\/\/www.msf.org\/sites\/msf.org\/files\/2016_04_hiv_report_eng.pdf"},{"key":"e_1_2_8_8_1","unstructured":"Overcoming Challenges in Global Health [Internet]. The Global Fund to fight AIDS Tuberculosis and Malaria. [cited 2016 Oct 19]. Available from:http:\/\/www.theglobalfund.org\/en\/blog\/2016\u201005\u201024_Overcoming_Challenges_in_Global_Health\/"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/13623699.2013.813108"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1505-4-12"},{"key":"e_1_2_8_11_1","unstructured":"MSF International Activity Report 2015 [Internet]. M\u00e9decins Sans Fronti\u00e8res (MSF) International. [cited 2016 Oct 19]. Available from:http:\/\/www.msf.org\/en\/article\/msf\u2010international\u2010activity\u2010report\u20102015"},{"key":"e_1_2_8_12_1","unstructured":"Pr\u00e9valence de l'Infection VIH et Facteurs Associ\u00e9s en R\u00e9publique Centrafricaine en 2010 [FR263] \u2010 pnadz800.pdf[Internet]. [cited 2016 Oct 19]. Available from:http:\/\/pdf.usaid.gov\/pdf_docs\/pnadz800.pdf"},{"key":"e_1_2_8_13_1","unstructured":"Countries |UNAIDS [Internet]. [cited 2016 Sep 20]. Available from:http:\/\/www.unaids.org\/en\/regionscountries\/countries"},{"key":"e_1_2_8_14_1","unstructured":"Data The World Bank [Internet]. [cited 2016 Oct 19]. Available from:http:\/\/data.worldbank.org\/"},{"key":"e_1_2_8_15_1","unstructured":"R\u00e9publique centrafricaine |ONUSIDA [Internet]. [cited 2016 Oct 19]. Available from:http:\/\/www.unaids.org\/fr\/regionscountries\/countries\/centralafricanrepublic"},{"key":"e_1_2_8_16_1","unstructured":"2016_04_hiv_report_eng.pdf[Internet]. [cited 2016 Sep 7]. Available from:http:\/\/www.msf.org\/sites\/msf.org\/files\/2016_04_hiv_report_eng.pdf"},{"key":"e_1_2_8_17_1","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection [Internet]","author":"WHO"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2010.525615"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.7448%2FIAS.20.5.21654","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.7448\/IAS.20.5.21654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T17:23:13Z","timestamp":1694884993000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.7448\/IAS.20.5.21654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":17,"journal-issue":{"issue":"S4","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.7448\/IAS.20.5.21654"],"URL":"https:\/\/doi.org\/10.7448\/ias.20.5.21654","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]},"assertion":[{"value":"2016-11-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-04-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-07-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"21654"}}