In Malawi, innovative models have been developed to optimize the efficiency of HIV service delivery in order to scale up access to treatment. In particular, three key models of differentiated care have emerged: multi-month prescriptions; fast-track drug refills; and community ART groups. In collaboration with the Ministry of Health of Malawi, CHAI conducted a mixed methods process evaluation that assessed the extent to which patients in Malawi are differentiated based on clinical stability and described the characteristics and costs of the models.
Our findings suggest that there are major benefits to be offered by implementing differentiated models of care, but there is also potential for improvement in the implementation of these models in Malawi. Multi-month prescriptions are already the standard of care throughout Malawi; however, patients are not being differentiated properly in all cases, such that there are stable and eligible patients not receiving MMS and unstable, ineligible patients that are receiving MMS. Further improving patient differentiation will maximize the efficiency benefits of MMS and provide the highest quality of care possible. Fast-track drug refills and community ART groups are currently implemented on a more limited basis in Malawi. The additional benefits of these models beyond those offered by multi-month prescriptions are limited and may not justify an aggressive scale-up of these models. Recommendations are offered to facilitate improvements to the implementation of differentiated models of care in Malawi, and many of these findings may be applied to other country settings. Read the full policy brief here.
