Table 2 Strengths and constraints of HIV health service delivery in improving HIV case detection and retention in care

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]