title: HIV service delivery models towards 'Zero AIDS-related Deaths': a collaborative case study of 6 Asia and Pacific countries.
abstract: BACKGROUND
  In the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance monitoring for maximizing HIV case detection and retention.
  
  
  METHODS
  Each country formed a review team that provided published and unpublished information from the national HIV program. Four types of continuum were examined: (i) service linkages between key population outreach and HIV diagnosis (vertical-community continuum); (ii) chronic care provision across HIV diagnosis and treatment (chronological continuum); (iii) linkages between HIV and other health services (horizontal continuum); and (iv) comprehensive care sites coordinating care provision (hub and heart of continuum).
  
  
  RESULTS
  Regarding the vertical-community continuum, all districts had voluntary counselling and testing (VCT) in all countries except for Myanmar and Vietnam. In these two countries, limited VCT availability was a constraint for referring key populations reached. All countries monitored HIV testing coverage among key populations. Concerning the chronological continuum, the proportion of districts/townships having antiretroviral treatment (ART) was less than 70% except in Thailand, posing a barrier for accessing pre-ART/ART care. Mechanisms for providing chronic care and monitoring retention were less developed for VCT/pre-ART process compared to ART process in all countries. On the horizontal continuum, the availability of HIV testing for tuberculosis patients and pregnant women was limited and there were sub-optimal linkages between tuberculosis, antenatal care and HIV services except for Cambodia and Thailand. These two countries indicated higher HIV testing coverage than other countries. Regarding hub and heart of continuum, all countries had comprehensive care sites with different degrees of community involvement.
  
  
  CONCLUSIONS
  The analytical framework was useful to identify similarities and considerable variations in service availability and linking approaches across the countries. The study findings would help each country critically adapt and adopt global recommendations on HIV service decentralization, linkages and integration. Especially, the findings would inform cross-fertilization among the countries and national HIV program reviews to determine county-specific measures for maximizing HIV case detection and retention.
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authors.affiliation: Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, USA. krishna@schoolph.umass.edu.
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authors.lastname: Poudel
authors.affiliation: Formerly FHI 360, Accra, Ghana. kimberlyegreen@icloud.com.
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authors.affiliation: Pan American Health Organization, World Health Organization Regional Office for the Americas, Washington, DC, USA. ghidinellim@paho.org.
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authors.affiliation: World Health Organization, Hanoi, Vietnam. KatoM@wpro.who.int.
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authors.affiliation: National Center for HIV/AIDS, Dermatology and STD, Ministry of Health, Phnom Penh, Cambodia. mchhivun@nchads.org.
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authors.affiliation: National Center for HIV/AIDS, Dermatology and STD, Ministry of Health, Phnom Penh, Cambodia. sengsopheap@nchads.org.
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authors.affiliation: Formerly National AIDS Program, Ministry of Health, Nay Pyi Taw, Myanmar. komsinya@gmail.com.
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authors.affiliation: World Health Organization, Yangon, Myanmar. Bollenp@SEARO.WHO.INT.
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authors.affiliation: National Center for AIDS and STD Control, Ministry of Health, Kathmandu, Nepal. raikrishnadr@yahoo.com.
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authors.lastname: Rai
authors.affiliation: World Health Organization, Kathmandu, Nepal. dahala@SEARO.WHO.INT.
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authors.affiliation: FHI 360, Kathmandu, Nepal. durgapbhandari@gmail.com.
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authors.affiliation: STI, HIV and AIDS Surveillance Unit, Ministry of Health, Port Moresby, Papua New Guinea. boaspeniel@yahoo.com.
authors.forename: Peniel
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authors.affiliation: National AIDS Management Center, Ministry of Public Health, Bangkok, Thailand. spetchsri@gmail.com.
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authors.affiliation: National AIDS Management Center, Ministry of Public Health, Bangkok, Thailand. drpairoj.saonuam@yahoo.com.
authors.forename: Pairoj
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authors.affiliation: Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam. bdduong06@gmail.com.
authors.forename: Bui Duc
authors.initials: BD
authors.lastname: Duong
authors.affiliation: Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam. dothinhan@gmail.com.
authors.forename: Do Thi
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authors.lastname: Nhan
authors.affiliation: Clinton Health Access Initiative, Hanoi, Vietnam. thu2009@gmail.com.
authors.forename: Nguyen Thi Minh
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authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. ohjimba@gmail.com.
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mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D001208:Asia; D001210:Asia, Southeastern / Q000453:epidemiology; D003299:Cooperative Behavior; D003376:Counseling; D005260:Female; D006296:Health Services / Q000592:standards*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D017146:Models, Organizational; D009390:Nepal / Q000453:epidemiology; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D011787:Quality of Health Care; D014376:Tuberculosis; D055815:Young Adult