Differentiated service delivery: a qualitative study of people living with HIV and accessing care in a tertiary facility in Ghana

BMC Health Serv Res. 2019 Feb 4;19(1):95. doi: 10.1186/s12913-019-3878-7.


Background: In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) set out a treatment target with the objective to help end the AIDS epidemic by 2030. This was supported by the UNAIDS '90-90-90' target that by 2020, 90% of all people living with HIV (PLHIV) will know their HIV status; 90% of all those diagnosed with HIV will be on sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression. The concept of offering differentiated care services using community-based models is evidence-based and is suggested as a means to bring this target into reality. This study sought to explore the possible predictors and acceptability of Community-based health service provision among PLHIV accessing ART services at the Cape Coast Teaching Hospital (CCTH) in Ghana.

Methods: A qualitative study, using 5 focus group discussions (FGD) of 8 participants per group, was conducted at the HIV Clinic in CCTH, in the Central Region of Ghana. Facilitators administered open-ended topic-guided questions. Answers were audio recorded, later transcribed and combined with notes taken during the discussions. Themes around Facility-based and Community-based service delivery and sub-themes developed from the codes, were verified and analyzed by the authors, with the group as the unit for analysis.

Results: Participants expressed preference for facility-based service provision with the construct that, it ensures comprehensive health checks before provision of necessary medications. PLHIV in this study wished that the facility-based visits be more streamlined so "stable clients" could visit twice in a year to reduce the associated time and financial cost. The main barrier to community-based service delivery was concerns about stigmatization and abandonment in the community upon inadvertent disclosure of status.

Conclusions: Although existing evidence suggests that facility-based care was relatively more expensive and time consuming, PLHIV preferred facility-based individualized differentiated model to a community-based model. The fear of stigma and discrimination was very strong and is the main barrier to community-based model among PLHIV in this study and this needs to be explored further and managed.

Keywords: ART; Differentiated Model of Care; Ghana; PLHIV.

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use
  • Delivery of Health Care / organization & administration*
  • Female
  • Focus Groups
  • Ghana
  • HIV Infections / drug therapy*
  • Health Services Accessibility / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Program Evaluation
  • Qualitative Research
  • Tertiary Healthcare* / organization & administration


  • Anti-Retroviral Agents