Bibliographic information
GuidelineConsolidated HIV guidelines: service delivery
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
Decentralization of HIV treatment and care should be considered as a way to increase access to and improve retention in care: initiation of ART in hospitals with maintenance of ART in health facilities
Recommended in favor
Strong
Certainty of evidence
Low
Notes and Remarks
- The optimal decentralization model depends on local disease burden and health system capacity. Partial decentralization models include specialist-led shared care, teleconsultation, nurse-led follow-up and community refill sites.
- Programme managers should consider client preferences, expected volumes and whether decentralization brings services closer to people; community engagement should be supported to ensure personcentred decisions.
- Standards of care, roles and responsibilities should be clearly defined at each level, including the private sector.
- Decentralization must be supported by strong linkage and referral systems and adequate laboratory services, monitoring and evaluation and supply management.
- Decentralized services should be adapted for key populations, pregnant and postpartum women and HIVexposed children and children living with HIV.