HIV/AIDS Care Delivery Value Chain

INFORMING & ENGAGING

•  Prevention counseling on modes of transmission on risk factors

•  Explaining diagnosis and implications

•  Explaining course and prognosis of HIV

•  Explaining approach to forestalling progression

•  Explaining medical instructions and side effects

•  Counseling about adherence; understanding factors for non-adherence

•  Explaining co-morbid diagnoses

•  End-of-life counseling

PATIENT VALUE

MEASURING

•  HIV testing

•  TB, STI screening

•  Collecting baseline demographics

•  HIV testing for others at risk

•  CD4+ count, clinical exam, labs

•  Monitoring CD4+

•  Continuously assessing co-morbidities

•  Regular primary care assessments

•  Lab evaluations for initiating drugs

•  HIV staging, response to drugs

•  Managing complications

•  HIV staging, response to drugs

•  Regular primary care assessments

ACCESSING

•  Meeting patients in high-risk settings

•  Primary care clinics

•  Testing centers

•  Primary care clinics

•  Clinic labs

•  Testing centers

•  Primary care clinics

•  Food centers

•  Home visits

•  Primary care clinics

•  Pharmacy

•  Support groups

•  Primary care clinics

•  Pharmacy

•  Support groups

•  Primary care clinics

•  Pharmacy

•  Hospitals, hospices

PREVENTION & SCREENING

DIAGNOSING & STAGING

DELAYING PROGRESSION

INITIATING ARV THERAPY

ONGOING DISEASE MANAGEMENT

MANAGEMENT OF CLINICAL DETERIORATION

(Health outcomes per unit of cost)

•  Connecting patient with primary care

•  Identifying high-risk individuals

•  Testing at-risk individuals

•  Promoting appropriate risk reduction strategies

•  Modifying behavioral risk factors

•  Creating medical records

•  Formal diagnosis, staging

•  Determining method of transmission

•  Identifying others at risk

•  TB, STI screening

•  Pregnancy testing, contraceptive counseling

•  Creating treatment plans

•  Initiating therapies that can delay onset, including vitamins and food

•  Treating co-morbidities that affect disease progression, especially TB

•  Improving patient awareness of disease progression, prognosis, transmission

•  Connecting patient with care team

•  Initiating comprehensive ARV therapy, assessing drug readiness

•  Preparing patient for disease progression, treatment side effects

•  Managing secondary infections, associated illnesses

•  Managing effects of associated illnesses

•  Managing side effects

•  Determining supporting nutritional modifications

•  Preparing patient for end-of-life management

•  Primary care, health maintenance

•  Identifying clinical and laboratory deterioration

•  Initiating second- and third-line drug therapies

•  Managing acute illnesses and opportunistic infection through aggressive outpatient management or hospitalization

•  Providing social support

•  Access to hospice care