Human-centered design of an adapted differentiated service delivery model for pregnant and postpartum women living with HIV in Kenya

Abstract

Differentiated service delivery (DSD) models for pregnant and postpartum women living with HIV (WLH) are lacking despite guidelines recommending DSD for this population. We used human-centered design (HCD) to develop a DSD model for pregnant and postpartum WLH at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya. We conducted co-creation workshops with 11 postpartum women, 9 male partners and 9 providers from three AMPATH-affiliated facilities to develop a DSD model, refined by program/county health officials. The workshops used WHO building blocks for DSD to determine eligibility criteria and strategies for clinical encounters, antiretroviral therapy (ART) distribution, and psychosocial support. We used nominal group techniques and thematic analyses to identify DSD attributes, themes and preference heterogeneity. Workshops yielded a facility-based DSD model with these attributes: eligibility criteria including age ≥18 years, not primigravida, retention in care, viral load <50 copies/mL, no active maternal/child comorbidities; monthly clinical encounters during pregnancy and 6 months postpartum, then every 2-3 months aligned with immunization/HIV testing schedules; flexible ART refills every 1-6 months; psychosocial counseling by mentor mothers as needed. This model was acceptable to stakeholders with perceived feasibility/scalability. Engaging end-users through HCD generated a person-centered DSD model for integrated MCH clinics in Kenya.