The Gambia Transforms HIV Care as Clinics Introduce More Flexible Treatment System

(WHO. Photo by Premuim Times)

In The Gambia, a visit to the clinic for HIV services is no longer just one step in a lengthy process clients now experience tailored, integrated care.

Driving this shift is differentiated service delivery, led by the Ministry of Health with support from the World Health Organization (WHO).

Around 30% of people in The Gambia who test HIV-positive do not begin treatment immediately, often because services are too distant, fragmented or difficult to access when they are needed most.

Differentiated service delivery is designed to eliminate these obstacles and tailor services to meet the individual needs of health clients.

In The Gambia, roughly 25,000 people are living with HIV, and more than two-thirds are aware of their status.

Among those diagnosed, about 70% are on antiretroviral treatment, while nearly 55% have achieved viral suppression.

Historically, HIV prevention and treatment efforts in The Gambia centred largely on preventing mother-to-child transmission (PMTCT) of HIV.

Now, in order to expand testing and treatment access to more people living with HIV, services have been integrated into 77 health facilities, which now serve as broader entry points into care.

To improve the quality of care, the Ministry of Health, working in partnership with WHO and UNAIDS, conducted a three-day training session for 60 health workers and lay counsellors on differentiated service delivery in May 2026.

The training covered the service delivery model, community-based delivery of HIV treatment, adherence support, viral load monitoring and stigma reduction.

This has enabled health facilities to offer more flexible, client-centred services, including improved counselling, multi-month dispensing of HIV treatment and better use of patient data.

These changes have allowed for more personalised care, fewer missed appointments and stronger continuity of treatment.

Clinics are now less congested, with smoother patient flow and shorter waiting times, creating a more supportive environment that encourages people to seek care.

Flexible service hours, including weekend and extended clinic sessions, also help clients stay engaged with their treatment without disrupting their daily lives.

"What used to require separate visits have now been integrated into routine services," says Omar Dampha, officer in charge at Brufut Health Centre in Kombo North, West Coast Region of The Gambia.

"This has made care more discreet, more convenient and easier to navigate."

He adds that clients no longer need to make additional trips solely for treatment, which reduces transport costs and makes it easier for those living far away to stay in care.

"So far, we have recorded no treatment defaulters among enrolled clients," he says.

At the health centre, differentiated service delivery was introduced in October 2025, and by May 2026, 15 clients had been enrolled under the model.

According to senior nursing officer at Brufut Health Centre, Binta Jallow, the shift is evident in how services are now delivered.

"Now care is organized so that clients receive counselling and treatment on one visit," she says, noting that this has streamlined the process and reduced the number of repeat visits required from both clients and health workers.

Health care officer at the centre, Rohey Sarr, has observed the change in how clients experience these services: "When clients feel their privacy is respected and they are treated with dignity, they are more willing to return and continue treatment," she explains.

Between October 2025 and March 2026, more than 1,000 people in The Gambia began HIV treatment through this approach.

Of these, 85% were starting treatment for the first time, while the remainder were mothers enrolled through PMTCT services.

"When HIV services are designed around the needs of people rather than the needs of the system, barriers to care begin to disappear," says Dr Nathan Bakyaita, WHO Representative in The Gambia.

"Differentiated service delivery is helping clients access treatment with greater dignity, convenience and continuity, ultimately improving their quality of life."