Pharmaceutical Services for Underdeveloped, Frontier, and Outermost (3T) Areas Related to HIV Disease Programs Based on the Integration of Differentiated Service Delivery (DSD) Models: A Systematic Review / Pelayanan Farmasi untuk Daerah Tertinggal, Terdepan, dan Terluar (3T) Terkait Program Penyakit HIV Berdasarkan Integrasi Model Pemberi Layanan yang Terdiferensiasi (PLD): Sebuah Tinjauan Sistematis

Background: Differentiated Service Delivery (DSD) has been proposed to improve HIV treatment continuity in remote areas; however, its success depends on the integration of systemic supports. Objective: This review synthesizes evidence on the effectiveness of community-based DSD models and the determinants of their success in underdeveloped, frontier, and outermost (3T) areas, particularly concerning supply chain resilience, quality assurance, and aligned governance and financing. Methods: A systematic review with narrative synthesis was conducted following PRISMA guidelines. Literature searches were performed in PubMed, Scopus, Web of Science, and grey literature repositories (2010–2025). Out of 1,520 records, 32 studies met the inclusion criteria. Results: Community-based DSD models (ART groups, MMD) were effective in improving adherence, retention, and reducing visit burden. This success was strongly determined by: (1) ARV supply chain stability (minimal stock-out days, synchronization with MMD schedules); (2) quality assurance in storage–distribution (temperature control, FEFO); and (3) aligned governance and financing (pharmacist roles, community health worker incentives, last-mile funding). Qualitative findings identified service proximity, confidentiality, and logistical reliability as key facilitators. Conclusion: DSD is a systemic intervention whose effectiveness hinges on multidimensional readiness. Strengthening HIV pharmaceutical services in 3T areas requires an integrated approach that simultaneously builds supply resilience, service quality, and adaptive governance. This review proposes operational indicators and a phased implementation roadmap for contextual adaptation.

Latar Belakang: Differentiated Service Delivery (DSD) diusulkan untuk meningkatkan kesinambungan pengobatan HIV di wilayah terpencil, namun keberhasilannya bergantung pada integrasi dukungan sistemik. Tujuan: Tinjauan ini mensintesis bukti mengenai efektivitas model DSD berbasis komunitas dan faktor penentu keberhasilannya di wilayah 3T, khususnya terkait rantai pasokan, jaminan mutu, serta tata kelola dan pembiayaan. Metode: Dilakukan tinjauan sistematis dengan sintesis naratif mengikuti pedoman PRISMA. Pencarian literatur dilakukan pada basis data PubMed, Scopus, Web of Science, dan repositori abu-abu (2010–2025). Dari 1.520 rekaman, 32 studi memenuhi kriteria inklusi. Hasil: Model DSD berbasis komunitas (kelompok ART, MMD) efektif meningkatkan kepatuhan dan retensi serta mengurangi beban kunjungan. Keberhasilan ini sangat ditentukan oleh: (1) stabilitas rantai pasokan ARV (minimnya hari kehabisan stok, sinkronisasi dengan MMD); (2) jaminan mutu penyimpanan-distribusi (kontrol suhu, FEFO); dan (3) tata kelola-pembiayaan yang selaras (peran apoteker, insentif kader, pembiayaan last-mile). Temuan kualitatif mengidentifikasi kedekatan layanan, kerahasiaan, dan keandalan logistik sebagai pendorong utama. Kesimpulan: DSD merupakan intervensi sistemik yang keefektifannya bergantung pada kesiapan multidimensi. Penguatan layanan farmasi HIV di wilayah 3T memerlukan pendekatan terpadu yang secara simultan membangun ketahanan pasokan, mutu layanan, dan tata kelola yang adaptif. Tinjauan ini mengusulkan indikator operasional dan peta jalan bertahap untuk implementasi kontekstual.