The Decision Framework is aimed at supporting the implementation of differentiated models of ART delivery. It provides a background to the principles and a menu of examples. A 5-step plan to guide ART programme managers is outlined and the key “elements” to consider are described along with the “building blocks” of service delivery. The Decision Framework gives guidance on how to prioritize differentiated care to address some of the common challenges of people living with HIV in a given setting. Further iterations of the Decision Framework will be developed to support other parts of the treatment cascade, specific sub-populations and other contexts.