DSD in WCA: Perspective of the Global Fund Differentiated ART - - PowerPoint PPT Presentation

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DSD in WCA: Perspective of the Global Fund

Differentiated ART delivery approaches for West and Central Africa: From pilots to plans for scale-up ICASA 2019 Lee Abdelfadil The Global Fund 4 December 2019

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Outline

• HIV funding landscape in WCA
• Highlights of Differentiated Service

Delivery for key populations

• New funding cycle for 2021-2023

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Imperative of epidemic control in WCA

• 7% of the global population
• 17% of the world’s population living with

HIV

• 21% of new HIV infections
• 30% of the world’s AIDS-related deaths.

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Global Fund investments (2017-2019 allocation): USD$ 1.0 billion (USD$ 477 million allocated to CIV, DRC, Ghana, Nigeria)

0% 1% 1% 1% 2% 3% 4% 8% 9% 18% 52% TB/HIV Reducing HR barriers Other RSSH Components RSSH: HRH HIV Testing Services RSSH: PSCM PMTCT RSSH: HMIS and M&E All prevention programs Program management Treatment, care and support

Increasing financial absorption rates over the years forecasted to reach 95% from the current allocation by 2020

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5 Great dependency on Global Fund support to the HIV response particularly in non-PEPFAR countries

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Cabo Verde Cameroon CAR Congo Gambia Liberia Niger Senegal Sierra Leone Togo Burkina Faso Côte d'Ivoire DRC Ghana Mali Nigeria Ethiopia Kenya Mozambique South Africa Uganda Tanzania Zambia Zimbabwe Algeria Eritrea Lebanon Mauritania Morocco South Sudan Sudan Angola Botswana Comoros Eswatini Lesotho Madagascar Malawi Mauritius Namibia Rwanda Chad

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PLHIV ON ART (%) 2018 PLHIV WHO KNOW THEIR STATUS (%) 2018

WCA+HIA1+HIA2+SEAF+MENA: PLHIV that know their status

vs PLHIV on ART Targe

*Please note that for Chad first 90, country data have been used in order to include the country in this analysis.

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Benin Cabo Verde Niger Sierra Leone Côte d'Ivoire Nigeria South Africa Uganda Tanzania Zambia Algeria Eritrea Lebanon Morocco Tunisia Botswana Comoros Eswatini Lesotho Malawi Mauritius Namibia Rwanda

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PLHIV ON ART WHO ACHIEVED VIRAL LOAD SUPPRESSION

PLHIV ON ART

WCA+HIA1+HIA2+SEAF+MENA

PLHIV on ART vs PLHIV on ART who achieved VL suppression

Targe ts

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Challenges and DSD priorities

• Low ART coverage

juxtaposed with high investments

• Health system

constrains

• Quality of care (ARD

and VL suppression)

• Community based and

led services

• Key populations access
• DSD for clinically stable

clients

• Extend ART refills
• DSD for KPs: Refills

and psychosocial support by peers and lay providers

• Decentralization and

task-shifting

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Building blocks of model for men who have sex with men- Ghana

ART refills Clinical consultation Psychosocial support

3 months 6 months 6 monthly ART refills Medical check + Adherence counselling At community At the facility of their choice At the health facility OR in the community if it was community based testing Health care worker Doctors/nurses Counsellors and psychologists

See examples to complete table in Decision Framework for ART delivery

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Ghana:

Outcomes for DSD model for MSM

In outreach model, all 60 MSM PLHIV initiated ART and were retained at 12- months

0,00 10,00 20,00 30,00 40,00 50,00 60,00 70,00 80,00 90,00 100,00 20 40 60 80 100 120 140 160 Facility Outreach Rate of initiation/VL Suppression # initiated/retained # Initiated # Retained %Initiation VL Suppression Rate Nagai, 2019

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Funding request requirements

Focus on both HIV treatment and HIV prevention Prioritize interventions at sufficient coverage and scale to have an impact Address populations with greatest HIV burden and barriers to accessing services Rapidly scale-up new and innovative medicines and technologies, as recommended by the WHO and other normative agencies

To save lives and reduce the incidence

• f HIV, the Global Fund urges applicants

to propose funding requests that:

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Global Fund and partner-recommended prioritized interventions across the HIV cascade

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1 2 3 4 5 Hum Human Rig Rights ts HI HIV Trea eatment t and and Car are HI HIV Preventio ion HI HIV Testing g Ser Services HI HIV St Strategic Information

• HIV prevention pro

rogram ams ad addressin ing g KPs in al all l epid idemic ic se settin ings gs, and AGYW and ad adole lescent boys an and me men in high prevalence settings

• Comprehensive condom programming
• PrEP

rEP programs for populations with substantial HIV risk

1

• HIV testing servi

vice ces strategy that uses up up-to to-date and regu gular arly revi viewed dat ata a

• A strat

ategic c mix of differentiated approac aches, including self-testing, that improve testing cove verage, testing yield and effici ciency of HIV testing services

• Interventions that ensure people across all age, sex and risk categories are

linked to the services they need depending on their test results

2

• Scal

Scaled-up DSD DSD models that offer a mix of interventions at both faci acility and community levels

• Rap

apid initiat ation for all people diagnosed with HIV and strong mechanisms to retain people across the cascade

• Introduction at scale of optimal ARV regimens in line with WHO

recommendations

• Advanced HIV disease pathways
• Optimize

zed VL testing at scal cale as preferred treatment monitoring.

• Monitoring of drug resistance through WHO-recommended surveys
• TB preventive treatment (TP

TPT) at scale in countries with high burden of TB/HIV

3

• Routine revi

view of dat ata tracking people along the HIV prevention, testing and treatment cascade

• HIV case surveillance

4

• UNAIDS-endorsed ke

key human rights components, scal aled up up and integrat ated into prevention and treatment programs

5

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• Scaled-up DSD models that provide people-

centered services and offer an appropriate mix

• f interventions at both facility and community

levels, including:

i) Scaling up differentiated approaches with fidelity that address all age, sex and priority groups; ii) Rapid initiation of ART for people diagnosed with HIV including the offer of same-day initiation where there is no clinical contraindication; iii) For stable patients, adopting multi-month (3-6 months) scripting and standardized multi-month refills facilitated by improved capacity of respective procurement and supply management systems.

DSD in the Global Fund information note 2019