In Support Of South Africas National HIV Program PEPFAR Oversight - - PowerPoint PPT Presentation

In Support Of South Africa’s National HIV Program PEPFAR Oversight and Accountability Results Team (POART) COP16 (F (FY17 Q4) ) Annual Program Results Review 27 Focus Dis istricts

PEPFAR South Africa December 2017

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COP16 - FY17 Q4 POART – 27 Focus Districts Outline/Table of Contents

Program Area Slides Overview – Results 3-5 VMMC 6-11 DREAMS 12-14 OVC 15-20 Priority Populations Prevention 21-25 Key Populations 26-31 1st 90 32-46 2nd 90 47-63 3rd 90 64-69 Above Site Investments 70-76 SIMS 77-81

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COP16 (FY17 APR) Overview: 27 Focus Districts

*PP_PREV target excludes SRHR and condom promotion / provision *OVC_SERV results reported for 52 districts APR-Annual Program Results

Good performance against target: HTS, Viral load suppression, and Prevention portfolio

FY2017 Q1 FY2017 Q2 FY2017 Q3 FY2017 Q4 FY2017 APR FY2017 TARGET % Achievement HTS_TST 2,456,092 2,567,085 2,870,112 2,778,479 10,671,768 5,767,766 185% HTS_TST_POS 221,892 234,127 241,300 223,025 920,344 839,648 110% HTS Yield 9.0% 9.1% 8.4% 8.0% 8.6% 14.6% TX-NEW 183,957 191,305 155,646 163,816 694,724 965,131 72% Linkage 83% 82% 65% 73% 75% 115% TX_CURR 2,950,894 3,040,021 3,157,137 3,157,965 3,157,965 3,935,927 80% TX_NET_NEW 235,131 89,127 117,116 828 442,202 1,220,164 36% TX_RET 70% 70% 90% 78% TX_PVLS 85% 85% 91% 93% VMMC_CIRC 44,626 47,280 158,791 189,950 440,647 393,465 112% PrEP_NEW 304 381 698 768 2,151 1,279 168% KP_PREV 116,930 71,115 188,045 109,385 172% PP_PREV 343,849 752,441 1,096,290 579,323 189% OVC_SERV 442,200 762,304 799,820 664,521 120%

NB: Low net increase in Tx_Curr Q3 to Q4 was due to data reporting corrections, which have been addressed. Net increase in reported Tx_Curr was 207,071 for facilities supported in the 27 focus districts.

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COP16 (FY17 APR) Overview: 27 Focus Districts

*PP_PREV target excludes SRHR and condom promotion / provision *OVC_SERV results reported for 52 districts APR-Annual Program Results

Did not achieve target: TX_NEW, TX_CURR, Retention

FY2017 Q1 FY2017 Q2 FY2017 Q3 FY2017 Q4 FY2017 APR FY2017 TARGET % Achievement HTS_TST 2,456,092 2,567,085 2,870,112 2,778,479 10,671,768 5,767,766 185% HTS_TST_POS 221,892 234,127 241,300 223,025 920,344 839,648 110% HTS Yield 9.0% 9.1% 8.4% 8.0% 8.6% 14.6% TX-NEW 183,957 191,305 155,646 163,816 694,724 965,131 72% Linkage 83% 82% 65% 73% 75% 115% TX_CURR 2,950,894 3,040,021 3,157,137 3,157,965 3,157,965 3,935,927 80% TX_NET_NEW 235,131 89,127 117,116 828 442,202 1,220,164 36% TX_RET 70% 70% 90% 78% TX_PVLS 85% 85% 91% 93% VMMC_CIRC 44,626 47,280 158,791 189,950 440,647 393,465 112% PrEP_NEW 304 381 698 768 2,151 1,279 168% KP_PREV 116,930 71,115 188,045 109,385 172% PP_PREV 343,849 752,441 1,096,290 579,323 189% OVC_SERV 442,200 762,304 799,820 664,521 120%

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Substantial Improvements Between COP15 and COP16 (FY16 and FY17)

8,968,393 861,291 546,797 63% 2,715,763 285,260 11 10,671,768 920,344 694,724 76% 3,157,965 440,647 2,151

FY2016APR FY2017APR

19% increase 7% increase 27% increase 20% increase 16% increase 54% increase Large increase

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VMMC

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Overall COP16 (FY17) Performance

1,273,212 males circumcised through the PEPFAR program in the past three years 428 486

Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017 July-Sep 2017

460 668

• 50 000

100 000 150 000 200 000 250 000 300 000 350 000 400 000 450 000 500 000

FY17 Targets FY17 Results

50000 100000 150000 200000 250000 Jul-Sep 14 Oct-Dec 14Jan-Mar 15Apr-Jun 15 Jul-Sep 15 Oct-Dec 15Jan-Mar 16Apr-Jun 16 Jul-Sep16 Oct-Dec 16Jan-Mar 17Apr-Jun 17 Jul-Sep 17

VMMC Perfomance Linear (VMMC Perfomance)

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53% 50% 96% 39% 35% 25% 79% 48% 70% 50% 59% 47% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

• 10 000

20 000 30 000 40 000 50 000 60 000

FY17 Oct 16 - Sep 17 Results FY17 Results (%)

FY17 Performance Across Districts

DREAMS Performance above 100%

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VMMC Age trend FY16 – FY17

49% 47% 49% 55% 43% 32% 38% 50% 23% 18% 16% 17% 16% 26% 26% 20% 11% 10% 11% 9% 12% 12% 15% 10% 17% 23% 23% 18% 27% 28% 20% 19% 1% 1% 1% 1% 2% 1% 1% 1%

131 389 47 400 55 890 121 067 48 878 49 763 163 301 198 410

0% 20% 40% 60% 80% 100% FY16 Q1 FY16 Q2 FY16 Q3 FY16 Q4 FY17 Q1 FY17 Q2 FY17 Q3 FY17 Q4

Total >=50 25-49 20-24 15-19 10-14

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VMMC Program Quality (SIMS)

• Overall performance: 82% Green
• New VMMC registers were introduced last month
• AE training & introduction of improved AE reporting forms

VMMC SETS Total CEEs RED YELLOW GREEN 05_01 [069] VMMC Registers (paper) 31 23% 3% 74% 05_02 [070] VMMC Registers (electronic) 1 0% 0% 100% 05_03 [071] Adverse Event Prevention and Management 33 21% 0% 79% 05_04 [072] Voluntarism and Informed Consent 30 7% 0% 93% 05_05 [073] VMMC Clinical Follow-Up 30 7% 10% 83%

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DREAMS

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DREAMS Districts (CoJ, Ekurhuleni, eThekwini, uMgungunlovu, uMkandekude)

Distribution of ANC clients by age between COP15 and 16 (FY16 - FY17)

R² = 0.7527

1000 2000 3000 4000 5000 6000 7000 8000 9000 FY2016Q1 FY2016Q2 FY2016Q3 FY2016Q4 FY2017Q1 FY2017Q2 FY2017Q3 FY2017Q4

ANC Clients Ages 15-19

ANC Clients (Ages 15-19) Linear (ANC Clients (Ages 15-19)) R² = 0.7534 5000 10000 15000 20000 25000 30000 FY2016Q1 FY2016Q2 FY2016Q3 FY2016Q4 FY2017Q1 FY2017Q2 FY2017Q3 FY2017Q4

ANC Clients Ages 20-24

ANC Clients (Ages 20-24) Linear (ANC Clients (Ages 20-24)) R² = 0.3431 10000 20000 30000 40000 50000 60000 FY2016Q1 FY2016Q2 FY2016Q3 FY2016Q4 FY2017Q1 FY2017Q2 FY2017Q3 FY2017Q4

ANC Clients Ages 25+

ANC Clients (Ages 25+) Linear (ANC Clients (Ages 25+))

25% % dr drop

• p be

between FY FY 16 & & FY FY 17 33% % dr drop

• p be

between FY FY16 & & FY FY 17 8 % % dr drop between FY FY 16 & & FY FY 17

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Distribution of Newly Identified Positives by age between FY 16 & FY 17

Reduction in Identified positives in ANC in DREAMS districts between FY 16 and FY 17:

• 15-19 years:

25%

• 20-24 years:

6.8%

• 25+ years:

7.4%

2000 4000 6000 8000 10000 12000 FY2016Q1 FY2016Q2 FY2016Q3 FY2016Q4 FY2017Q1 FY2017Q2 FY2017Q3 FY2017Q4

DREAMS Districts Newly Identified Positive by Age

Newly Identified Positive (Ages 25+) Newly Identified Positive (Ages 20-24) Newly Identified Positive (Ages 15-19)

DREAMS Districts (CoJ, Ekurhuleni, eThekwini, uMgungunlovu, uMkandekude)

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742 266 349 600 282 330 12 285 1 501 1 344 771 366 907 257 330 10 769 1 233 181% 105% 91% 88% 82% 0% 20% 40% 60% 80% 100% 120% 140% 160% 180% 200% 200000 400000 600000 800000 1000000 1200000 1400000 1600000 HTS_Community PP_Prev OVC_Serv Gend_GBV PrEP New

DREAMS Districts Performance, FY17

Target Result %Achieved

DREAMS Districts (CoJ, Ekurhuleni, eThekwini, uMgungunlovu, uMkandekude)

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Orphans and Vulnerable Children (OVC)

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OVC Served – Summary Achievement

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% 140.00% 160.00% 10000 20000 30000 40000 50000 60000 70000 80000 90000

FY17 Q4 OVC_SERV Results & % Achievement

OVC_SERV Results DSD +TA % Achieved

% Achieved

Gray = Saturation Districts

*Results over 175% not reported in chart. This includes: Buffalo City Metro, Mopani District, Ugu District, Harry Gwala District, King Cetshwayo District, Alfred Nzo District, Dr. KK District, and Waterburg District.

• No. of beneficiaries reached
• OVC Program

achieved 115% of FY2017 target

• 23 of the 27 Focus

Districts achieved 80% or above target.

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OVC HIV_Status Program Performance and Linkage to ART

0% 20% 40% 60% 80% 100% 120% 200 400 600 800 1000 1200 1400 1600 1800 2000 ec Alfred Nzo District Municipality ec Chris Hani District Municipality ec Oliver Tambo District Municipality gp City of Johannesburg Metropolitan… kz Uthukela District Municipality gp Ekurhuleni Metropolitan Municipality gp City of Tshwane Metropolitan… fs Lejweleputswa District Municipality lp Capricorn District Municipality kz Zululand District Municipality nw Bojanala Platinum District… mp Ehlanzeni District Municipality wc City of Cape Town Metropolitan… kz Ugu District Municipality lp Mopani District Municipality gp Sedibeng District Municipality mp Gert Sibande District Municipality kz uMgungundlovu District Municipality ec Buffalo City Metropolitan Municipality kz King Cetshwayo District Municipality nw Dr Kenneth Kaunda District… fs Thabo Mofutsanyane District… kz eThekwini Metropolitan Municipality kz Harry Gwala District Municipality mp Nkangala District Municipality ec Amathole District Municipality nw Ngaka Modiri Molema District…

OVC_HIV STAT_POS and Linkage to ART FY17 APR

Total OVC_HIVSTAT_POS Total OVC_HIVSTAT_ART Target Proxy Linkage to ART

• No. of beneficiaries

170 914 9 079 320 775 66 716 100 000 200 000 300 000 400 000 500 000 600 000 APR 2017 Result No of Beneficiaries

OVC_HIVSTAT Results

OVC_HIVSTAT Test Not Indicated OVC_HIVSTAT Other Reasons OVC_HIVSTAT Positive OVC_HIVSTAT Negative

12% 57% 2% 30%

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Site Improvement Monitoring System (SIMS) Scores: OVC

• OVC identified as area for improvement

in South Africa.

• OVC sites identified for increased SIMS

assessments.

• Weakest CEEs in both FY 16 & FY 17

include: Preventing HIV in Girls and Linkages to HIV testing Note: The assessments take place at different sites in each quarter. Assumption is if IPs are strengthening certain aspects of their support, they are doing so in all their PEPFAR supported sites

Compiled SIMS CEEs include: Case Management Services, Preventing HIV in Girls, Linkages to HIV Testing, Child Protection Services, Education Services, Girls Secondary Education Transition, Economic Strengthening and Social Protection Services, Early Childhood Development Services, Community Pediatric Nutrition Screening & Referral to Clinical Services, Family Planning/HIV Integration Service Delivery in Community Settings

29 assessments 28 assessments 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FY 16 FY 17

Community Tool Set 3 All Core Essential Elements (CEEs)

Exceeds Expectation Meets Expectation Needs Improvement Urgent Remediation

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Focus to Reaching Girls Aged 15-17

• Focusing to reach more girls 15-

17 (priority population) with evidence-based, layered programming.

• Number of adolescent girls ages

15-17 has increased by 138% from COP 2014 to COP 2016.

• Aiming to increase this by 56%

to reach almost 140,000 girls ages 15-17 in COP 2017.

37534 47058 89347 139655 20000 40000 60000 80000 100000 120000 140000 160000 OVC_SERV (DSD + TA): Beneficiaries 15-17 Female

• No. of beneficiaries

OVC_SERV Females 15-17

APR 2015 APR 2016 APR 2017 APR 2018 (Target) 1827 1331 823 3366 2542 3474 3638 6132 15330 10507 8313 6938 5000 10000 15000 20000 gp City of Johannesburg Metro gp Ekurhuleni Metro kz eThekwini Metro kz uMgungundlovu District

• No. of beneficairies

OVC_SERV Females 15-17: Saturation Districts

Total OVC_SERV Females ages 15-17 APR 2015 Total OVC_SERV Females ages 15-17 APR 2016 Total OVC_SERV Females ages 15-17 APR 2017

• Focus on the Saturation

Districts: The number of adolescent girls ages 15- 17 increased by almost 460% from APR 2015 to APR 2017.

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Case Example: Linkages & Layering

Edith Moleko*, 17 years old

• lives with grandmother & two siblings in Johannesburg
• parents passed away when she was 13
• Two years later, raped by an immediate family member
• reported to grandmother, Gogo Lizzy*; labelled a liar
• substance abuse & unprotected sex with multiple partners
• contracted HIV, became pregnant, struggled in school
• Interventions:
• Risk Assessment & enrolment into HIVSA DREAMS program;
• Vhutshilo HIV Prevention Education;
• ART adherence support (including PTMCT);
• Access to SRHR;
• Psychosocial support: family-centred disclosure, communication

skills;

• Educational support;
• Safe space (Choma DREAMS café - internet access);
• Financial capabilities: savings skills and entrepreneurship support; &
• Older, female mentor (DREAMS facilitator).

Edith Moleko and her grandmother, Gogo Lizzy at Ikageng Itireleng AIDS Ministry

• utside a DREAMS Choma café .

“She was transformed from being an abused child into being an independent and dedicated young mother. She is determined to live a positive life and succeed in achieving her goals.”

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Priority Populations Prevention

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Priority Population Prevention (PP_Prev) in Non-DREAMS Districts, COP16 (FY17)

209% 132% 123% 115% 111% 107% 105% 99% 98% 80% 71% 59% 39%

0% 50% 100% 150% 200% 250% 10000 20000 30000 40000 50000 60000 RESULT 10-14 RESULT 15-19 RESULT 20-24 RESULT 25-49 RESULT 50+ %Overall Achievement

Focus on High Burden Areas in High Priority Age Cohort

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PP_Prev by Sex in Non-DREAMS Districts - FY17

209% 132% 123% 115% 111% 107% 105% 99% 98% 80% 71% 59% 39% 0% 50% 100% 150% 200% 250% 10000 20000 30000 40000 50000 60000 Males RESULT Females RESULT %Achieved Overall

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COP16 Number of people receiving postgender based violence (GBV) clinical care based on the minimum package

GEND_GBV REACH by District, APR 2017

568% 208% 167% 159% 151% 136% 119% 119% 116% 116% 115% 115% 105% 99% 90% 84% 83% 49% 44% 41% 16% 2% 0% 100% 200% 300% 400% 500% 600% 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 Target Result %Achieved

Top 5 Districts <50% Achievement

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Site Improvement Monitoring System (SIMS) Prevention Scores

2 4 1 10 4 21 6 62 1 2 1 23 6 16 3 98 2 1 3 16 32 39 45 92 325 14 20 34 0% 25% 50% 75% 100%

C_01_26 [226] Condom Availability at the Service Delivery Point [AP-HTC] C_01_11 [211] Risk Reduction Counseling [AP] C_01_12 [212] Facilitation of Small Group Sessions for HIV Prevention [AP] C_01_13 [213] Small Group Sessions for HIV Prevention [AP] C_01_03 [203] Accessible Services [AP] F_01_03 [003] Risk Reduction Counseling and Condom Availability C_05_02 [255] Preventing HIV in Girls C_05_06 [226] Condom Availability C_03_02 [255] Preventing HIV in Girls 01C 01B 01A 5 3

FY 17, Q4 Scores for Prevention Related CEEs

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Key Populations

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Key Population Prevention (KP_PREV) Results and Estimated Reach, FY17

179% 229% 144% 741% 354% 196% 64% 66% 19% 99% 46% 50% 0% 100% 200% 300% 400% 500% 600% 700% 800% 50000 100000 150000 200000 250000 300000 Inmates FSW MSM/TGW Male PWID Female PWID Grand Total Results Results (%)

• Est. Population Reached (%)
• Collectively doubled

targets at 196% (253,711/129,424)

• Focus on

strengthening MSM response through SNS, social media

• PSE revisions

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Comparison of Clinical Cascade by Group, FY17

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PrEP with FSWs: June 2016 – August 2017

Note: Data as of 5 September 2017 (NDoH)

Estimated SW population size1: 153,000 [132,000 -182,000]; ~95% female Operational PrEP sites: 14 in 7 of the 9 provinces HIV Tests 36,239 HIV-Negatives 31,590 (87%) Initiated 2,311 (7%)

PrEP for Female Sex Workers PrEP for MSM

HIV Tests 2,219 HIV-Negatives 2,098 (95%) Initiated 325 (15%) Estimated MSM population size1: 850,000 -1.2 million Operational PrEP sites: 3 in 2 provinces

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Increased Collaboration with Global Fund Grantees

Challenges Identified Solutions Implemented Overlap with site and partner funds Regular meetings, sharing plans and targets on grassroots levels Duplication of targets in the same geographic areas Movement out of some sites by PEPFAR where overlap does not justify yield

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South African Government Shares Responsibility for MSM Clinic

• Stigma and marginalization area

significant barriers to accessing and utilizing public health services

• Ivan Toms Health4Men Clinic in

Cape Town has provided sensitized and clinically competent services for MSM

• Ivan Toms Center will be co-located

with Western Cape Provincial Government from Dec 2017

•  Support and sustainable key

populations services

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1st 90

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COP16 HIV Testing (HTS_POS) Yield by District

Comparing HTS_POS Target to Result (#s)

9% 10% 12% 11% 8% 9%9%8% 10% 9%9% 5% 4% 9% 4% 8% 11% 4% 8% 8% 7% 11% 8% 6% 5% 9% 6%

0% 2% 4% 6% 8% 10% 12% 14% 20000 40000 60000 80000 100000 120000 140000 160000 180000 200000 kz eThekwini gp City of Johannesburg gp Ekurhuleni gp City of Tshwane mp Ehlanzeni mp Nkangala ec Oliver Tambo nw Bojanala Platinum kz uMgungundlovu kz King Cetshwayo mp Gert Sibande wc City of Cape Town lp Capricorn kz Zululand ec Amathole kz Ugu gp Sedibeng lp Mopani ec Alfred Nzo fs Thabo Mofutsanyane nw Dr Kenneth Kaunda kz Uthukela ec Buffalo City nw Ngaka Modiri Molema ec Chris Hani fs Lejweleputswa kz Harry Gwala Fy2017Apr Fy2017 Targets Yield

Overall improving case finding 24/27 districts have a yield between 5 and 12% Apr – Annual Program Report

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COP16 HIV Testing Yield by Partner – Facility-based District Support Partners (DSPs)

12% 10% 10% 10% 9% 9% 9% 8% 8% 3% 0% 2% 4% 6% 8% 10% 12% 14% 50000 100000 150000 200000 250000 300000 350000 Sum of HTS_TST_POS Sum of Yield (%)

Facility yield remains higher when compared to community yield as most cases are identified in facilities

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Who are we identifying?

AGYW HTS Yield trend in DREAMS Districts <01 – 14 year olds Yield in DREAMS District

Yield by sex and age

Under 15 Case Finding in Facility: Child Health Services, Family Planning, Indexing Community: OVC, CBOs

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6% 7% 9% 8% 8% 13% 19% 9% 2% 2% 17% 0% 5% 10% 15% 20% 25% 100000 200000 300000 400000 500000 600000 MobileMod HomeMod Index OtherMod OtherPITC PMTCT ANC TBClinic KeyPop VMMC Pediatric Index Community Facility HTS_TST_POS Yield

HTS Modalities and associated yields

Community index yield improved from 7% in Q3 to 9% in Q4 Actual numbers of index networks tested low: currently training of service providers, standardized SOPs and strengthened M&E underway

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COP16 Index testing quarterly trend

Remedial Actions Facility: Training of providers, SOPs and correct reporting by implementing partners Community: Reducing costs- classifying the contact list according to the neighborhoods for tracing

33 152 12 205 16 515 14 999

8% 11% 6% 12%

0% 2% 4% 6% 8% 10% 12% 14% 5 000 10 000 15 000 20 000 25 000 30 000 35 000 Fy2017Q1 Fy2017Q2 Fy2017Q3 Fy2017Q4 HTS Index testing Yield

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COp16 HTS Index Testing –Identified HIV Positives: Peads and Males

Community HTS Index Peads age distribution

Successes in identifying children of PLHIV and men aged 25-49 through index testing.

0% 0% 0% 0% 30% 50% 62% 86% 70% 50% 38% 14% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sum of Fy2017Q1 Sum of Fy2017Q2 Sum of Fy2017Q3 Sum of Fy2017Q4 HTS_TST_POS 10-14 01-09 <01 3% 0% 2% 1% 16% 6% 7% 8% 73% 84% 75% 86% 6% 9% 5% 5% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sum of Fy2017Q1 Sum of Fy2017Q2 Sum of Fy2017Q3 Sum of Fy2017Q4 HTS_TST_POS Male 50+ 25-49 20-24 15-19 10-14

Community HTS Index Male age distribution

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COP15 and COP16: Site Improvement Monitoring System (SIMS) Index Testing Scores

Comment: Index testing has improved in the Gen Pop and PMTCT_ANC from FY16 to FY 17

229 assessments 203 assessments 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FY 16 FY 17

Facility Tool CEE: F_02.13 Routine HIV Testing of children

• f Adult Patients (C&T Gen Pop)

194 assessments 147 assessments 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FY 16 FY 17

Facility Tool CEE: F_02.13 Routine HIV Testing of children of Adult Patients (PMTCT-ANC)

1st 90: Linkage to Treatment

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Linkage interventions

Facility linkage:

• UTT
• Linkage Officers
• Health education
• TIER. Net expansion (HTS

& Pre-ART module)

• Same day and same site

initiation

• Flexi hour (adolescents

and men)

• Unique Identifier

Community linkage:

• Linkage ‘handshake’

between facility and community

• Linkage tracers
• HTS_POS_ART

indicator

• Health education
• Scaling up recording of

ID numbers at community testing sites

Sowetan times: 13 July 2015

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Linkage Across the 27 Districts

908 881 728 848 693 600 693 600

76% 95%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 100 000 200 000 300 000 400 000 500 000 600 000 700 000 800 000 900 000 1 000 000

Coarse Linkage Facility Linkage

HTS_TST_POS TX_NEW Linkage

COP16 (FY 17) Facility linkage is 95%

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COP16 Age/Sex Linkage in Saturation Districts

Linkage Challenges in AGYW and Men

Diagnosis: Highest number linked - females 25-49 Remediation: Flexi hour services for linking adolescents

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COP16 District Linkage

All saturation districts have a linkage rate of above 90%

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COP15 and COP16 SIMS Linkage Services Scores

234 assessments 204 assessments 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FY 16 FY 17

Facility tool CEE: F_07.03 HTC Referrals to HIV Care and Treatment

Improved SIMS results for linkage

• f patients from

HTS to ART

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Direct Linkage Indicator

Community HTS_TST

Referral of HTS_POS clients to facility Work with Facility Staff and Implementing partners Confirmed HIV positive patients in TIER.Net HTS module Confirmed HIV positive patients linkage to ART in TIER.Net HTS module

Beginning in COP17 (FY18), PEPFAR CDC and USAID will require additional data to directly measure ART initiation among persons newly tested positive

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2nd 90

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COP15 and COP16 (FY16 &FY17): TX_NEW results by quarter

FY16 total: 546,797 FY17 total: 693,600 (72% of target) Increase of 146,803 vs. FY16 (+27%)

∆ Q1: +39,683 ∆ Q2: +59,208 ∆ Q3: +22,283 ∆ Q4: +25,629

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COP16 (FY17) TX_NEW Cumulative Results by Partner & District (27 focus districts)

Intrapartner variability across districts-actions:

• Improve performance consistency across

districts /partners by addressing district-level situational barriers

• Shift targets to other partners where feasible
• Set up district and Provincial level engagement
• Direct Service Delivery staff secondment

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COP16 TX_NEW Achievement by Partner (27 focus districts)

>150%

Remediation/Ongoing interventions:

• Active partner management and

weekly tracking of results to inform course correction

• Transition of targets to higher

performing partners

• SIMS visits and intensified site-

level data quality assessments

• PEPFAR/SA mandating DSPs to:
• Fully implement SDI
• Ensure active linkage and

tracking to down-referral sites

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COP16 (FY17): TX_NEW by Age/Sex (4 saturation districts)

Cumulative FY17 performance

For purposes of epidemic control, implement and scale innovative strategies targeting:

• Adolescents friendly services (AYFS expansion support);
• Targeted DSD and linkage with DREAMS demand creation and mobilization
• Male friendly services (including extended hours, male counsellors, entry points,

workplace ART initiation)

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Update: Same Day ART Initiation (SDI)

• District Support Partners representing 18 districts (and 1021 facilities)

responded to survey to ascertain status of 3 core interventions in the field: SDI, Tx and Retention Acceleration Plan, and community-based ART initiation

• Same Day ART Initiation

– 12 districts (634 facilities) report 100% of supported facilities implementing SDI

25 assessments 110 assessments 47 assessments 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FY 17 Q2 FY 17 Q3 FY 17 Q4

SIMS Set 12, CEE 12_01: Test and Start

26 assessments 40 assessments 112 assessments 0% 20% 40% 60% 80% 100% FY 17 Q2 FY 17 Q3 FY 17 Q4

SIMS Set 12, CEE 12_02: Appointment Spacing and Multi- Month Drug Dispensing (Differentiated Care)

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NDoH Treatment & Retention Acceleration Plan

NDoH Engagement and Policy Update Timeline

54

Tx and Retention Acceleration Plan Implementation

• # of districts fully implementing TRAP

13 # of districts responding to data calls 11 # of districts whose DSP is participating in weekly data calls 16 # of districts whose DSP is involved in remediation plans 12

• Survey responses from DSPs representing 18 districts
• Acceleration plan is being brought to scale

Source: Rapid DSP assessment survey findings (November 2017)

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eThekwini COP17 Strategy Update –Dec 2017

Core Intervention Progress to date Comments 1.Enhanced M&E (Evaluation by clusters and weekly performance tracking)

• 12 clusters with referral hubs identified,

communicated to facilities

• All identified clusters: Nerve centre meetings

started.

• 2. Tier.net Expansion
• On track
• Completion of module implementation by

end March 2018

• 3. Unique Patient Identifier

Current coverage 30% Mitigation plans in place to increase ( 90% coverage 90% by September 2018

• 4. Maximizing Entry Points
• All hospitals now have clinic navigators and

professional nurses actively tracking all hospital admissions and all hospital entry points to ART initiation

• Advance clinical care for Unstable clients and

complicated patients

• 5. Moving Stable Patients out of facilities
• 88 483 clients decanted 46% of stable patients)
• Tier.net export actively traces stable clients

for CCMDD enrolment

• 6. GP Models
• District Management Team signed off on GP pilot

project and ARV Drug Supply and HTS testing kits provided by DOH health facility

• Submitted General Practitioner Contracting

Model to USAID 7.Mass Media for TX_NEW

• Provincial media campaign underway and signage

and messaging at all health facilities

• Local media involvement via community

engagement ongoing.

• 8. Ideal Clinic Expansion and

reconfiguring of service delivery platforms

• Achieved 22% coverage . Overall, average scoring

eThekwini is 76% green areas

• Mitigation strategy in place to increase

coverage.

• 9. Community Facility Linkage
• Facilitated meetings with community partners –

formalised linkage processes

• Campaigns targeting men to increase

awareness on Men’s Health with linkage

• fficers and mobile ART teams

2nd 90: Treatment Retention

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Current on Treatment (TX_CURR) Progress Toward COP16 Targets - 27 Focus Districts

• TX_CURR increased by 19% in the 27 focus

districts over FY16 (COP15) achievement.

• FY17 (COP16) coverage reached 70% of the

saturation goal in the 27 focus districts.

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TX_CURR Progress Toward COP16 Targets - 4 Saturation Districts

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TX_CURR COP16 Achievement vs. TX_CURR % Gap to 2nd 90 by Age and Sex - 4 Saturation Districts

TX_CURR, FY17APR TX_CURR gap to 81% PLHIV coverage Labels show saturation levels (81% of total PLHIV, 2016 estimate)

60

COP16 TX_RET Performance by District - 27 focus districts

Saturation district

61

COP16 TX_RET Performance by Facility - 27 Focus Districts

93% facilities <90% 79% facilities <80% 48% facilities <70%

62

Retention Remediation Activities

▪ Improve Patient Access ▪ Expanded clinic hours and Saturday hours ▪ Expand use of mobile clinics for both initiation and ongoing care ▪ Improve Patient Experience ▪ Encourage appointment time scheduling to reduce waiting time ▪ Direct service delivery support by DSPs to reduce burden on under-staffed facilities ▪ Motivate staff through recognition ▪ Mentors to foster respectful, non-discriminatory care ▪ Implement adolescent & youth friendly services ▪ Expand incorporation of peer navigators/expert patients into facility-based services. ▪ Use of interpersonal health communication products ▪ Maximize effectiveness of Linkage & Retention Coordinators

63

Interpersonal Health Communication Products

64

3rd 90

65

Retention on ART, VL Done, and VL Suppression COPs 14, 15, 16 (Fys 15-17): 27 Focus Districts

76% 61% 79% 77% 63% 87% 70% 80% 85% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 12-month retention VL completed VL <1,000 cp/mL

FY15 FY16 FY17 FY15 FY16 FY17 FY15 FY16 FY17

66

FY 2016 (COP15) TX Cascade thru Retention at 12 Months, , VLD and VL Suppression

100 000 200 000 300 000 400 000 500 000 600 000 700 000 800 000 900 000 1 000 000 South Africa

One Year Outcomes of Persons Initiated on ART in FY16

FY16 HTS_PoS FY16 TX_NEW FY17 TX_RET_N FY17 PVLS_D FY17 PVLS_N

80% of those retained

85% of those tested

70% of TX_NE W FY16 861,291 positive tests in FY16

63% of Positive Tests = Tx_New

67

COP16 Annual Viral Load Done & Suppressed Trend—Saturation Districts

68

NHLS: Monthly Viral Suppression Monitoring

69

VL Suppression by Age, Sex (Source: NHLS)

• 3,218,394 VL tests done in the

previous 12 months among 27 focus districts

• 83.1% of the tests had a

suppressed VL (< 1000 copies/mL),

• 16.9% had VL results above 1,000

copies/mL, and

• 9.8% were above 10,000 copies/mL
• Proportion of VLS ↑ with age from a

low of 64% in children < 10 years to 85% in patients 25 years and older.

• ↑ VLS among females 15+ vs males

15+ (84.4% vs 79.4%)

• VLS age 1-9: 66.4%;

10-14F: 65.0%, 10-14M: 62.9%

70

Above-Site Investments

71

2017 Sustainability Index Dashboard (SID) Summary

Sustainability Analysis for Epidemic Control:

Epidemic Type: Income Level: Upper middle income PEPFAR Categorization: Long-term Strategy (Co-finance) PEPFAR COP 17 Planning Level: $483 million (+ $51 million central VMMC funds) 2015 (SID 2.0) 2017 (SID 3.0) 2019 2021 Governance, Leadership, and Accountability

• 1. Planning and Coordination

9.67 9.17

• 2. Policies and Governance

8.45 8.87

• 3. Civil Society Engagement

7.33 9.04

• 4. Private Sector Engagement

6.50 9.17

• 5. Public Access to Information

10.00 8.00 National Health System and Service Delivery

• 6. Service Delivery

7.69 6.71

• 7. Human Resources for Health

6.97 6.16

• 8. Commodity Security and Supply Chain

4.67 6.92

• 9. Quality Management

8.38 8.00

• 10. Laboratory

6.67 9.58 Strategic Investments, Efficiency, and Sustainable Financing

• 11. Domestic Resource Mobilization

8.61 8.53

• 12. Technical and Allocative Efficiencies

8.61 9.28 Strategic Information

• 13. Epidemiological and Health Data

6.77 6.90

• 14. Financial/Expenditure Data

9.58 8.33

• 15. Performance Data

8.73 8.83

SUSTAINABILITY DOMAINS and ELEMENTS

South Africa

Generalized

Financing the HIV Response

GNI Per Capita (Atlas Method)

Epidemiological Data

Population and Fertility

• Pop. Growth Rate

National DoH Clinical Cascade (3/17)

Population Pyramid (2017)

CONTEXTUAL DATA CONTEXTUAL DATA

72

SID and Table 6 Activities

Supply Chain: key interventions improved score from 4.67 to 6.92

Lab: significant gains from 6.67 to 9.58 Service Delivery: despite significant efforts, decreased from 7.69 to 6.71 HRH: PEPFAR increased direct service delivery also reflects the decrease from 6.97 to 6.16

73

SID 2.0 & 3.0 Comparison (2015 and 2017)

1 2 3 4 5 6 7 8 9 Dark Green Light Green Yellow

SID 2.0 & 3.0 Comparison

SID 2.0 SID 3.0

• SID 3.0 completed November

2017

• Overall, SID scores have

improved from 2015 to 2017

• Lab and private sector

engagement go from Yellow to Dark Green in

• Only decreasing scores: service

delivery (a reflection

• f need for increased service

delivery support in the program and other health system delivery challenges)

74

Shift in Laboratory Support

• Laboratory and Clinic Lab interface Continuous

Quality Improvement capacity building

• Strengthening of communication, training and

support, and collaboration

• Strengthening of NDoH ownership and oversight of

laboratory support

75

Strategic Shifts

• Focus program to scale what works
• Coalesce behind key activities to achieve priorities &

ensure all activities fall under identified priority areas

• Identify and eliminate duplication
• Exchange activities between partners to keep similar

activities together

• Identify activities not strategically aligned with 90-90-90
• r sustainability

– Redirect activity (change work plan) – Discontinue funding in COP18

76

Strategic Shifts

Key Population Programming Models Laboratory Support New and Efficient Service Delivery

77

Site Improvement Monitoring System (SIMS) Data

78

PEPFAR SA SIMS Sites Surveyed Cumulative Performance

CDC

Q1 Q2 Q3 Q4 Total FY15 14 11 22 47 FY16 37 9 30 63 139 FY17 57 39 71 46 213 Total 108 59 101 85 399

USAID

Q1 Q2 Q3 Q4 Total FY16 1 68 123 192 FY17 36 8 74 19 137 Total 36 9 142 123 329

* The USAID visits are underreported for FY17 as some of the visits conducted are not showing in the USAID GHSMA system. The USAID HQ team is currently investigating and rectifying this issue.

79

SIMS 2.0/3.0 Scores by Partners FY 16 & FY 17 Facility Tool

Note: The assessments take place at different sites each quarter. Assumption is if IPs are strengthening certain aspects of their support, they are doing so in all their PEPFAR supported sites

FY 17 FY 16

80

SIMS 2.0/3.0 Scores by Partners COP15 & cop16 Community Tool

Note: The assessments take place at different sites in each quarter. Assumption is if IPs are strengthening certain aspects of their support, they are doing so in all their PEPFAR supported sites

FY 17 (COP16) FY 16 (COP15)

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End – FY 17 Q4 (COP16 Summary Results Review - POART)

Siyabonga ! For additional details please contact:

Charles Pill SA PEPFAR Coordinator pillc@state.gov