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Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Project Cooperative Agreement No

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Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Project Cooperative Agreement No Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Project Cooperative Agreement No. AID-OAA-A-14-00045 DEMOCRATIC REPUBLIC OF THE CONGO QUARTERLY PROGRESS REPORT JULY 1 TO SEPTEMBER 30, 2018 OCTOBER 31, 2018 LINKAGES Quarterly Report (July 1 – September 30, 2018) - DRC 0 LINKAGES DRC Quarterly Progress Report July 1 to September 30, 2018 Overall Achievement This quarter marks the end of strong year of implementation for Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Democratic Republic of the Congo (DRC). The project exceeded all annual targets for female sex workers (FSWs) and reached most targets for men who have sex with men (MSM). This quarter (Q4), case finding rates, linkage to care, and viral load (VL) testing coverage all increased notably compared with Q3. The project continued to benefit from central TOM+ funds, which were allocated to targeted technical assistance (TA) from LINKAGES headquarters (HQ), as well as to training and seed funding to improve implementation. An index testing strategy was developed and incorporated into activities, and HIV self-testing started. Enhanced peer outreach approach (EPOA) activities and risk assessment tools were reinforced to improve reach and testing services. Additionally, LINKAGES DRC signed a subagreement with a key population (KP)/MSM-led organization (Jeunialissime), launched a community service delivery point (CSDP) with a trained nurse in Kasumbalesa, and conducted programmatic mapping in two health zones (Rwashi and Kampemba) that will be covered in FY19. 1. Summary of Key Results • 3,390 FSWs, 1,338 MSM, and 735 FSW clients were reached with HIV prevention interventions. • 3,165 FSWs, 1,077 MSM, and 707 FSW clients were tested and received their results. • 321 FSWs (10.1 percent), 102 MSM (9.5 percent), and 53 FSW clients (7.5 percent) tested positive for HIV. • 283 FSWs (88.2 percent), 87 MSM (85.3 percent), and 43 FSW clients (81.1 percent) were newly enrolled in care and initiated on antiretroviral therapy (ART). • 107 Zambian KPs (103 FSWs and 4 clients of FSWs) were reached with HIV prevention interventions in cross-border activities; 90 FSWs and 4 clients of FSWs were tested and received their results; 17 FSWs (26.4 percent) tested positive for HIV, and 13 of them were initiated on ART. • 110 people living with HIV were enrolled at one of LINKAGES’ drop-in center (DIC) points of distribution: 53 FSWs, 54 MSM, and 3 FSW clients, including 44 in Haut-Katanga (18 newly enrolled) and 66 in Kinshasa (11 newly enrolled). • 299,452 male condoms, 34,822 female condoms, and 21,206 lubricant packs were distributed. • During EPOA campaigns conducted in Kinshasa, Lualaba, and Haut-Katanga, 591 FSWs and 103 MSM were tested for HIV, and 63 FSWs and 13 MSM tested positive. For FSWs, this yielded a 10 percent case finding rate (similar to Q3), but for MSM, the case finding rate increased from 9.5 percent (Q3) to 12.5 percent (Q4). 56 FSWs and 11 MSM were newly enrolled in care and initiated on ART. • 384 KPs/priority populations were screened for sexually transmitted infections (STIs) in DICs, including 313 FSWs, 35 MSM, and 36 FSW clients. • 17,261,000 Congolese Franc (CDF) (~USD $10,788) were saved by 19 KP saving groups. • The organizational performance index (OPI) was implemented for 4 LINKAGES implementing partners (IPs) with 31 key participants (PSSP, Bak Congo, Faradja, Lamuka). • 1 CSDP was launched at Kasumablessa in Haut-Katanga. • Programmatic mapping was conducted in 2 new health zones in Haut-Katanga (Rwashi and Kampemba). LINKAGES Quarterly Report (July 1 – September 30, 2018) - DRC 1 TOM+ funding contribution to DRC project success This quarter, LINKAGES DRC received funding for TA, training, and implementation from USAID DC TOM+ funds. This funding was critical to finish the fiscal year successfully. TOM+ funds allowed the project to achieve the following performance as of Q4: ✓ FSWs: 130 percent of KP_PREV target reached, 107 percent of HTC_TST target reached, and 86 percent of linkage-to- care target reached. ✓ MSM: 147 percent of KP_PREV target reached, 47.6 percent of HTC_TST target reached, and 83 percent of linkage-to- care target reached. In addition, TOM+ funds have been instrumental in the implementation of multiple trainings for IP staff, peer educators (PEs), peer navigators (PNs), and outreach workers (ORWs) to improve the scope and efficacy of services offered. Topics covered in these trainings included correct use of the risk assessment tool, use of ICT, quality improvement of HIV testing services (HTS) sessions, implementation of index testing and HIV self-testing (HIVST), capacity building of HIV case managers and providers to administer motivational interviewing, and strengthening of the EPOA strategy. All of these trainings positively affected program performance, especially case findings, in the last quarter of FY18. TOM+ funds were also used for EPOA TA to improve the ways we track, monitor, and guide risk and HIV-positive KP networks to reach more individuals within those networks. This work will be continued in FY19 Q1: EPOA site plans will be developed for all provinces, and our capacity to capture data will be improved through weekly network analysis reviews to better target productive networks. 2. Result Areas Result Area 1: Increase availability of comprehensive prevention, care, and treatment services, including reliable coverage across the continuum of care for MSM and FSWs • Provided comprehensive services in DICs: The four DICs continued to provide safe spaces for KPs with additional options for accessing services. Services included social and behavior change communication (SBCC), HIV testing and counseling (HTC), STI screening and treatment, referral for HIV case management, condom and lubricant distribution, and psychosocial support, including recreational activities. Three DICs are being used as points of distribution of ART to stable HIV- positive KPs (see additional details on points of distribution further below). During this quarter: ➢ 2,567 KP individuals were registered in the four DICs (1435 FSWs, 999 MSM, and 133 FSW clients), of which 782 benefited from HTS and 384 were screened for STIs (313 FSWs, 35 MSM, and 36 FSW clients). ➢ DIC committee meetings continue to be held regularly, which improves institutional capacity. ➢ The Lubumbashi DIC was visitedE by the U.S. Centers for Disease Control and Prevention (CDC) and Programme National de la Lutte contre le SIDA (PNLS) to discuss the upcoming integrated biological and behavioral survey. ➢ A new MSM-led community-based organization (CBO), Jeunialissime, joined LINKAGES DRC as a partner at the end of Q4. The partner has a safe space in its office where prevention activities are conducted, including HTC, psychosocial support, and distribution of condoms and lubricants. • Launched a CSDP in Kasumbalesa: Following a USAID recommendation, made during a visit in July of FY18, to improve the availability of community services for KPs in Kasumbalessa, a CSDP was LINKAGES Quarterly Report (July 1 – September 30, 2018) - DRC 2 developed. Through the CSDP, HTC, STI screening and treatment, family planning services, ART initiation, psychosocial support, and condom and lubricant distribution are available through a trained nurse. Data on services provided and number of beneficiaries served will be reported in the following quarter (FY19 Q1). • Strengthened EPOA: Using TOM+ funds, an EPOA campaign was organized in the three LINKAGES provinces. Through this EPOA campaign, we reached 745 KPs, including 591 FSWs and 154 MSM, and we tested 694 KPs, including 591 FSWs and 103 MSM. Among those tested, 73 KPs tested positive for HIV (63 FSWs and 13 MSM), which represents a case finding rate of 10.7 percent for FSWs and 8.4 percent for MSM. The results are similar to overall case finding rates for Q4 (10.1 percent for FSWs and 9.5 percent for MSM). In addition, EPOA contributed to better linkage to care for both FSWs and MSM. • Started HIVST: In line with the LINKAGES DRC FY18 work plan, HIVST implementation began this quarter using oral fluid test kits (World Health Organization pre-qualified OraQuick HIV self-tests). This testing method allowed the project to reach those who are not reached by existing HTS, especially high-risk KPs who may not otherwise participate in outreach HTS sessions or visit DICs because of perceived stigma or confidentiality concerns. During Q4, 315 self-test kits were distributed to KPs, and 247 were used (111 by FSWs, 124 by MSM, and 12 by FSW clients). Sixty-one kits were reactive, and 49 were confirmed positive. All positive KPs were linked to ART. The case finding rate was 18.8 percent for both KPs and FSW clients. HIVST has positively and significantly affected HIV case finding during the reporting quarter when compared with overall case finding obtained with regular testing methods for the same quarter. • Strengthened voluntary partner referral strategy: To improve case finding, emphasis was put on expanding implementation of the violence prevention response (VPR) strategy to enable KPs living with HIV (KPLHIV) to make life-saving referrals to HTS for members of their social and risk networks. After implementing a training of community providers, including PNs, the following results were achieved: 28 index cases (16 FSWs, 11 MSM, and 1 FSW client) were contacted, and 56 contacts were referred to HTS (11 FSW, 26 MSM, 6 FSW clients, 11 biological children, and 2 female FSW clients). Thirty-six of those referred tested positive, including 4 FSWs, 5 FSW clients, 5 biological children, 1 FSW client’s spouse, and 21 partners of MSM. All HIV-positive cases were linked to ART services. • Reinforced community-based ART distribution: As in past quarters, the three points of distribution continued to provide ART services to the stable KPLHIV referred by Integrated Health HIV/AIDS Project (IHAP) health facilities.
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