USAID COOPERATIVE AGREEMENT NO. AID-660-A-17-00001
INTEGRATED HIV/AIDS PROJECT HAUT KATANGA/LUALABA
Fiscal Year 2019 Annual Performance Report
October 1, 2018–September 30, 2019 Submitted: November 15, 2019
This document was produced by the Integrated HIV/AIDS Project in Haut Katanga and Lualaba consortium through support provided by the United States Agency for International Development. The opinions herein are those of the author(s) and do not necessarily reflect the views of the United States Agency for International Development or the United States government.
Table of Contents
Abbreviations ...... iv Executive Summary ...... vi Quantitative impact ...... vi Testing ...... vi Care and treatment ...... viii Tuberculosis and HIV coinfection ...... ix Viral suppression ...... ix Qualitative impact ...... ix Key Achievements and Program Progress ...... 1 Objective One: Continuum of care for HIV/AIDS services ensured ...... 1 Sub-objective 1.1: Increased availability of comprehensive HIV prevention services...... 1 Sub-objective 1.2: Expanded comprehensive HIV/AIDS care and treatment services...... 10 Sub-objective 1.3: Improved integration of HIV/TB services...... 14 Sub-objective 1.4: Expanded network and referral systems for other health and social services. . 16 Objective Two: Use of integrated HIV/AIDS services increased at both facility- and community- based levels ...... 17 Sub-objective 2.1: Improved community environment to support healthy behaviors...... 17 Sub-objective 2.2: Optimized service delivery models...... 18 Objective Three: Health systems strengthened to improve access to services and improve outcomes of PLHIV ...... 21 Sub-objective 3.1: Essential commodities are available and effectively managed at all appropriate levels...... 21 Sub-objective 3.2: Improved use of reliable data to continuously improve service delivery quality and effectiveness...... 23 Sub-objective 3.3: Effective, operational laboratory systems ensured...... 25 Annexes ...... 29 Annex One: Monitoring and evaluation table ...... 29 Annex Two: Trainings and site visits ...... 33 Annex Three: Environmental Mitigation and Monitoring Plan reporting form ...... 47 Annex Four: Success story ...... 49
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 iii Abbreviations
ART antiretroviral therapy ARV antiretroviral BDOM Bureau Diocésain des Ouvres Médicales (Diocesan Office of Medical Works) CDC Centers for Disease Control and Prevention CIELS Comité Inter Entreprise de Lutte contre le Sida (Inter Business Committee for the Fight against AIDS) CS Centre de Santé (Health Center) CSDT tuberculosis diagnostic and treatment center CSR Centre de Santé de Référence (Health Referral Center) DATIM Data for Accountability, Transparency, Impact, and Monitoring DBS dried blood spot DCM differentiated care model DHIS2 District Health Information Software 2 EID early infant diagnosis ELIKIA Enhancing Services and Linkages for Children Affected by HIV and AIDS FY Fiscal Year (e.g., Fiscal Year 2019 = FY19; Fiscal Year 2018 = FY2018; etc.) GHSC-TA Global Health Supply Chain—Technical Assistance HGR Hôpital General de Référence (General Referral Hospital) HIV human immunodeficiency virus HTS HIV testing services HZ health zone HZMT health zone management team IHAP-HK/L Integrated HIV/AIDS Project in Haut Katanga and Lualaba IPT isoniazid preventive therapy IQPM integrated quality and performance management LINKAGES Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV M&E monitoring and evaluation MER Monitoring, Evaluation, and Reporting (PEPFAR indicators) NGO nongovernmental organization PEPFAR US President’s Emergency Plan for AIDS Relief PLHIV people living with HIV/AIDS PNLS Programme National de Lutte contre le SIDA (National Program for the Fight against AIDS) PNLT Programme National de Lutte contre la Tuberculose (National Program for the Fight against Tuberculosis) PNMLS Programme National Multisectoriel de Lutte contre le SIDA (National Multisectoral Program for the Fight against AIDS) PoDi+ community-based point of antiretroviral medication distribution Q Quarter (e.g., Quarter 1 = Q1; Quarter 2 = Q2, etc.) RNOAC Réseau National des Organisations d’Assises Communautaires (National Network of Community-Based Organizations) SSC site support coordinator TB tuberculosis TBIC tuberculosis infection control TLD tenofovir disoproxil fumarate/lamivudine/dolutegravir TO technical officer
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 iv USAID US Agency for International Development VL viral load VLSM Viral Load System Management
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 v Executive Summary
The Integrated HIV/AIDS Project in Haut Katanga and Lualaba (IHAP-HK/L) is pleased to share the Fiscal Year 2019 (FY19) Annual Performance Report covering the period October 1, 2018, through September 30, 2019.
Quantitative impact
A total of 106 facilities in Haut Katanga and 56a facilities in Lualaba provided a comprehensive package of HIV testing, care, and treatment services from October 2018 through September 2019.
Testing As of the end of September 2019, the project has tested 249,926 individuals in facilities and communities and informed them of their serologic status in FY19, representing 85% of the FY19 annual target (287,348). Among those tested in FY19, 14,778 tested HIV positive—a yield of 5.9% (
Figure 1). This represents an achievement of 114% of the FY19 annual target (12,913).
Figure 1. HIV case-finding by quarter, October 2018–September 2019.
a. Although IHAP-HK/L reports data for 159 facilities in the Data for Accountability, Transparency, Impact, and Monitoring system, IHAP- HK/L supports 162 total facilities under the hub-and-spoke model (Kamoto Cooper Complex and Centre de Santé Bora, which are linked to Hôpital General de Référence Dilala, and Centre de Santé Lueu, which is linked to Centre de Santé Pour Tous). The project also provides a limited package of support for 35 satellite facilities.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 vi 14,778
12,913 10,151
6,301
2,953
2,953 3,348 3,850 4,627
Q1 Q2 Q3 Q4
Quarterly achievements FY19 annual target Cumulative achievements
Abbreviations: FY19, Fiscal Year 2019; Q, quarter. Of the 71,295 pregnant women received at antenatal care or labor and delivery wards in FY19, 70,761 (99%) knew their HIV status (i.e., either knew their status at entry or were tested for HIV and informed of their status). 1,101 pregnant women were HIV positive (1.6% seropositivity), of whom 97% were linked to treatment (Figure 2).
Figure 2. HIV testing among pregnant women who attended antenatal clinics by quarter, October 2018–September 2019.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 vii Abbreviations: ANC, antenatal care; Q, quarter. In FY19, facility-based providers collected and transported 784 dried blood spot (DBS) samples from infants to two laboratories in Lubumbashi for analysis, representing 54% of the FY19 target (1,452). Of the 553 samples analyzed so far (71%), four tested positive for HIV (0.7% yield) and began treatment.
In FY19, IHAP-HK/L tested 333 (25% of the registered HIV-exposed infants) HIV-exposed infants who reached 18 months of age, among whom 321 (95%) were uninfected at 18 months and 12 were HIV-infected (Figure 3). 40 died before being tested.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 viii Figure 3. Prevention of mother-to-child transmission through final outcome, July-September 2019
3%
11%
% HEI still infected at 18 years of birth %HEI uninfected at 18 years of birth % HEI deceased before 18 years of birth
86%
Abbreviations: HEI, HIV-exposed infants. Care and treatment In total, 40,398 adults and children living with HIV/AIDS were enrolled in IHAP-HK/L’s treatment and care cohort by the end of September 2019; 14,353 (97%) of them were newly enrolled in FY19 (Figure ).
Figure 4. Treatment enrollment by quarter, October 2018–September 2019.
16,000 103%
100% 14,000 13,958
12,000 70% 80%
10,000
60%
8,000 44% 14,778
6,000 40% 10,151
4,000 21%
6,301 20%
2,000 2,953 2,872 6,105 9,779 14,328
0 0% Q1 Q2 Q3 Q4
Tested HIV positive Newly initiated on ART (Cumulative) TX-New target TX-New achievement rate
Abbreviations: ART, antiretroviral therapy; TX_NEW, newly initiated on ART; Q, quarter.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 ix By the end of FY19 Quarter 4 (Q4), 17,173 stable PLHIV (42% of the project’s overall cohort) were enrolled in differentiated care services. Among the 17,173 enrolled in a DCM, 11,937 (70%) were enrolled in the fast-track antiretroviral therapy (ART) pick-up system; 3,662 (21%) were enrolled in ART support groups; and 2,180 (13%) were enrolled at PoDi+ sites (community-based points of antiretroviral [ARV] medication distribution).
Tuberculosis and HIV coinfection Among the 7,021 new and relapsed tuberculosis (TB) patients registered in FY19, 6,747 (96%) were tested for HIV and had their status documented in their patient file. 961 were identified HIV positive (14% yield), among whom 889 (92%) were on ART.
Viral suppression From October 2018 through September 2019, the project collected plasma or DBS samples for viral load (VL) counts from 29,942 patients. In FY19, project-supported laboratories have analyzed 29,447 DBS and plasma samples of which 24,331 (83%) were virally suppressed (<1,000 copies/mL).
Figure 3 shows the VL cascade by province for FY19.
Figure 3. Viral load cascade by province, October 2018–September 2019.
25,000 100% 22,050 21,953 90% 83% 20,000 18,308 80% 80%
70%
15,000 60%
50%
10,000 40% 7,892 7,494 6,023 30%
5,000 20%
10%
0 0% Haut Katanga Lualaba
Patients with VL samples collected Patients with VL results Patients with suppressed VL VL suppression rate
Abbreviations: Q, quarter; VL, viral load.
Qualitative impact
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 x In FY19, as part of the project’s quality improvement and quality assurance initiatives, IHAP- HK/L focused on developing and implementing a set of strategies to improve performance in critical areas related to 95-95-95.
To improve efficient case-finding, IHAP-HK/L introduced a strategy of supporting a network of 35 satellite sites (facilities not formally supported by IHAP-HK/L) as spokes for HIV testing services, with escorted referrals to IHAP-HK/L facilities provided to those identified HIV positive for confirmatory testing and treatment initiation. IHAP-HK/L also placed emphasis on scaling up index testing, particularly the use of assisted partner notification options for more active outreach to sexual partners, biological children, and biological parents of index clients. Focus was also placed on contact elicitation and follow-up among higher-risk index clients, specifically clients with unsuppressed VLs, newly identified PLHIV, and clients experiencing challenges with treatment adherence.
To accelerate progress toward the project’s annual target for PLHIV on ART, IHAP-HK/L emphasized follow-up of individuals who missed appointments as part of the project’s weekly monitoring system (introduced in Q2). Under this system, each facility was assigned weekly targets for tracking PLHIV who miss appointments. IHAP-HK/L measured progress against these targets at the end of the week and deployed technical assistance for low-performing facilities. IHAP-HK/L also supported facilities to provide multimonth stocks of ARV drugs for mobile PLHIV who were not eligible for transfer to DCMs but would be away from their homes for extended periods of time in order to support their adherence to treatment while away. Finally, IHAP-HK/L also scaled up transfer of stable PLHIV to DCMs in Q4, primarily by accelerating the creation of fast-track circuits at project-supported facilities.
To scale VL coverage and suppression, in addition to assigning weekly targets for VL sample collection and following up PLHIV with unsuppressed VLs as part of the project’s weekly performance monitoring system, IHAP-HK/L advocated with facility administrators and head doctors to designate a VL focal point at each high-volume facility. The focal point would be responsible for identifying PLHIV eligible for VL sample collection and assigning facility-based providers or peer educators for follow-up. IHAP-HK/L also facilitated VL sample transportation and rapid return of results to patients by reinforcing the weekly hub-and-spoke model for transporting DBS and plasma VL samples from rural facilities to the laboratories in Lubumbashi; conducting daily monitoring of VL results processed by the two laboratories in Lubumbashi; and supporting the rollout of the electronic Viral Load System Management in Lualaba and Lubumbashi.
In addition to the above noted strategies, IHAP-HK/L also introduced performance-based financing in FY19, which contributed to incentivizing facility performance in key areas, such as efficient case-finding, immediate treatment initiation, and VL sample collection.
Table 1 below outlines changes to the planned activities that were detailed in IHAP-HK/L’s FY19 implementation plan.
Table 1. Changes to the Fiscal Year 2019 implementation plan.*
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 xi Planned activities Status Explanation for change Coordinate with World Production to create Not done in Activity canceled due to lack of resources needed digital outreach strategies to reach youth FY19 to create a vibrant and active Facebook and adolescents with messaging and community that is moderated by an external information on HIV and available services. media firm. Train staff from HIV testing entry points Not done in Activity postponed due to shortage of Determine who scored less than 100% as part of the FY19 test kits and subsequent shortages of VIKIA and PNLS-sponsored HIV proficiency testing. Uni-Gold HIV test kits. Microplan with Kasaji and Dilolo health Not done in Activity canceled due to IHAP-HK/L’s phaseout zones. FY19 in Lualaba province. Quarterly awards for high-performing Not done in The money allocated for quarterly awards to facilities FY19 facilities was used to cover other technical needs instead. * This table outlines changes to the FY19 implementation plan that was submitted to the US Agency for International Development (USAID) on October 2, 2018 and was approved in October 2019.
Abbreviations: CDC, Centers for Disease Control and Prevention; FY, Fiscal Year; IHAP-HK/L, Integrated HIV/AIDS Project in Haut Katanga and Lualaba; Programme National de Lutte contre le SIDA (National Program for the Fight against AIDS).
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 xii Key Achievements and Program Progress
Objective One: Continuum of care for HIV/AIDS services ensured
Sub-objective 1.1: Increased availability of comprehensive HIV prevention services. In Q4 FY19, IHAP-HK/L offered the minimum package of HIV prevention services to 8,296 individuals at hot spots frequented by priority populations, among whom 6,745 accepted a referral for HIV pre-test counseling. Of the 6,745 individuals provided with pre-test counseling, 6,137 (91%) accepted HIV testing services, and 167 tested HIV-positive (2.7% yield). In order to improve the testing yield from these community outreach sessions, IHAP-HK/L began updating health zone hot spot mapping (to reflect homes/originating locations of newly-identified HIV positive individuals from FY19) in order to identify new or emerging hot spots where community prevention and testing services will be deployed in FY20 (see sub-objective 3.2). In Fiscal Year 2019 (FY19) Quarter 4 (Q4), 71,583 individuals received HIV testing services (HTS) in facilities or in the community—49,571 in Haut Katanga (70%) and 22,012 in Lualaba (30%). Among those tested, 4,627 (6.5%) tested positive—3,272 in Haut Katanga (6.6% yield) and 1,355 in Lualaba (6.2% yield).
Figure 4. HIV testing yield by province, July–September 2019.
60,000 10.0%
49,571 9.0%
50,000
8.0%
7.0% 40,000 6.6% 6.2% 6.0%
30,000 5.0% 22,012 4.0%
20,000
3.0%
2.0%
10,000
3,272 1,355 1.0%
0 0.0% Haut Katanga Lualaba
Tested tested positive Yield
As shown in Figure 6 below, 87% (63,512) of individuals were provided with HIV testing services at the facility-level, with 4,332 identified HIV-positive (6.8% yield), and 8,071 were tested at the community-level, among whom 295 were identified HIV-positive (3.7% yield).
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 1 Figure 6. HIV testing yield at facility and community levels, July–September 2019.
70,000 63,512 8.0%
7.0% 60,000 6.8%
6.0%
50,000
5.0%
40,000
4.0%
30,000 3.7%
3.0%
20,000
2.0% 8,071 10,000 4,332 1.0% 295
0 0.0% Facility Community
Tested Tested positive Yield
41,827 (71%) of the individuals tested at the facility-level were female (6.1% yield), and 17,353 (29%) were male (10% yield). Figure 7 below shows yield by age and sex for FY19 Q4. Testing yields are higher among men than women, with a rising curve between the ages of 20 and 49 years and decreasing after 49 years (with the same trend echoed among females). This increasing yield from 15 to 49 years old among both males and females can be attributed to heightened sexual activity following sexual debut and an increase in socioeconomic status and income among men over 35 years old. To address this, IHAP-HK/L will continue to hold discussions with ELIKIA to strengthen collaboration, especially to improve HIV prevention messaging and counseling provided to adolescents.
Figure 7. HIV testing yield at project-support facilities by age and sex, July–September 2019.
19.7% 19.1% 17.6% 15.3% 14.7% 14.6% 12.4% 10.7% 9.1% 8.7% 9.0%
5.9% 6.4% 6.4% 5.3% 5.0% 4.1% 4.2% 3.8% 3.2% 3.1% 1.9%
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 >50
Females Males
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 2 Figure 8 below depicts volume of newly identified HIV positive individuals in Q4 by age and sex of individuals. As highlighted in the below figure, higher volumes of HIV-positive individuals are observed among females in the 20- to 44-year-old age bands.
Figure 8. Volume of newly identified HIV-positive individuals at project-supported facilities by age and sex, July-September 2019.
50+ years 198 253 45-49 years 163 238 40-44 years 286 290 35-39 years 383 324 30-34 years 422 258 25-29 years 417 120 20-24 years 272 50 15-19 years 96 28 10-14 years 52 36 5-9 years 103 84 1-4 years 138 121 <1 year 0 0
Female Male
Figure 9 shows seropositivity by health zone (HZ). The health zones with the most efficient testing (above 4.5% yield and more than 350 newly-identified PLHIV) were observed in Manika, Kampemba, Lubumbashi, and Sakania HZs.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 3 Figure 9. Seropositivity by health zone, July–September 2019.
12,000 12.0%
10,000 10.0%
8,000 7.1% 8.0% 6.8% 6.6% 6.0% 5.4% 6,000 5.4% 6.0% 5.1% 4.4% 4.2% 3.7% 3.4% 3.4% 3.4% 3.6% 3.5% 4,000 3.3% 3.4% 4.0% 2.6%
2,000 2.0%
3,530 799 443 9,678 2,649 2,670 1,738 1,145 10,413 8,564 1,729 5,929 1,353 5,831 5,790 2,105 1,649 1,234
- 0.0%
Figure 10 shows seropositivity by entry point for 56,399 clients tested at health facilities. Of the two orphans and vulnerable children referred by Enhancing Services and Linkages for Children Affected by HIV and AIDS (ELIKIA) to the project-supported sites for HTS within the reporting period, one tested positive.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 4 Figure 10. HIV testing yield by service delivery point at facility level, July–September 2019.
20000 30.0%
18000
23.8% 25.0%
16000
19.9% 14000
20.0%
12000
10000 15.0% 12.6% 17406 8000 16218 9.3% 8.8% 8.3% 10.0%
6000
5.0% 5.0% 4000 8750 4.3% 3.4% 5201 5.0%
2000 1.4% 3280 1.2% 0.9% 0.6% 151 1388 1666 140 140 851 203 215 790
0 0.0%
HTS_TST Yield
Abbreviations: HTS, HIV testing services; STI, sexually transmitted infection; PMTCT, prevention of mother-to-child transmission of HIV; TB, tuberculosis; VCT, voluntary HIV counseling and testing . As observed in previous quarters, high testing volume and yield were observed at the index- testing entry point (Figure 11), and IHAP-HK/L focused on intensifying case-finding through this entry point in Q4. 3,952 HIV-positive individuals received counseling on the importance of having their sexual partners, biological children, and/or biological parents tested for HIV. Of those counseled, 3,742 (95%) provided a list of 8,889 contacts for follow-up (2.4 contact elicitation rate), among whom 8,750 received HTS (98% acceptance). Of those, 1,743 individuals tested HIV positive (20% seropositivity); this represented 38% of the 4,627 HIV- positive individuals identified by IHAP-HK/L this quarter, which exceeded the 30% target set by US President’s Emergency Plan for AIDS Relief (PEPFAR).
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 5 Figure 11. IHAP-HK/L index testing cascade by province, July-September 2019.
8,230 8,165
2.5 contact elicitation rate 3,374 3,336 19% yield 1.6 contact 37% 1,524 elicitation yield 578 rate 659 585 406 219
Haut Katanga Lualaba Index clients counseled Index clients providing list of contacts Contacts elicited Contacts tested for HIV Contacts identified HIV-positive
Abbreviations: IHAP-HK/L, Integrated HIV/AIDS Project in Haut Katanga and Lualaba. Figure 12 provides available disaggregated data showing HIV testing results and yield by contact category. Of the 8,621 individuals for whom we have disaggregated data, 31% (2,719) were sexual partners (47% seropositivity); 67% (5,766) were biological children of female PLHIV (6.7% seropositivity); and 2% (136) were biological parents of young PLHIV (55% yield).
Figure 12. Index testing results and yield by contact category, July-September 2019
Abbreviation: PLHIV, people living with HIV/AIDS.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 6 In FY19 Q4, IHAP-HK/L developed an assisted partner notification services dashboard to better track and follow up with contacts elicited from index clients through final outcome (provision of HIV test result and linkage to treatment or pre-exposure prophylaxis). This tool will be distributed to all project-supported sites in FY20, with an onsite briefing on use of the tool for facility-based providers and peer educators.
In Q4, 17,612 pregnant women were received at ANC wards, among whom 17,436 (99%) were tested for HIV and informed of their status. Of the 17,345 tested for HIV, 301 were newly identified as HIV positive (1.7% yield) —181 in Haut Katanga (1.6% yield) and 120 in Lualaba (1.9% yield). A total of 291 pregnant women (97%) were initiated on antiretroviral therapy (ART). Figure 13 shows the prevention of mother-to-child transmission of HIV cascade by province in FY19 Q4.
Figure 13. Prevention of mother-to-child transmission of HIV cascade by province, July–September 2019.
12,000 120.0%
10,000 11,066 11,062 100.0% 96.7% 96.7%
8,000 80.0%
6,000 60.0% 6,546 6,374
4,000 40.0%
2,000 20.0%
181 175 120 116
0 0.0% Haut Katanga Lualaba
Pregnant women attending ANC Pregnant women knowing their HIV status HIV positive pregnant women HIV positive pregnant women initiated on ART Linkage to ART
Abbreviations: ANC, antenatal care; ART, antiretroviral therapy. From July through September 2019, project-supported facilities collected 199 dried blood spot (DBS) samples from HIV-exposed infants, of which 147 (74%) were collected within 2 months of birth and 52 (26%) were collected between 2- and 12-months following birth. Of the 199 samples collected, 149 (75%) were analyzed and results returned to patients. Two infants tested HIV positive (1.3%) and were initiated on ART. Figure 14 shows the yield from early infant diagnosis by province.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 7
Figure 14. Early infant diagnosis coverage and yield by province, July–September 2019.
140 1.8%
1.6% 120 1.6%
1.4%
100 1.2% 1.2%
80
1.0%
0.8%
60
0.6%
40
0.4%
20
0.2% 125 85 74 64
0 0.0% Haut Katanga Lualaba
HEI with DBS samples collected HEI with DBS samples analyzed Yield
Abbreviations: EID, early infant diagnosis; HEI, HIV-exposed infants. Activity 1: Improve efficiency of provider-initiated HIV testing and counseling at all entry points in 162 supported facilities and 35 satellite sites in Lualaba and Haut Katanga. IHAP-HK/L continued to provide ongoing mentorship and technical assistance to 162 project- supported facilities and 35 satellite sites on the use of registers, tools, job aids, and standard operating procedures with focus on index testing (including partner notification process); consistent use of the HIV-risk screening tool; and expanding reach of HIV testing services to non-projected supported facilities through the network of satellite sites. The project increased HIV case-finding under the index testing entry point by prioritizing contact elicitation and partner notification among three categories of PLHIV newly identified HIV- positive individuals; non-adherent PLHIV on ART; and PLHIV with unsuppressed viral loads (VLs). IHAP-HK/L continued to reinforce use of the risk assessment tool at inpatient, outpatient, and emergency wards at hub and satellite sites by providing supportive supervision during site visits. IHAP-HK/L also provided support to a network of 35 satellite sites, linked to 16 project- supported hub facilities, to extend the geographic coverage of project-supported HIV testing activities. The 35 satellite sites provided HIV testing services to 2,182 individuals, among whom 164 HIV-positive individuals were identified (7.5%) yield. All 164 newly identified PLHIV were provided with an escorted referral to project-supported facilities for confirmatory diagnosis and ART initiation. Activity 2: Strengthen provision of targeted HIV testing and counseling services for adolescents and youth in eight health zones of Haut Katanga and Lualaba. The IHAP-HK/L technical team hosted a training session for 20 adolescent peer educators on HIV status disclosure in five HZs of Haut Katanga (Lubumbashi, Kenya, Kamalondo, Rwashi,
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 8 and Kampemba). IHAP-HK/L also supported HZ focal points to conduct quarterly monitoring visits of youth- and adolescent-focused outreach sessions in three HZs in Haut Katanga (Kampemba, Lubumbashi, and Rwashi).
Activity 3: Scale up targeted mobile and workplace HIV counseling and testing for fishing communities and commercial and artisanal mining enterprises in four health zones of Haut Katanga and Lualaba. To increase HIV case finding among men, IHAP-HK/L coordinated with Comité Inter Entreprise de Lutte contre le Sida (CIELS) to identify new professional associations to introduce workplace testing. Using the HZs’ microplanning and mapping data, IHAP-HK/L identified two taxi driver associations (moto-taxis and bus taxis) and 15 taxi ranks across five HZs of Lubumbashi where the taximen and truck drivers tend to park and congregate. IHAP-HK/L conducted a training session in August for 15 taxi drivers and five social assistants from World Production on the provision of sensitization and HIV testing services (both mobile and workplace testing).
Activity 4: Strengthen provision of home-based testing for children and partners of index case patients who cannot be tested through another method in six health zones of Haut Katanga and Lualaba. During monitoring visits to PoDi+ sites (community-based points of antiretroviral medication distribution), IHAP-HK/L conducted an on-site refresher briefing and provided ongoing technical assistance to peer educators on index testing counseling and contact elicitation, methods of assisted partner notification (including supporting HIV status disclosure), and procedures for home-based testing to reach children and partners of index clients who do not want to come to facilities for testing.
Activity 5: Conduct analysis of programmatic data to understand barriers impeding index case testing and preferred modes of index case testing (home-based testing, testing at PoDi+ sites, or facility-based index case testing) In the last quarter of FY19, IHAP-HK/L noted that the majority of contacts of index clients preferred to be tested by their usual doctor or nurse (i.e. an individual they trusted), and at times or places convenient to them (at PoDi+ facilities; homes; in their office or car) due to fear of stigmatization and for reasons of confidentiality. Providing HIV testing services based on client preferences was one of the drivers of the project’s success in reaching a higher percentage of elicited contacts with HIV testing services this past quarter. Activity 6: Improve the follow-up of early infant diagnosis and mother-baby pairs in all 162 project-supported structures. IHAP-HK/L conducted weekly follow-up with the two reference laboratories in Lubumbashi to confirm receipt of early infant diagnosis (EID) samples transported from project-supported facilities, track sample analysis, facilitate transmission of results to facilities, and record results in patient files. During regular site visits, IHAP-HK/L technical officers (TOs) and site support coordinators (SSCs) continued to coach facility-based service providers in Haut Katanga to record EID results in patient files and applicable registers as soon as they came into the facilities and conduct
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 9 immediate follow up with family members of infants who receive an HIV-positive result for confirmatory diagnosis and treatment initiation.
Sub-objective 1.2: Expanded comprehensive HIV/AIDS care and treatment services. Of the 4,627 individuals identified as HIV positive in IHAP-HK/L‒supported facilities and communities in Q4, 4,549 HIV-positive patients were newly initiated on ART (98%). Figure 5 shows linkage to treatment, by province, in Q4.
Figure 5. Linkage to treatment by province, July–September 2019.
4000 120.0% 100.7%
3500 97.3%
100.0%
3000
80.0%
2500
2000 60.0%
1500
40.0%
1000
20.0%
500 3272 3184 1355 1365
0 0.0% Haut Katanga Lualaba
Tested positive Linked to ART Linkage rate
Abbreviation: ART, antiretroviral therapy. Figure 6 shows the time to treatment initiation in FY19 Q4 for 4,287 patients for whom disaggregated data is available. 97% were enrolled in treatment within seven days of being identified as HIV positive, with 91% enrolled in treatment on the same day as their HIV test.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 10 Figure 6. Time to treatment initiation by province, July–September 2019.
2,933 965 157 92 61 12 12 27 14 14
Same day 2–7 days 8–14 days 15–21 days >21 days
Haut Katanga Lualaba
IHAP-HK/L supported a cohort of 40,398 PLHIV at the end of September 2019—28,962 patients (72%) in Haut Katanga and 11,436 patients (28%) in Lualaba. Figure 7 shows the treatment cohort by HZ.
Figure 7. Treatment cohort by health zone, September 2019.
8748
4837 4693 4161
2943 2903 2843 2193 1299 1215 1165 920 555 554 453 431 277 207
26,612 (66%) of the project’s treatment cohort were females and 13,785 (34%) were males. Figure 17 shows their distribution rate by age and sex.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 11 Figure 17. Treatment cohort by age band and sex, September 2019.
+50 years 3,319 2,631 45-49 years 2,491 1,917 40-44 years 3,333 2,049 35-39 years 4,112 1,932 30-34 years 4,310 1,639 25-29 years 3,637 985 20-24 years 2,480 427 15-19 years 958 376 10-14 years 557 479 5-9 years 687 638 1-4 years 687 685 <1 year 42 27
Female Male
From October 2018 through September 2019, IHAP-HK/L registered 824 missed appointments: 224 were due to death (27%); 58 were transfers out of the project’s cohort (7%); and 542 were patients lost to follow-up (66%). Of the 542 lost to follow-up, 231 (43%) were tracked with success and reengaged in the treatment cohort.
Beginning in April 2019 and in alignment with PEPFAR guidance to transition all eligible PLHIV to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD), IHAP-HK/L took the following actions to be monitored on a weekly basis: disseminating new national instructions (shifting all to TLD), removing the nevirapine- and efavirenz-based regimens from all sites in Haut Katanga and replacing them with TLD, and calling all patients under tenofovir/lamivudine/efavirenz for a special appointment to shift them to TLD. As of the end of September 2019, of the 38,096 patients eligible for TLD, IHAP-HK/L has transitioned 33,730 patients (89%) to TLD. Figure 18 shows a timeline of progress towards TLD transition from April to September 2019.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 12 Figure 18. Progress towards transition to tenofovir disoproxil fumarate/lamivudine/dolutegravir by month, April—September 2019.
Activity 1: Ensure PLHIV are enrolled and retained in HIV treatment. In FY19 Q4, IHAP-HK/L continued to provide supportive supervision to providers to reinforce same-day treatment enrollment, ensure proper use of Tier.Net and registers, provide counseling on treatment literacy, identify patients to transfer to DCMs, and offer sexually transmitted infection and sexual- and gender-based violence screening and treatment/care services as needed for all PLHIV. During their regular site visits, TOs and SSCs continued to mentor providers to coordinate with peer educators to track PLHIV who missed appointments and were lost to follow-up.
Activity 2: Provide psychosocial support for PLHIV on treatment via self-help groups. IHAP-HK/L held training sessions for adolescent peer educators on providing psychosocial support and HIV counseling, with a focus on HIV status disclosure and strategies for following up with adolescent PLHIV and re-engaging them in care and treatment services. IHAP-HK/L also continued to support three NGOs across Haut Katanga and Lualaba to provide psychosocial support and care services to 422 PLHIV enrolled in 20 self-help groups (Table 2). In order to increase access to differentiated care for stable PLHIV, IHAP-HK/L began shifting some self- help groups into ART support groups in Q4.
Table 2. Self-help groups and patients supported by Bread and Knowledge Too Congo in Haut Katanga and Bureau Diocésain des Ouvres Médicales and LAMUKA in Lualaba, September 2019.
Health zones Nongovernmental # of self-help # of self-help group organizations groups members Lubumbashi BAK-Congo 9 201 Kamalondo BAK-Congo 2 51 Rwashi BAK-Congo 1 19
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 13 Kenya BAK-Congo 3 85 Kampemba BAK-Congo 2 43 Dilala BDOM 1 12 Fungurume LAMUKA 2 11 TOTAL 20 422 Abbreviations: BAK-Congo, Bread and Knowledge Too Congo; BDOM, Bureau Diocésain des Ouvres Médicales (Diocesan Office of Medical Works). Activity 3: Strengthen linkage to treatment at six new facilities in Kasaji and Dilolo by introducing models to reinforce the integration of provider-initiated HIV testing and counseling and ART services. In August 2019, ten months after the six facilities in Kasaji and Dilolo HZs began implementing the one-stop shop models, IHAP-HK/L documented the linkage to treatment rate to measure impact of these models on linkage. As highlighted in Figure 18, the linkage to treatment ranged from 85% to 165%.
Figure 8. Linkage to treatment by site in Dilolo and Kasaji HZs, August—September 2019.
Abbreviations: CS, Centre de Santé (Health Center); CSR, Centre de Santé de Référence (Health Referral Center); HTS-pos, Newly-identified HIV positive individuals Linkage rates above 100% were observed in Centre de Santé de Référence (CSR; Health Referral Center) Santé pour Tous (165%), Kasaji Hôpital General de Référence (HGR; General Referral Hospital) (111%), and Dilolo HGR (117%), which received escorted referrals of HIV-positive individuals from the spoke site of Centre de Santé (CS; Health Center) Lueu and the satellite sites of Katoka and Lizangenu.
Sub-objective 1.3: Improved integration of HIV/TB services. In FY19 Q4, IHAP-HK/L provided technical assistance to all supported facilities to strengthen HIV testing, care, and treatment for tuberculosis (TB) patients and to screen PLHIV for TB. As
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 14 depicted in Figure 9, among the 1,892 patients with new and relapsed TB who were registered at the 52 tuberculosis diagnostic and treatment centers (CSDTs) supported by IHAP-HK/L in Q4, the HIV status of 1,888 patients (99.8%) was documented in their patient file. Of these patients, 237 were HIV positive (13% seropositivity). Among the 237 HIV-positive patients, 210 were linked to ART (89%). The remaining 27 were not yet initiated on ART in the reporting period due to deteriorated clinical status requiring stabilization before starting ART.
Figure 9. HIV cascade among tuberculosis patients, by province, July–September 2019.
1200 100%
89% 88% 90%
1000
80%
70%
800
60%
600 50%
40%
400
30%
20%
200
10% 1111 1112 145 129 781 776 92 81 0 0% Haut Katanga Lualaba
New and relapse TB patients TB patients with documented HIV status TB/HIV coinfected patients TB/HIV coinfected patients linked to ART Linkage rate
Abbreviation: TB, tuberculosis.
Activity 1: Strengthen provision of TB case finding and isoniazid preventive therapy in 162 IHAP-HK/L facilities. In FY19 Q4, IHAP-HK/L continued to coach facilities on the use of TB/HIV data collection tools, provision of HTS to all TB presumptive cases, and referrals of their sputum samples to the CSDTs for GeneXpert® analysis. In all, 53% of the project’s cohort was screened for TB. Of the 21,536 PLHIV screened for TB across Haut Katanga and Lualaba, 21,258 (57%) screened negative. However, they were not initiated on isoniazid preventive therapy (IPT) due to the limited quantity of IPT available in country; existing stocks of IPT was allocated to the patients already on IPT to ensure continuation and completion of their IPT course.
Of the 3,228 patients expected to complete at least six months of IPT from July through September 2019, 1,264 (39%) completed their course of IPT as expected. The 61% who did not complete their courses of IPT were unable to do so because of shortages in stocks of isoniazid. However, IHAP-HK/L continued advocacy with the Programme National de Lutte contre la Tuberculose (PNLT; National Program for the Fight against Tuberculosis) and obtained a quantity of isoniazid to cover six months of IPT for 4,348 patients.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 15 Activity 2: Coordinate with the Programme National de Lutte contre la Tuberculose (PNLT) and Programme National de Lutte contre le SIDA(PNLS) to monitor and expand the network for sample transportation and results return for TB diagnosis. In FY19 Q4, IHAP-HK/L continued ongoing support to providers on the collection, preparation, packaging, and transportation of sputum samples from the 110 non-CSDT project-supported sites to CSDTs for GeneXpert analysis.
In total, IHAP-HK/L collected sputum samples from 278 presumptive TB patients. The project referred 170 samples for GeneXpert confirmation and the remaining 108 for other confirmation exams (e.g., microscopy) for TB diagnosis. Of the 278 referred for TB confirmation, 93 (34%) were confirmed TB positive, of which 82 (88%) were initiated on TB treatment.
Activity 3: Strengthen TB infection control practices in 106 IHAP-HK/L‒supported facilities. In FY19 Q4, IHAP-HK/L expanded tuberculosis infection control (TBIC) committees to 54 additional facilities (28 in Haut Katanga and 26 in Lualaba). The project also provided technical assistance to 52 facilities with existing TBIC committees to improve administrative, environmental, and personal protective measures. IHAP-HK/L participated in joint supervision visits organized by the PNLT to monitor the implementation of TBIC practices in 75 selected facilities with TBIC committees (46 in Haut Katanga and 29 in Lualaba). IHAP-HK/L staff shared recommendations on correct sputum collection techniques, transportation, and use of protective materials provided by the project.
Sub-objective 1.4: Expanded network and referral systems for other health and social services. Activity 1: Support the Division Provinciale de la Santé in Lualaba to extend implementation of the bidirectional referral system to Kasaji and Dilolo health zones. In FY19 Q4, IHAP-HK/L continued to monitor the functioning of the bidirectional referral system in the six project-supported sites and satellite site CS Lueu located in Kasaji and Dilolo HZs to ensure that facilities are familiar with the tools and forms required under the system.
Activity 2: Orient network of 35 satellite sites linked to IHAP-HK/L–supported facilities on procedures for bidirectional referrals. IHAP-HK/L continued to coach the HIV focal points in the 35 satellite sites on escorted bidirectional referrals between satellite sites and hub sites for clients who are found to be HIV positive and initiated on ART at hub sites. For these patients, IHAP-HK/L integrated bidirectional reference data into its weekly monitoring system to ensure that all patients initiated on ART at the hub site continue regular appointments at the satellite site.
Activity 3: Post mapping of HIV services online. In FY19 Q4, the IHAP-HK/L developer collected and imported geocoordinates and administrative data from 19 missing sites to complete the online mapping of HIV services.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 16 In FY20, the project will work on verifying facility geocoordinates and once completed, will post the final mapping online and share the link with all project-supported facilities and health zones for use in facilitating referrals.
Activity 4: Monitor and reinforce functioning of the updated bidirectional referral system. In FY19 Q4, IHAP-HK/L held five on-site meetings in the Kenya (2), Lubumbashi (1), Ruashi (1), and Kampemba (1) HZs and conducted joint visits with HZ staff to do spot checks of referral documentation and identify areas for improvement.
Objective Two: Use of integrated HIV/AIDS services increased at both facility- and community-based levels
Sub-objective 2.1: Improved community environment to support healthy behaviors. In FY19 Q4, IHAP-HK/L continued to support 18 HZMTs and five nongovernmental organizations (NGOs) to implement community-based HIV outreach, prevention, testing, and support activities in Haut Katanga and Lualaba.
Activity 1: Update and distribute communication materials for community-level HIV sensitization and adherence counseling. IHAP-HK/L reviewed, updated, and printed counseling cards on HIV prevention, care, and treatment adherence. These updated counseling cards were distributed to to 48 peer educators, 8 HZ social assistants, 28 facility-based HIV focal point, and 32 relais communautaires (community health workers) for use in HIV prevention/testing outreach and psychosocial support sessions. The IHAP-HK/L technical team also developed and distributed a flyer on the advantages of dolutegravir, ART retention, and VL suppression to be posted at all project- supported facilities and PoDi+ sites.
Activity 2: Support 18 HZMTs and five NGOs to coordinate community-level interventions to increase uptake of testing and prevention services and support retention on treatment. IHAP-HK/L provided support to five community-based non-governmental organizations to conduct mobile and community testing services, and offer community-based care and treatment services to PLHIV. During monthly data review meetings, IHAP-HK/L provided technical support to four HZs in Lualaba and eight HZs in Haut Katanga to review community-level data in line with PEPFAR indicators.
Activity 3: Coordinate with World Production, BDOM, and LAMUKA to create digital outreach strategies to reach youth and adolescents with messaging and information on HIV and available services. This activity has been canceled due to budget limitations and a decision to focus limited resources on activities that directly contribute to case-finding, treatment initiation, and treatment retention, especially given the additional resources that would need to be dedicated in order to
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 17 maintain a dynamic Facebook page and outreach strategies to effectively reach youth and adolescents and link them to counseling and testing services.
Activity 4: Involve the Programme National Multisectoriel de Lutte contre le SIDA (National Multisectoral Program for the Fight against AIDS) in quarterly project supervision visits to monitor implementation of community-level activities in Haut Katanga and Lualaba. In FY19 Q4, IHAP-HK/L held meetings with the Programme National Multisectoriel de Lutte contre le SIDA (National Multisectoral Program for the Fight against AIDS) to discuss community-level activities. Following these discussions, workplace testing was identified as an area for improvement in collaboration with CIELS and driver associations. Information gathered from these associations and HZ microplans helped to identify new locations where workplace testing can be introduced in FY20.
Sub-objective 2.2: Optimized service delivery models. From July to September 2019, as shown in Error! Reference source not found., IHAP-HK/L enrolled 10,026 stable PLHIV in differentiated care services, which reflects 43% of the project’s treatment cohort. Among them, 9,528 (95%) were enrolled in a fast-track circuit, 392 in self-help group meetings (4%), and 106 (1%) in PoDi+ sites.
Table 3. PLHIV enrolled in differentiated care models by province, September 2019.
Province Service delivery model Number of sites New patients Total number of enrolled in Q4 current patients
Haut Katanga PoDi+ 2 100 2,020 Distribution at self-help group 85 355 2,422 meetings Fast-track circuit 106 9,020 10,697 Subtotal 193 9,475 15,139 Lualaba PoDi+ 1 6 160 Distribution at self-help group 17 37 634 meetings Fast-track circuit 18 508 1,240 Subtotal 36 551 2,034 TOTAL 229 10,026 17,173 Abbreviation: PoDi+, community-based points of antiretroviral medication distribution; Q, quarter. Activity 1: Strengthen quality of services provided at three PoDi+ sites to improve retention of stable PLHIV on treatment. IHAP-HK/L funded RNOAC to maintain three PoDi+ sites, one each in Kenya, Lubumbashi, and Dilala HZs. In FY19 Q4, a total of 33 stable PLHIV were newly enrolled at the Kenya PoDi+ site, 67 at the Lubumbashi PoDi+ site, and 6 at the Dilala PoDi+ site; this resulted in a total cohort of 2,180 PLHIV supported by PoDi+ sites by the end of September 2019.
VL counts were recorded in the files of 810 patients enrolled at Kenya’s PoDi+ site, of whom 765 (95%) had suppressed VL. VL counts were recorded for 1,060 PLHIV enrolled at the
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 18 Lubumbashi PoDi+ site and 160 PLHIV enrolled at the Dilala PoDi+ site, all of whom had suppressed VL.
PoDi+ staff actively checked medical records to ensure that VL counts were recorded in all patient files, reminded patients about their VL sample appointments, and referred patients to health facilities for sample collection. PoDi+ staff referred 145 patients (40 from the Kenya PoDi+ site and 105 from the Lubumbashi PoDi+ site) to HGR Kenya and Centre d’Excellence, respectively, for VL sample collection in FY19 Q4. IHAP-HK/L continues to work with RNOAC to maintain active outreach to PLHIV enrolled at the Kenya PoDi+ site who do not have a VL count to collect and send samples to the laboratory for analysis.
IHAP-HK/L recorded average 12- and 24-month patient retention rates above 90% at both Kenya and Lubumbashi PoDi+ sites: The Kenya PoDi+ site recorded an average 12-month retention rate of 92% and an average 24-month retention rate of 90%. The Lubumbashi PoDi+ site recorded an average 12-month retention rate of 91% and an average 24-month retention rate of 95%.
Activity 2: Expand distribution of antiretrovirals to an additional 172 ART support groups to improve PLHIV’s retention on treatment. IHAP-HK/L designed, reproduced, and distributed longitudinal registers to more accurately track stable patients receiving differentiated care at monthly meetings of 102 ART support groups run by peer educators and operating in 10 HZs in Haut Katanga and Lualaba at the end of September 2019 (Error! Reference source not found.).
Table 4. Patients enrolled in antiretroviral therapy support groups by health zone, September 2019. Health zone ART support groups Patients enrolled in ART groups Lubumbashi 36 976 Sakania 8 161 Kampemba 9 346 Kenya 23 627 Kamalondo 6 203 Rwashi 3 109 Manika 7 206 Dilala 3 226 Lualaba 2 48 Fungurume 5 154 TOTAL 102 3,056 Abbreviation: ART, antiretroviral therapy. Activity 3: Expand the fast-track ARV pick-up system model to an additional 34 facilities in Haut Katanga and Lualaba.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 19 IHAP-HK/L designed, reproduced, and distributed longitudinal registers to accurately track stable patients enrolled in differentiated care services across the 124 facilities implementing the fast-track refill circuit. As of the end of September 2019, a total of 11,937 patients were enrolled in fast-track pick-up circuits: 10,697 in Haut Katanga and 1,240 in Lualaba (Error! Reference source not found.). Of the 10,697 patients enrolled in the fast-track system in Haut Katanga, 7,008 (65%) were female and 3,689 (35%) were male. Of the 1,240 patients enrolled in the fast-track system in Lualaba, 756 (61%) were female and 484 (39%) were male.
Table 5. Patients enrolled in fast-track pick-up circuits by health zones and facility, September 2019.
Health zone Number of facilities with fast- Patients enrolled in fast track track circuits Lubumbashi 17 5,047 Kenya 14 626 Kamalondo 2 178 Kapolowe 8 290 Panda 7 335 Ruashi 14 1,286 Sakania 17 698 Kampemba 27 2,237 Total Haut Katanga 106 10,697 Manika 7 387 Dilala 4 461 Lualaba 2 51 Fungurume 5 341 Total Lualaba 18 1,240 Total 124 11,937
Activity 4: Conduct analysis of programmatic data to compare clinical and biological outcomes for DCMs implemented by IHAP-HK/L. IHAP-HK/L continued to collect programmatic data on retention and VL suppression at PoDi+ facilities. This updated data indicated a 93% retention rate and 95% viral suppression rate, and a 95% retention rate and 99.7% viral suppression rate, among PLHIV enrolled in differentiated care at the Kenya and Lubumbashi PoDi+ sites, respectively.
IHAP-HK/L held a debriefing session for staff from Kenya HGR, Kenya PoDi+, and HZMTs with recommendations to extend the DCM models to other HZs. IHAP-HK/L also began a dialogue with the Sakania health zone management team to begin discussions around creating a PoDi+ site in Kasumbalesa in FY20 linked to CSR Kasumbalesa.
Activity 5: Continue implementation of integrated quality and performance management (IQPM) activities at 71 facilities in Haut Katanga and Lualaba.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 20 In FY19 Q4, IHAP-HK/L TOs and SSCs continued to provide technical assistance to 56 sites that have been implementing quality improvement activities since FY18 through routine and targeted site visits to address underperformance and/or quality issues.
IHAP-HK/L assisted sites to continually monitor gaps for key indicators using both weekly data monitoring, High Frequency Reporting data, and monthly data to track underperformance and address identified issues. IHAP-HK/L focused its effort on supporting high-volume sites to reduce gaps between weekly targets and achievements, working with facility-based providers to identify and address root causes for weak performance.
Activity 6: Expand IQPM activities to 91 additional facilities in Haut Katanga and Lualaba. In FY19 Q4, IHAP-HK/L extended the integrated quality and performance management (IQPM) approach to 15 additional sites (13 in Lualaba and 2 in Haut Katanga), reaching a total of 32 sites with functional quality improvement teams and plans. In Q4, IHAP-HK/L held one-day briefing sessions for the 41 remaining project-supported sites in Haut Katanga in their respective HZ offices. Two providers per site participated in these briefing sessions, which were led by the HZMT and IHAP-HK/L staff. The sessions focused on assisted partner notification, tracking tools for appointment defaulters (for ART refills, clinic visits, VL sampling), supportive adherence counseling tools, and a dashboard for case management of patients with unsuppressed VLs. By the end of FY19, all project-supported sites were provided with functional IQPM teams. These teams meet on a weekly basis to analyze site performance and implement remediation plans.
Activity 7: Identify, document, and disseminate best practices that are identified by the IQPM approach with a virtual quality- and performance-improvement community. IHAP-HK/L continued to monitor IQPM data at the site level; TOs and SSCs coordinated with facility-based providers to share successful practices through face-to-face coaching visits. One particularly successful practice that was observed in Sakania HZ in Q4 was contact elicitation and partner notification through sexual networks in polygamous households. IHAP-HK/L observed a high ratio of partners tested per index client as a result of using assisted partner notification and focused contact elicitation/counseling to reach and test sexual partners within polygamous households. The IHAP-HK/L quality assurance/quality improvement team shared this experience and tips on conducting motivational contact elicitation through the WhatsApp channel to encourage other facilities to focus on index testing outreach through sexual networks.
Objective Three: Health systems strengthened to improve access to services and improve outcomes of PLHIV
Sub-objective 3.1: Essential commodities are available and effectively managed at all appropriate levels. In the last quarter of FY19, IHAP-HK/L continued to collaborate with the Global Health Supply Chain—Technical Assistance (GHSC-TA) project to supply all project-supported sites with
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 21 essential commodities, including consumables for biomedical waste management and laboratory services (sample collection and diagnostics); strengthen the capacity of HZs in commodity forecasting and quantification; and provide technical support to the commodity management technical working groups (TWGs).
Activity 1: Supply 162 project-supported sites with needed medical supplies and consumables (including supplies for biomedical waste management and laboratory services) to offer HIV and TB services. In FY19 Q4, the IHAP-HK/L supply chain team continued to work with all project-supported facilities to quantify existing stocks of supplies and consumables and forecast needed items on a quarterly basis. TOs and SSCs provided coaching during regular site visits.
IHAP-HK/L–supported facilities continued to experience stockouts of key commodities in Q4, which decreased the quality of HIV and TB/HIV services, as well as critically affected the provision of TB preventive therapy for PLHIV and rapid HTS (given the low stock and subsequent stockout of Uni-Gold™ test kits for confirmatory diagnosis). To mitigate (to the degree possible) the impact of stockouts on service delivery, the IHAP-HK/L supply chain team closely tracked stocks of HIV test kits and ARVs at the site level and redeployed any surplus stocks from low-volume/low-performing facilities to high-volume facilities. For isoniazid, IHAP-HK/L advocated to the PNLT to provide some isoniazid to cover 74 facilities across six HZs of Haut Katanga. As a result of these advocacy efforts, IHAP-HK/L received isoniazid to provide TB preventive therapy to more than 4,700 PLHIV, including a six-month course for 4,403 adults and a three-month course for 306 children.
Table 6 documents stockouts of commodities experienced by IHAP-HK/L–supported facilities throughout FY19.
Table 6. Stockouts in Fiscal Year 2019 in IHAP-HK/L–supported sites.
Reagent/commodities Period of stockout (dates) Length of stockout (days) Abacavir/Lamivudine (adult) January 1 to September 30, 2019 273+ days (ongoing) Isoniazid 100 mg October 12, 2018 to September 30, 2019 273+ days (ongoing) Isoniazid 300 mg October 12, 2018 to July 30, 2019 212+ days Cotrimoxazole 480 mg January 1 to July 22, 2019 203+ days Azidothymidine/Lamivudine/Nevirapine January 1 to May 1, 2019 121 days pediatric Uni-Gold test kits March 5 to 31, 2019; July 1 to September 92 days (ongoing) 30, 2019 Abacavir/Lamivudine 300/150 mg October 12 to December 31, 2018 80 days dispersible tablets DBS kits October 16 to 31, 2018; January 24 to 79 days February 27, 2019; July 1 to 30, 2019 Efavirenz 200 mg April 1 to May 1, 2019 31 days Male and female condoms April 1 to May 1, 2019 31 days Lamivudine/Nevirapine/Zidovudine December 1 to 31, 2018 31 days 30/50/60 mg tablets
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 22 Abacavir/Lamivudine120 mg/60 mg July 1 to 22, 2019 22 days Abbreviations: DBS, dried blood spot;
Activity 2: Strengthen the capacity of HZMTs and project-supported facilities in commodity management and storage, including commodity quantification, forecasting, and ordering. IHAP-HK/L held on-site meetings in July and August 2019 with the pharmacist and HIV focal point from high volume facilities and select members of HZ management teams to provide them with technical support on commodity quantification, forecasting, and ordering. Meetings were held in two HZs in Lualaba in July 2019 (Manika and Dilala) and five HZs in Haut Katanga ( Lubumbashi, Kampemba, Ruashi, Kamalondo and Kenya) in August 2019.
Activity 3: Provide technical support to existing commodity management technical working groups. In Q4, IHAP-HK/L participated in and provided technical support during the July and August meetings of the commodity management technical working groups in Haut Katanga and Lualaba. During these meetings, IHAP-HK/L advocated with success to the health zone management teams for the redeployment of 50 mg dolutegravir, which was overstocked at the Haut Katanga commodity depot, to improve the commodity distribution circuit among health facilities. IHAP- HK/L also recommended that GHSC-TA consider using the Logistics Management International System tool for monthly commodity reporting at the facility level. In addition, due to the consistent delays in receiving quarterly stocks of commodities from GHSC-TA (shipments frequently arrived at the end of the quarter they were meant to be used for), IHAP-HK/L advocated for future shipments to be made at least two weeks before the targeted delivery date to improve time management and facilitate receiving stocks of commodities earlier.
Sub-objective 3.2: Improved use of reliable data to continuously improve service delivery quality and effectiveness. IHAP-HK/L continued to map metadata between District Health Information Software 2 (DHIS2) and DATIM (Data for Accountability, Transparency, Impact, and Monitoring) in order to facilitate interoperability between the two systems. IHAP-HK/L staff produced and validated an import file and imported it into the DATIM demonstration space. After IHAP-HK/L verified successful import of the file, the project shared the file with the PEPFAR country team for analysis and creation of a file for all countries to use for import. The team checked whether the data were successfully imported, verified figures against indicator data, and made corrections as needed.
Activity 1: Coach 162 IHAP-HK/L‒supported sites on monthly data collection and reporting to ensure high-quality data reporting. TOs and SSCs continued to support sites with monthly reporting and verifying monthly data reported by project-supported facilities before entering the data into DHIS2. The IHAP-HK/L monitoring and evaluation (M&E) team continued to validate reported data and provided feedback to TOs and SSCs to correct data entry errors as needed in DHIS2. To reduce discrepancies in the data reported in DHIS2, the team developed a checklist to support verification of data completeness, accuracy, and consistency.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 23
During FY19 Q4, the project began collecting data on a weekly basis in order to meet High Frequency Report requirements. The IHAP-HK/L M&E team developed a weekly reporting template with data to be collected by TOs, SSCs, and health workers and reported in DHIS2. The IHAP-HK/L M&E team held a refresher meeting in September with TOs and SSCs to ensure understanding of weekly and monthly TLD reporting.
The PEPFAR Strategic Information country team held a refresher workshop at ICAP’s Lubumbashi office in September to harmonize understanding of Monitoring, Evaluation, and Reporting (MER) 2.3 indicators. Six project staff from IHAP-HK/L—three M&E team members and three technical program team members—participated in the workshop.
Activity 2: Improve data quality and use at health zone and facility levels. IHAP-HK/L continued to provide technical support during monthly HZ data review meetings in the 16 project-supported HZs. During the reporting period, IHAP-HK/L conducted 20 new site visits for routine data quality assurance in Haut Katanga (all in Lubumbashi) and 10 site visits for routine data quality assurance in Lualaba. IHAP-HK/L M&E staff also conducted on-site training sessions on data quality improvement during these site visits.
Activity 3: Effectively use Tier.Net for cohort management at 162 project-supported facilities. In FY19 Q4, IHAP-HK/L engaged HZMTs to provide supportive supervision of the 38 health providers from 20 facilities in Sakania, Panda, and Kapolowe HZs who had been trained in June on use of Tier.Net for cohort management. The M&E team followed those providers to ensure their effective involvement in updating Tier.Net. Among the 38 individuals trained, 34 have been encoding data under the supervision of TO/SSCs and the data clerk; 4 have not yet started due to the lack of computers, which will be provided in early FY20. In addition, IHAP-HK/L M&E staff continued to work with TOs to rapidly check and analyze Tier.Net data. In July 2019, IHAP-HK/L proceeded to clean up the cohort, as required by PEPFAR, to remove all patients no longer counted under the active cohort (lost to follow-up, deaths, transferred out, or not recovered). A total of 1,704 patients (6%) were removed from the project’s cohort in Haut Katanga.
Activity 4: Effectively use DHIS2 for data analysis, reporting, and visualization. IHAP-HK/L uses DHIS2 to analyze, report, and visualize data. The project has updated the project database to align with changes made in version 2.3 of the PEPFAR MER indicator guidance. Data entered into DHIS2 on a monthly basis are displayed in dashboards built into the database, which IHAP-HK/L staff use for monthly data analysis.
During the reporting period, IHAP-HK/L M&E staff provided additional support to TOs and SSCs to use the dashboards embedded in the project’s DHIS2 instance for site-level performance monitoring. In August 2019, the IHAP-HK/L M&E team conducted a refresher training for 50 sites on the use DHIS2 for data analysis, reporting, and visualization. Subsequently, the sites
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 24 started entering data directly into DHIS2 in weekly datasets. All 50 sites are currently using DHIS2. In FY20, the team will continue these on-site trainings to cover all supported sites as well.
Activity 5: Conduct health zone microplanning for eight health zones in Haut Katanga and Lualaba. IHAP-HK/L did not conduct a microplanning process with Kasaji and Dilolo HZs in FY19 as planned, due to the project’s phaseout of Lualaba province. IHAP-HK/L continued to use microplans to identify the most active hot spots for community and mobile testing outreach, targeting the high-priority populations of fishermen, truckers, artisanal miners, adolescent and youth, and clients of sex workers. IHAP-HK/L also began the process of revising the hot spot mapping (included in HZ microplans) with FY19 HTS_Pos data to include emerging high- prevalence areas/hot spots or to identify places where new cases are being identified. This is anticipated to be completed in October 2019, with the updated mapping used to inform community outreach and testing activities starting in November 2019. Activity 6: Participate in Site Improvement Through Monitoring System visits at project- supported facilities in Lualaba and Haut Katanga. Following the Site Improvement Through Monitoring System visits conducted by USAID in May and June at 32 facilities in Haut Katanga and 17 facilities in Lualaba, IHAP-HK/L TOs and SSCs coordinated with facilities to develop remediation plans, with a particular emphasis on accelerating transition to TLD, improving use of referral tools to strengthen linkages between community and clinical services, and encouraging site-level collaboration with peer educators to support active follow-up of PLHIV for index testing, tracing appointment defaulters, or collecting VL samples.
Activity 7: Support the leadership role of provincial PNLS and Division Provinciale de la Santé (Provincial Health Division) in coordinating HIV/AIDS activities in Haut Katanga and Lualaba. In Q4, IHAP-HK/L supported the provincial PNLS in Haut Katanga and Lualaba to disseminate and reinforce use of the updated HIV risk-screening tool, which was standardized and validated by the national PNLS from April to May 2019. IHAP-HK/L also supported the provincial PNLS in the transition to TLD and phasing out of nevirapine by disseminating and providing technical assistance to facility-based providers on the guidance outlined in the PNLS’ original memorandum, which restricted women of childbearing potential from being transitioned to TLD.
With the release of updated guidelines from the World Health Organization in July, which encouraged all adults to be transitioned to TLD as the preferred first-line treatment regimen, IHAP-HK/L began focused advocacy with the provincial PNLS to update the memorandum to align with the new World Health Organization guidelines. An updated memorandum was released in early September 2019, and IHAP-HK/L facilitated the dissemination of this guidance to the facility level to enable the immediate transition of women of childbearing potential to TLD.
Sub-objective 3.3: Effective, operational laboratory systems ensured.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 25 During the reporting period, IHAP-HK/L supported 162 laboratories and 501 testing entry points (338 in Haut Katanga and 163 in Lualaba) across all project-supported facilities to provide high- quality HIV diagnostic and monitoring services.
From July to September 2019, IHAP-HK/L collected plasma and DBS samples from 3,107 PLHIV for VL counts. In the same period, 4,218 samples (including those collected in the previous period) were analyzed and results were returned to the patients. In all, 3,585 (85%) of the 4,283 PLHIV who were provided with VL counts were virally suppressed. Figure 10
Figure 10 shows the VL cascade by province in FY19 Q4.
Figure 10. Viral load cascade by province, July–September 2019.
10,500 90% 84%
80%
10,000 Patients with VL samples70% collected
9,500 Patients60% with VL results
50% Patients with 9,000 suppressed VL 40% VL suppression rate
8,500 30%
20%
8,000
10% 9,018 10,191 8,597
7,500 0%
Abbreviations: VL, viral load. Activity 1: Strengthen laboratory capacity in Haut Katanga and Lualaba to provide high-quality diagnostic and analytical services (e.g., EID, VL, HIV, and TB diagnostics). In FY19 Q4, IHAP-HK/L continued to provide focused technical assistance to the seven new project-supported facilities in Kasaji and Dilolo (six hub sites and one spoke site) to ensure provision of high-quality HTS in accordance with PEPFAR standards; appropriate collection, packaging, and transportation of DBS and plasma samples; and immediate recording and communication of results to patients.
In August, the Centers for Disease Control and Prevention (CDC)/PEPFAR lab advisor visited Sendwe HGR and Kenya HGR to assess their capacity in conducting routine surveillance of PLHIV on ART, implementing the system for provision of routine VL counts, and interpreting results using the Viral Load Scale-Up Clinical Facility Readiness Assessment tool. Following this assessment, Sendwe HGR scored 81% and Kenya HGR 69%. IHAP-HK/L will provide
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 26 technical support to these two facilities in the organization of their labs and ongoing maintenance of data collection tools.
Activity 2: Strengthen the capacity of IHAP-HK/L‒supported facilities to provide high-quality HIV diagnostic services. In Q4, the PNLS Provincial Laboratory conducted proficiency testing with dried tube specimen panels at 422 testing entry points in all project-supported facilities and linked satellite sites. 346 testing entry points (82%) scored 100% and 77 testing entry points (18%) scored less than 100%. The 77 testing points will be provided with onsite technical assistance to address weakness in FY20, after the shortage of testing reagents and kits is over.
The IHAP-HK/L lab officer and lab advisor participated in a training of trainers session on the continuous improvement of the quality of HIV testing through rapid tests process, held in Lubumbashi from August 14 to 16, 2019. At the end of the training session, the CDC strongly recommended that all implementing partners develop a training plan for orienting facility-based providers on the process, which IHAP-HK/L will do in FY20 (since the test kit shortage impacted the ability to hold these orientation sessions in FY19).
Following this training, ICAP and the PNLS Laboratory conducted a joint audit visit of PEPFAR-supported sites in Haut Katanga, including 26 testing points at eight IHAP-HK/L sites (Sendwe Center of Excellence, CS Scholastique, HGR Kenya, CS Andre Barbier, Kasumbalesa CSR, HGR Sakania, CS Mary Elmer, and Sangaji). This audit was conducted from September 11 to 19, using the Graduation Process Evaluation tool. Data is currently being compiled and analyzed, and results will be available in early FY20.
Additionally, Global Health System Solutions conducted a second assessment visit of the laboratory at HGR Sendwe in August, related to the Strengthening Laboratory Management Towards Accreditation process.
Activity 3: Improve practices related to management and disposal of biomedical waste in 162 IHAP-HK/L facilities and 55 community outlets. IHAP-HK/L laboratory officers, TOs, and SSCs continued routine mentorship of facility-based providers on developing and implementing biomedical waste management plans, including placing garbage cans at all HIV testing entry points and using personal protective equipment (gloves, boots, and masks) and bleach/alcohol disinfection materials during collection and transportation of biomedical waste to disposal and destruction sites.
In FYQ4, IHAP-HK/L developed two standard operating procedures: one on the spill cleanup procedure for blood and other potentially infectious products, and the other on prevention and management of blood exposure accidents. These standard operating procedures were distributed to all the project-supported facilities, and TO/SSCs provided on-site briefings for facility providers during regular visits.
Activity 4: Strengthen the laboratory data management system.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 27 In FY19 Q4, IHAP-HK/L continued to provide technical assistance, through regular site visits by TOs and SSCs, on accurate and regular completion of laboratory data tools, including immediate updating of laboratory registers to record HIV testing results and VL counts.
To ensure that numbers of individuals, not tests, are reported, each VL sample sent to the laboratory for testing includes the patient’s unique identification number on both the voucher and the sample. This identification number is used to record results in patient files, facility-based registers, and in Tier.Net. IHAP-HK/L’s M&E team uses a function in Microsoft Excel to eliminate all duplicates and record only the last VL result received for each unique identifying number.
IHAP-HK/L designed two registers as recommended by PEPFAR: one for longitudinal follow- up of VL and the second for follow-up of the patients with unsuppressed VL. These registers will be distributed in the first quarter of FY20 to all the project-supported facilities, accompanied with an on-site briefing on use of these tools.
In August 2019, the American Society for Microbiology, with CDC/PEPFAR/Lab support, implemented the Viral Load System Management (VLSM) in three project-supported sites in Lualaba Province (Kolwezi Personnel Hospital, HGR Mwangeji, and Dipeta). They also conducted a mission in Haut Katanga from September 3 to 6 to train and install VLSM in HGR Panda, to cover Panda and Kapolowe HZs, and in CSR Kasumbalesa to cover Sakania HZ. 12 staff have been trained on the use of VLSM, 7 from IHAP-HK/L and 5 data encoders from each of the facilities implementing VLSM.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 28 Annexes
Annex One: Monitoring and evaluation table
PEPFAR indicators
Haut Katanga
Kamalondo Kampemba Kapolowe Kenya Lubumbashi Panda Rwashi Sakania TOTAL HTS_TST 1,101 8,701 2,309 8,388 7,888 5,059 4,601 1,490 39,537 Female 651 6,276 1,777 5,604 5,837 3,815 3,224 1,133 28,317 Male 450 2,425 532 2,784 2,051 1244 1,377 357 11,220 PITC inpatient services 3 26 10 28 22 37 22 12 160 PITC pediatric services 0 0 0 2 0 1 2 0 5 PITC malnutrition services 0 0 0 1 0 3 0 0 4 PITC TB clinics 3 8 9 21 11 10 13 5 80 PITC PMTCT (ANC only) clinics 2 23 8 17 45 13 9 8 125 PITC (other) 45 249 76 222 168 125 110 24 1019 Emergency 0 0 0 16 0 0 0 0 16 Family planning 0 2 2 0 9 5 0 1 19 Outpatient services 44 235 70 193 148 111 104 22 927 Post ANC1 1 12 4 13 11 9 6 1 57 ELIKIA OVC 0 0 0 1 0 0 0 0 1 VCT facility 5 0 0 9 8 17 41 0 80 VCT (out) 0 14 7 0 13 0 1 7 42 Index testing facility 68 498 101 396 247 102 80 32 1,524 Tested positive 126 818 211 697 514 308 278 88 3,040
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 29 Positivity rate 11.44% 9.40% 9.14% 8.31% 6.52% 6.09% 6.04% 5.91% 7.69% Female 75 405 144 400 290 184 160 52 1,710 Male 51 413 67 297 224 124 118 36 1330 Abbreviations: ANC, antenatal care; ART, antiretroviral therapy; EID, early infant diagnosis; ELIKIA, Enhancing Services and Linkages for Children Affected by HIV and AIDS; HTS, HIV testing services; OVC, orphans and vulnerable children; PEPFAR, United States President’s Emergency Plan for AIDS Relief; PITC, provider-initiated HIV testing and counseling; PMTCT, prevention of mother-to-child transmission of HIV; TB, tuberculosis; VCT, voluntary HIV counseling and testing.
PEPFAR indicators
Lualaba
Bunkeya Dilala Dilolo Fungurume Kanzenze Kasaji Lualaba Lubudi Manika Mutshatsha TOTAL HTS_TST (facilities only) 3,321 799 443 2,455 1,145 1,353 5,441 2,003 1,526 1155 19,641 Female 2,615 655 340 1,767 951 1,047 2,519 1519 1,269 825 13,507 Male 706 144 103 688 194 306 2922 484 257 330 6,134 PITC inpatient services 34 15 10 25 7 9 23 10 10 1 144 PITC pediatric services 0 0 0 0 0 0 2 0 0 0 2 PITC malnutrition services 0 0 1 1 0 0 0 1 0 0 3 PITC TB clinics 19 3 0 10 2 4 12 4 1 4 59 PITC PMTCT (ANC only) clinics 20 5 1 16 4 4 12 8 15 0 85 PITC (other) 157 39 13 73 52 40 110 38 19 16 557 Emergency 9 0 0 0 0 0 11 0 0 0 20 Family planning 0 0 3 3 0 11 1 5 0 0 23 Outpatient services 143 38 10 66 52 29 91 32 18 14 493 Post ANC1 5 1 0 4 0 0 7 1 1 2 21 ELIKIA OVC 0 0 0 0 0 0 0 0 0 0 0 VCT facility 56 4 4 0 12 0 11 2 0 1 90 VCT (out) 29 1 0 50 0 4 35 8 6 0 133 Index testing facility 50 8 10 33 13 14 56 20 6 9 219 Tested positive (facilities only) 365 75 39 208 90 75 261 91 57 31 1,292
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 30 Positivity rate 10.99% 9.39% 8.80% 8.47% 7.86% 5.54% 4.80% 4.54% 3.74% 2.68% 6.58% Female 237 49 26 132 65 41 146 64 41 19 820 Male 128 26 13 76 25 34 115 27 16 12 472 Abbreviations: ANC, antenatal care; ART, antiretroviral therapy; EID, early infant diagnosis; ELIKIA, Enhancing Services and Linkages for Children Affected by HIV and AIDS; HTS, HIV testing services; OVC, orphans and vulnerable children; PEPFAR, United States President’s Emergency Plan for AIDS Relief; PITC, provider-initiated HIV testing and counseling; PMTCT, prevention of mother-to-child transmission of HIV; TB, tuberculosis; VCT, voluntary HIV counseling and testing.
PEPFAR indicators
FY19 FY19 FY19 Q1 FY19 Q2 FY19 Q3 Haut Katanga Lualaba Q4 TOTAL FY19 target % achievement TOTAL TOTAL TOTAL TOTAL (to date) HTS_TST 39,537 19,641 61,348 62,369 64,152 59,178 247,047 287,348 85.97% Female 28,317 13,507 42686 43980 44,292 41824 172,782 Male 11,220 6,134 18662 18389 19,860 17354 74,265 PITC inpatient services 160 144 4,623 5,280 4,072 304 14,279 PITC pediatric services 5 2 216 247 245 7 715 PITC malnutrition services 4 3 243 229 166 7 645 PITC TB clinics 80 59 1,693 1,374 1,595 139 4,801 PITC PMTCT (ANC only) clinics 125 85 17,148 17,964 17,882 210 53,204 PITC (other) 1,019 557 26,086 26,692 33,298 1576 87,652 Emergency 16 20 129 154 205 36 524 Family planning 19 23 2,035 2,115 2,222 42 6,414 Outpatient services 927 493 17,637 18,302 16,779 1420 54,138 Post ANC1 57 21 6,285 6,121 5,661 78 18,145 ELIKIA OVC 1 0 15 3 11 1 30 VCT facility 80 90 3,287 3,099 4,360 170 10,916 VCT (out) 42 133 1,567 1,286 1,518 175 4,546 Index testing facility 1,524 219 1,527 1,800 2,542 1743 7,612
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 31 Tested positive 3,040 1,292 2,953 3,192 3,850 4332 14,327 12,913 110.95% Positivity rate 7.69% 6.58% 4.80% 5.10% 6.00% 14.27% 30.17% 4.50% 670.38% Female 1,710 820 1,887 2,026 2,382 2530 8,825 Male 1330 472 1,066 1,166 1,468 1802 5,502 PMTCT_STAT 99.96% 97.37% 98.60% 99.30% 99.70% 99.00% 99.17% 98.00% PMTCT_STAT_N 11,062 6,374 17,223 18,063 17,978 17,497 70,761 78,514 90.12% PMTCT_STAT_D 11,066 6,546 17,467 18,182 18,034 17,612 71,295 80,154 88.95% PMTCT_EID 213 271 357 199 1,040 1,452 71.63% PMTCT_ART_N 179 116 223 278 290 295 1086 1,498 72.50% TX_NEW 3,184 1,365 2,899 3,236 3,669 4,549 14,353 13,929 103.04% TX_CURR 28,962 11,436 33,211 34,336 36,228 40,398 40,398 42,658 94.70% TB_STAT 87.94% 98.00% 97.50% 92.00% 95.10% 92.16% 94.25% 99.90% TB_STAT_N 1,112 776 1,788 1,479 1,717 1,888 6,872 5,788 118.73% TB_STAT_D 1,111 781 1,834 1,607 1,805 1,892 7,138 5,793 123.22% TB_ART 92.41% 92.31% 90.60% 92.60% 94.30% 92.37% 92.51% 100.00% TB_ART_N 134 84 211 214 246 218 889 1,318 67.45% TB_ART_D 145 91 233 231 261 236 961 1,318 72.91% TB_PREV 21.29% 0.5063291 79.60% 79.80% 37.7% 23.00% 49.14% 84.90% TB_PREV_N 1093 160 1,829 1,886 358 1,264 3,150 6,316 49.87% TB_PREV_D 5133 316 2,298 2,362 950 3,228 5,590 7,439 75.14% TX_TB 0.22% 0.35% 0.60% 0.24% 1.57% N/A TX_TB_N 134 206 164 504 N/A TX_TB_D 21,077 4,546 23,079 28,384 28,338 42,650 TX_PVLS 82.60% TX_PVLS_N 24,731 24,731 27,242 91% TX_PVLS_D 29,942 29,942 34,483 87% PP_PREV 5,862 2,434 -- 6,106 -- 8,296 14,402 1,770 813%
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 32 GEND_GBV 72 Abbreviations: ANC, antenatal care; ART, antiretroviral therapy; EID, early infant diagnosis; ELIKIA, Enhancing Services and Linkages for Children Affected by HIV and AIDS; HTS, HIV testing services; OVC, orphans and vulnerable children; PEPFAR, United States President’s Emergency Plan for AIDS Relief; PITC, provider-initiated HIV testing and counseling; PMTCT, prevention of mother-to-child transmission of HIV; TB, tuberculosis; VCT, voluntary HIV counseling and testing.
Other indicators
FY19 FY19 Haut FY19 Q1 FY19 Q2 FY19 Q3 FY19 Q4 % Lualaba TOTAL annual Katanga TOTAL TOTAL TOTAL TOTAL achievement (to date) target Number of documented referrals. 224 137 71 1,299 1,731 TBD -- Percentage of health facilities without stockouts of essential drugs for HIV/AIDS and TB 33% 0% 0% 0% 0% 100% -- management. Abbreviations: TB, tuberculosis; TBD, to be determined
Annex Two: Trainings and site visits
Topic Location Dates Number of participants Trainings and workshops 2.2.3 Training for rapid circuit setup of stable patients Maison Safina August 22–23, 2019 25 (18 male, 7 female) 1.1.3 Training of taxi drivers on male testing Maison Safina August 27–29, 2019 20 (all male) 2.2.5 Briefing of providers on IQPM approach Lubumbashi PoDi+ August 24, 2019 18 (11 male, 7 female) 2.2.5 Briefing of providers on IQPM approach Ruashi health zone office August 25, 2019 15 (7 male, 8 female) 2.2.5 Briefing of providers on IQPM approach Kenya health zone office August 23, 2019 19 (10 male, 9 female) 2.2.5 Briefing of providers on IQPM approach Kampemba health zone office August 22, 2019 32 (22 male, 10 female) 1.1.2 HIV peer support and status disclosure for Maison Safina August 19–21, 2019 23 (12 male, 11 female) adolescents peer educators Abbreviations: IQPM, integrated quality and performance management; PMTCT, prevention of mother-to-child transmission of HIV; PoDi+, community-based points of antiretroviral medication distribution.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 33 2.2.3. Training for rapid circuit setup of stable patients
Agenda
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 34 Participant list
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 35
2.1.1 Training of taxi drivers on male testing
Agenda
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 36
Participant list
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 37 2.2.5 Training on integrated quality and performance management approach Agenda
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 38
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 39 Participant list
NOMS ET POST-NOMS SEXE TELEPHONES JOE TSHIMUANGA M 992664822 ISRAEL LUMINGU M 822666784 MARCEL BUKASA M 977768138 AMUZATI AMURI M 844981612 KISIMBA TUTADILA ATY M 820947715 PATRICK SANGWA M 9703982470 PRINCE MPANGA M 992389118 ALICE KIKUKA F 993797106 MARIE NGOLE F 994606751 FELICIEN NSENGO M 810405026 DIAMANTINE KATEMPA F 823023089 JOLIE ROSE KABEDI F 995447250 SHABANI TWAHA ASKA M 813813854 DORA KASONGO F 846679601 ADOLPHINE NDAYA F 821173286 NGWEJ MUFIND M 997216064 DJOMA JEAN PIERRE M 810670087 FIFI ANINGWE F 814050693 MIREILLE KAWEN F 819046546 FIDELE KAMBAKA M 822598113 MAMIE GRACE NGOIE F 818138567 GRACE THABU F 829784559
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 40 NOMS ET POST-NOMS SEXE TELEPHONES MWEPU ADAMO M 994595288 CATHY LENGE F 819417033 AIMEE WALO F 813034004 KYUNGU NGOIE F 820423341 GISELE MALEMBA F 95594899 IDRIS MUJINGA M 811769822 FEFE BULUNGO M 975529248 FAIDA SUZANE F 819379440 JOLIE MANYONGA F 814050168 MAMIE NZANGO F 813421472 PAULINE OMBALA F 814961555 KASONGO TSHIM M 810326881 PAPY KITENGE M 822549158 NYEMBO LWAMBA M 816601673 GABRIEL KYUNGU M 814038703 FIDELE KAMBAKA M 822598113 MAMIE GRACE NGOIE F 818138567
NOMS ET POST-NOMS SEXE TELEPHONES DAMIEN MUMBA M 995443764 MSIRI LONGO M 825567033 GABY SELEMANI M 824507702 LYLY KAMBAL F 822713330 SONI VIRGINIE F 997045432 YVONNE KITENGE F 817280650 BANZA PAPY M 812491727
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 41 FRANCINE YOHARI F 812860993 PAPY TSHILEWU M 814050168 ANNIE NGALIMA F 823482574 MIMI KAYUMBA F 829307050 LOUIS NGOY M 825550137 ODETTE KATATO F 810568648 BERTHE KOMBWISA F 812387997 GABY KISIMBA M 823117848 BANZA VENDICIEN M 812443980 PIERRE LUKUSA M 828764096 FRANCK MONGA M 819044068 MIANDA FELICITE F 819946093 CECILE EDAMBOLO F 812003397 MAMIE MALELE F 815111909 SIMON LUISI M 817093170
NOMS ET POST-NOMS SEXE TELEPHONES
AXELL MPOYI M 815819364 DIEUDONNE MUKADI M 810359895 YAN KILUBA M 890373000 JACQUES KAZADI M 813813520 JUSTIN TSHILUMBA M 824361258 MUFINDA JACQUES M 897740406 PHILODOR KATOKWE M 818790035 DELPHIN MBAYO M 811588616 PAPY KADIMA M 812876136
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 42 WILLY KASONGO M 823979877 JUNIOR MUNFINDA M 810027128 EMERANCE NTUMBA F 827777963 MABINDJA YAYA F 821933471 NYEMBO YABIYA M 810568648 IRENE NYEMBO F 824573634 ALAIN KALENGA M 814145627 ABDON KISIMBA M 825083345 AGNES KATEMPA F 823467695 KUMINGA JEAN CLAUDE M 811750939 PEZO JOEL F 821873172 KENDAL PALLAANG F 829259960 VERONIQUE TSHASI F 823790888 CUBAIN MBUYI M 817093170 PATRICE MUKAL M 814826845 CENTURNEE MUKENDI M 823469529 JEAN BERTIN NGOY M 810382454 MBUYI JOELLE F 811889725 AIMEE KAMIN F 815009825 LOUIS TSHAM M 811897083 PHACOCHERE KABWE M 817085750 SYLVIE MBIYA F 817085741 JACQUES KITUMBA M 817085823 MARK KAKOMPE M 828765225 AIMEE KIBWE F 858787775 CECILE EDAMBOLO F 812003397 MUFINDA JACQUES M 897740406
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 43 1.1.2 HIV peer support and status disclosure for adolescent peer educators Agenda
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 44 Participant list
NOMS ET POST-NOMS SEXE TELEPHONES SHONONGO AMEDE BEN M 971933240 JONATHAN KABWE MBUDJIKA M 853630266 PAOLA KAPUMPA KALUNGA F 971216190 TUMBA KATOND F MUTOMB IRUNG JOHN M 976561227 BAMPAMBU KAYOMBO MARIE F 977750123 MAMBWE KAMYOBO JOSUE M 979044446 KAMANGO NTAMBWE M ANITA KINKOLO F 855295353 FLORIANE MBOMBO F 811958476 MUSASA MAKAND M 829638610 MUFWAYA SASABU F AGNES CHOMBA F 990416798 DIENGA TOKANDJO BASIL M 853097629 KIBWE MUYUMBA BRIGHT F 974446770 MUDJAKA KAMAYI M 971446010 CARINE ODIA F 974810481 KANGWEJA KABEYA M EVELYNE MUJINGO F MUSUAMBA MELISA F PASCAL NGOY M PHACOCHERE KABWE M 817085750 MIREILLE KAWEN F MBAYO KABALO M ANGELE ASSILY F 997028024
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 45 RAPHAEL MWAMBA M 829784560 NADINE MUYUNGU F 9972072242 MUNUNGA KAYEMBE M 826796111
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 46 Annex Three: Environmental Mitigation and Monitoring Plan reporting form
Status of mitigating Outstanding issues Remarks Mitigation measure from column 3 in the Environmental Mitigation measures relating to required and Monitoring Plan conditions
Provision of technical assistance to develop/update and implement a safe waste Completed management and disposal plan/manual or standard operating procedures for each IHAP-HK/L–supported service delivery point, documenting how waste will be stored, destroyed, and disposed.
Training for all facility-based staff involved in waste management and destruction Completed on appropriate waste management practices.
Briefings for community health care workers on importance of correct disposal of Completed pharmaceutical waste and waste management and disposal procedures for community-based service delivery points.
Distribution of national guidelines and norms, job aids, and posters for waste Completed management at all entry points in IHAP-HK/L facilities.
Provision of necessary supplies and equipment to protect facility-based workers, Completed community health workers, ART PoDi+ staff, and other staff providing services. Supplies are provided to clean and disinfect all service delivery points and equipment used for transporting waste from community sites to facilities for destruction, as well as to secure disposal and storage of hazardous biomedical waste at all service delivery points.
Provision of technical assistance to develop or update facility-specific TB Completed infection control plans that address identifying and segregating coughers, instructing patients on cough etiquette, and fast-tracking coughing patients for TB diagnostic work-up.
Sensitization for people living with HIV and discordant couples on correct waste To be implemented in disposal practices for ART, pre-exposure prophylaxis, and other waste products FY20 as part of (e.g., used condoms). introduction and scale-up
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 47 Status of mitigating Outstanding issues Remarks Mitigation measure from column 3 in the Environmental Mitigation measures relating to required and Monitoring Plan conditions
of HIV self-testing and PrEP
Spot checks to observe waste disposal practices at project-supported facilities, Completed PoDi+ sites, mobile/home-based testing sessions, and self-help group/adherence club meetings, and on-site coaching and supportive supervision to ensure compliance with established site-specific standard operating procedures and national guidelines/standards.
Abbreviations: ART, antiretroviral therapy; IHAP-HK/L Integrated HIV/AIDS Project in Haut Katanga and Lualaba; PoDi+, community-based points of antiretroviral medication distribution; TB, tuberculosis.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 48 Annex Four: Success story
Please see attachment.
IHAP-HK/L FY19 ANNUAL PERFORMANCE REPORT OCTOBER 1, 2018–SEPTEMBER 30, 2019 49