The CQUIN Learning Network 2018 Annual Meeting Summary

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The CQUIN Learning Network 2018 Annual Meeting Summary The CQUIN Learning Network 2018 Annual Meeting Summary February 13-15 Maputo, Mozambique HIV LEARNING NETWORK The CQUIN Project for Differentiated Service Delivery Table of Contents Executive Summary ............................................................................................... 1 Introduction ............................................................................................................ 4 Opening Reception ................................................................................................ 6 Wafaa El-Sadr ................................................................................................................................................. 6 Miriam Rabkin ................................................................................................................................................ 6 Solange Baptiste .............................................................................................................................................. 8 Peter Ehrenkranz............................................................................................................................................ 8 Rosa Marlene Manjate Cuco ......................................................................................................................... 9 Coverage – Taking DSD to Scale ........................................................................... 6 Setting the Scene........................................................................................................................................... 11 Mapping DSD Scale-Up .............................................................................................................................. 13 Taking DSD for Stable Patients to Scale .................................................................................................. 14 Optimizing Treatment at Scale ................................................................................................................... 16 Quality – Ensuring Effective, Patient-Centered Services ................................... 17 Beyond “Stable” Patients (Part 1) .............................................................................................................. 17 Beyond “Stable” Patients (Part 2) .............................................................................................................. 18 DSD Scale-Up: Successes, Challenges, and Key Questions .................................................................. 19 Parellel Breakout Sessions ........................................................................................................................... 20 Impact – Assessing DSD Outcomes .................................................................... 24 Measuring Impact – Monitoring, Evaluation & Research ..................................................................... 24 M&E of DSD ............................................................................................................................................... 25 Parellel Breakout Sessions ........................................................................................................................... 26 Country Breakout Sessions ......................................................................................................................... 29 Closing Remarks .................................................................................................. 33 Agenda .................................................................................................................. 35 Participants ........................................................................................................... 39 Full Transcripts .................................................................................................... 71 Country Posters .................................................................................................... 82 CQUIN is made possible with funding from the Bill & Melinda Gates Foundation. The findings and conclusions contained within this report are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. Executive Summary Background In March 2017, ICAP at Columbia University launched the HIV Coverage, Quality, and Impact Network (CQUIN), with support from the Bill & Melinda Gates Foundation. In its first year, the CQUIN learning network expanded from six to ten countries, and now includes Cote d’Ivoire, Ethiopia, Kenya, Malawi, Mozambique, South Africa, Swaziland, Uganda, Zambia, and Zimbabwe. CQUIN has fostered ongoing knowledge exchange on the implementation and scale-up of differentiated service delivery (DSD) for HIV; hosted workshops, seminars, webinars, and journal clubs; and has supported south-to-south exchange visits, technical assistance, and catalytic research projects. The network launched three virtual communities of practice focusing on M&E of differentiated services, DSD for patients at high risk for HIV disease progression, and DSD for adolescents. CQUIN also introduced the CQUIN DSD dashboard, a self-assessment tool that helps ministries of health describe the stage of DSD scale-up in their countries. The CQUIN annual meeting allowed countries to review global DSD best practices, assess their progress, exchange tools and resources, and identify their priorities for 2018. It also allowed ICAP, as the convening organization, to receive feedback from network members and advisory group members on the network’s performance and priorities for year two. Meeting Dates and Objectives The Ministry of Health of Mozambique hosted the annual meeting in Maputo, from February 12 to 15, 2018. The objectives were to: Review progress towards DSD scale-up amongst network countries Facilitate exchange of knowledge, resources, and strategies for taking DSD models (DSDM) to national scale Share research findings, best practices, and innovations in DSDM for diverse patient groups Review initial experiences and outputs of the CQUIN communities of practice Identify common gaps, challenges, and opportunities for future joint-learning, co-creation of tools and resources, and future south-to-south exchange visits Meeting Participants Representatives from Ethiopia, Kenya, Malawi, Mozambique, South Africa, Swaziland, Uganda, Zambia, and Zimbabwe attended the meeting. Cote d’Ivoire had joined the network only weeks before the meeting, and was therefore unable to attend. Country teams included representatives from ministries of health, civil society, academic institutions, and PEPFAR implementing partners. Representatives from the Bill and Melinda Gates Foundation, the U.S. Centers for Disease Prevention and Control (CDC), the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the Joint United Nations Programme on HIV and AIDS (UNAIDS), the Global Fund (GF), the Elizabeth Glazer Pediatric AIDS Foundation (EGPAF), Médecins Sans Frontières (MSF), the International AIDS Society (IAS), the International Treatment Preparedness Coalition (ITPC), and the Global Forum on MSM and HIV (MSMGF), also attended. 1 Key Issues Presented/Discussed Dr. Wafaa El-Sadr, ICAP Global Director, set the stage for the three-day meeting. She highlighted the remarkable global scale-up of HIV treatment, especially in Sub-Saharan Africa, noting that coverage and health systems gaps remain. While scaling up DSD is not a panacea, it is one important strategy to achieve HIV epidemic control and a priority for many ministries of health. Dr. Nathan Ford, Scientific Officer, Department of HIV/AIDS & Global Hepatitis, reviewed data on national policies in the AFRO region, which demonstrate increasing national support for DSD. Many countries have policy guidelines supportive of reducing the frequency of clinic visits and medication pickups; support for community-based treatment services is more variable. CQUIN dashboard data presented by the network countries validated these findings, showing impressive progress towards a foundation for DSD scale-up, with expanding availability of supportive policies, guidelines, job aids, and training materials. This positions countries for a broad geographic scale-up of DSDM in the coming years. Dr. Miriam Rabkin, CQUIN Principal Investigator, and Dr. Peter Preko, CQUIN Project Director, highlighted key network activities and the year’s achievements. Three previous CQUIN workshops generated 24 action plans across nine countries. Of 132 action items, two-thirds are completed or are ongoing. Examples of south-to-south visits from Mozambique to Swaziland and Malawi, and from Swaziland to Malawi, demonstrated how exchange of best practices between the countries are informing guideline changes and adoption of new models. Ms. Solange Baptiste, ITPC Executive Director, presented community perspectives on DSD and stressed the need for more community engagement and education. Citing data from a rapid assessment with healthcare workers and people living with HIV (PLHIV) on their readiness for DSD, she noted that the majority of community members surveyed did not fully understand what DSD is. The Annual Meeting included 14 sessions: six panel discussions, moderated sessions, plenary presentations, and parallel breakout sessions. There were also daily poster sessions displaying progress made by each of the network countries towards DSD scale-up, as well as posters from implementing partners. One highlight of the meeting was a vibrant
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