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HIV Services and System Strengthening Project – HIV Services and System Strengthening Project – HS3 BILATERAL AGREEMENT NO. 72051719CA00002 DOMINICAN REPUBLIC QUARTERLY PROGRESS REPORT JANUARY 1 TO MARCH 31, 2020 Health System Strengthening and HIV Services (HS3) Project Quarterly Progress Report January 1 to March 31, 2020 1. INTRODUCTION HIV Services and System Strengthening (HS3) is a five-year, global project funded by the President's Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID), with a period of performance from April 24, 2019, to April 23, 2024. This quarterly progress report covers HS3 activities in the Dominican Republic (DR) from January 1 to March 31, 2020. The project works closely with a local health system strengthening partner (Gestión e Innovación en Salud – GIS), USAID, CDC, the National Health Service (SNS), the National HIV/AIDS Commission (CONAVIHSIDA) and the General Directorate for the Control of Sexually Transmitted Infections and AIDS (DIGECITSS). The following table describes the collaborative activities between the HS3 Project and partners. Partner Collaborative Activities GIS Supports HIV products supply management, quality of logistic information which feeds decision making, transportation of HIV laboratory samples and delivery of results SNS Transportation of CD4 and viral load results. Update portfolio service manual including HIV services. Refresher training on updated protocols for HIV treatment CONAVIHSIDA Technical support to improve HIV variables related to prevention, care and treatment in the national database DIGECITSS Updating HIV prevention, care and treatment guidelines. Dissemination of new treatment directives. Training of personnel at national and provincial levels HS3 works under four priority pillars which focus on filling existing gaps in HIV prevention, case finding, and treatment, and on building long-term sustainability to attain and maintain epidemic control: ● PRIORITY PILLAR 1: Expanding Access to HIV Services for Focus Clients (FC)1. ● PRIORITY PILLAR 2: FC community approaches strengthens linkages. ● PRIORITY PILLAR 3: Institutional reform to eliminate policy constraints. ● PRIORITY PILLAR 4: OVC program to serve FC Families. Key Population Incentive Fund’s (KPIF) and HS3’s goals align closely and are intended to complement existing efforts to improve programs for KP, specifically female sex workers (FSW), Men who have Sex with Men (MSM), and transgender (TG). KPIF promotes the acceleration of high-quality HIV prevention and treatment services for KP and extends the ability for local KP-led, trusted and competent implementing partners (IPs) to contribute to PEPFAR's KP scale-up of differentiated HIV prevention, 1 Defined as migrants from Haiti and their descendants living in the Dominican Republic care, and treatment services. KPIF funds support greater involvement of local organizations at the community and national level while scaling up innovative, evidence-based strategies to achieve epidemic control for KP. In FY20, HS3 has been implementing its COP approved activities, as well as KPIF programming in the geographic areas described in Table 1. Annex 1 illustrates the CSO-health facilities network implemented in Q1 and Q2, as well as the new network that will be implemented from Q3 onward. Changes to the sites in the network were based on FC, HIV positive burden analysis, and made to support high volume sites more efficiently and effectively. Support for KPIF-funded sites did not change. Four additional CSOs were sub-grantee in Q2 (Instituto Dominicano de Cirugía de Piel (IDCP), Aid for AIDS, and Batey Relief Alliance (BRA Dominicana) to support service delivery, and Heartland Alliance to provide legal support to FC prioritizing PLHIV FC). Table 1. Number and type of HS3 supported sites by province, and funding source Province Q1 Q2 Sub Funding GoDR HTS- GoDR HTS CSO HTS and GoDR HTS- GoDR HTS CSO HTS and granted source only site and ART site ART site only site and ART site ART site CSO (total number) Santo Domingo 7 4 2 7 4 2 6 COP/KPIF Monte Plata 0 2 1 0 2 1 1 COP Puerto Plata 3 1 1 3 1 1 2 COP Valverde 3 1 0 3 1 0 1 COP La Romana 0 1 1 0 1 1 2 KPIF Total 13 9 5 13 9 5 12 2. SUMMARY OF KEY RESULTS Annex 2 provides comprehensive information on the progress for Q1 and Q2 and semi-annual cumulative progress towards PEPFAR targets as of March 31, 2020. HS3 progress concerning the targets is summarized in Figures 1, Figure 2, and Figure 3 where the red- dotted line represents the semi-annual target of 50%. Some of the Q2 activities and their results have been affected by the COVID-19 pandemic. The DR’s first positive patient was identified on March 1, 2020, which led to a national quarantine which went into effect on March 19 until the present. Hence, Q2 achievements refer mostly to services offered in January and February 2020. Community HTS halted in March, while ART services continued and were partially offered at a community level to refill medications for those currently on treatment. It is anticipated that the COVID-19 pandemic will have a greater impact on Q3 achievements. Key highlights from Figure 1 show that PP Prev. reached 18%, while community HTS POS non-index and index reached respectively 13% and 2% among FC. Slightly better achievements are shown at the facility level with HTS POS at 21% and 23% on non-index and index testing, respectively. Among the 24,083 individuals who received HTS, 13,031 (54%) were FC; of those, 470 tested HIV positive (4% of positivity rate). Community testing yield increased from 2% in Q1 to 3% in Q2 and remained stable at 5% at 27 of HS3-supported facilities. Variations in case detection rate were observed among sites: ADOPLAFAM and Aid for AIDS in Santo Domingo reported 6% (1,200/77) yield among FC tested at the community level, while selected public health facilities yielded up to 18%, like the Bogaert Hospital in Valverde province. The first yield was driven by rolling out Enhanced Peer Outreach Approach (EPOA) with greater fidelity, the second one resulted from a generally higher yield in the Valverde region. Index testing continued representing 1% of the overall testing, yielding 22% on average. This service was offered by 11 health facilities (5 CSO-led and 6 public facilities) and 4 CSOs at the community level (ADOPLAFAM, IDEV, REDOVIH, CEPROSH, Bra Dominicana). In response to the statement above, HS3 will put more effort in Q3 to roll out EPOA with fidelity and will scale up index testing. Although only 6% of the annual TX NEW target among FC was met, the ART initiation rate increased to 49%, as compared to 30% in Q1. This may have resulted from the rollout of incentivized ART for HIV positive FC, which provided a stipend for transportation to help beneficiaries travel to ART clinics, food supplies, and a pre-paid SIM card which enabled the project to continually reach them with adherence counseling messages. Figure 1. Progress Towards FC-PEPFAR Annual Targets, by Quarter, FY20 Annual Target 5,093 256 1,279 1,421 20,116 554 2,768 51,267 3,076 63,503 As shown in Figure 2, the progress to target was met on the number of ART clients currently on treatment (TX CURR), 99% (compared to 95% in Q1); 88% of the target for ART clients with a documented viral load (VL) (TX PLVS Den); and 82% of the target for virally suppressed ART clients (TX PLVS Num). By the end of March 2020, the project reported 13,155 clients currently on ART at 14 HS3-supported ART health facilities; 80% had a documented VL test within the last 12 months and among them, 84% were virally suppressed (equal or below 1,000 copies). Only 2% of the target on ART clients screened for TB (TX TB) was met, while the target on TB treatment was surpassed (TX TB POS). This translates in 266 ART clients who received a TB screening and 77 who were diagnosed with TB and started treatment. Among 360 ART clients for whom TB was ruled out and who started isoniazid-based TB Preventive Therapy (TPT), 147 (45%) completed the 6-months of prophylaxis. As a result, more efforts will be placed on monitoring TB screening and supporting TB-HIV collaborative activities. For GEND GBV, only 13% of the annual target was met due to a delayed start-up of this service. Sites were assessed for the eligibility criteria, gaps had to be closed for services that needed to be provided and were not available, and staff capacity needed to be increased. It is expected that starting from Q3 more sites will become operational, resulting in increased service coverage. Figure 2. Progress Towards All Pop-PEPFAR Annual Targets, by Quarter, SAPR FY20 Annual Target TB_PREV DEN 5,538 TB_PREV NUM 4,986 TX_TB_POS New ART 53 TX_TB_POS Already ART 19 TX_TB_Den New ART 2,651 TX_TB_Den Already ART 10,660 GEND_GBV ALL 2,025 TX_PVLS_DEN TOTAL 12,012 10,811 TX_PVLS_NUM TOTAL 13,336 TX_CURR TOTAL 0% 20% 40% 60% 80% 100% In relation to KPIF, progress towards targets (Figure 3) shows that the project is surpassing its target for testing, non-index, FSW, and MSM, reaching 57% and 52% of the annual target respectively. Facility HST_TST_Pos (non-index) for FSW is at 17% progress to target identifying 9 FSW in Q2. This low percentage is due to a case detection rate of 1% against a target yield of 7%, a lack of testing through social networks (e.g. EPOA), and insufficient index testing. This small number also has impacted the TX_New targets for FSW which is at 25%. The project will work directly with KPIF grantees to ensure those FSW identified as positive are initiated on treatment by rolling out ART initiation support (approved project SOPs) as well as guaranteeing support from a trained peer navigator.
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