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Swaziland Country Operational Plan 2018 Strategic Direction Summary

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Swaziland Country Operational Plan 2018 Strategic Direction Summary SWAZILAND Country Operational Plan (COP) 2018 Strategic Direction Summary March 29, 2018 Acronym and Word List A Adolescents AE Adverse Event AG Adolescent Girls AGYW Adolescent Girls and Young Women ALHIV Adolescents Living with HIV ANC Antenatal Clinic APR Annual Program Results ARROWS ART Referral, Retention, and Ongoing Wellness Support ARV Antiretroviral ART Antiretroviral Therapy ASLM African Society for Laboratory Medicine C Children C/A Children/Adolescents CAG Community Adherence Group CANGO Coordinating Assembly of Non-Governmental Organizations CCM Country Coordinating Mechanism CEE Core Essential Element CHAI Clinton Health Access Initiative CIHTC Community-Initiated HIV Testing and Counseling CMIS Client Management Information System CMS Central Medical Stores CoAg Cooperative Agreement CQI Continuous Quality Improvement CS(O) Civil Society (Organizations) DBS Dried Blood Spot DQA Data Quality Assessment DSD Direct Service Delivery E Swazi Emalangeni (1 lilangeni equals 1 rand) ECD Early Childhood Development EID Early Infant Diagnosis eNSF extended National Multi-Sectoral Strategic Framework for HIV & AIDS EQA External Quality Assessment DMPPT Decision Makers Program Planning Toolkit EU European Union FDC Fixed dose combination FDI Foreign Direct Investment FP Family Planning FSW Female Sex Workers GBV Gender Based Violence GHSP Global Health Services Partnership GKoS Government of the Kingdom of Swaziland GF Global Fund to fight AIDS, Tuberculosis and Malaria GDP Gross Domestic Product GNI Gross National Income HC4 HIV Response Coordination, Community Capacity and Communication 2 | P a g e HCW Health Care Worker HR Human Resources HRH Human Resources for Health HRIS Human Resources Information System HSS Health Systems Strengthening HTC HIV Testing and Counseling HTS HIV Testing Services IEC Information, Education and Communication IM Implementing Mechanism KP Key Population LES Locally Employed Staff LGBTIQ Lesbian, Gay, Bisexual, Transgender/Transsexual, Intersex, Queer LTFU Lost to Follow Up LIS Laboratory Information System MBP Mother-Baby-Pair MCH Maternal and Child Health M&E Monitoring and Evaluation MER Monitoring, Evaluation and Reporting MEPD Ministry of Economic Planning and Development MICS Multi Indicator Cluster Survey MNCH Maternal Newborn and Child Health MoET Ministry of Education and Training MoF Ministry of Finance MoH Ministry of Health MSF Médecins Sans Frontières MSM Men who have sex with men MTC Matshapa Town Council NACS Nutritional Assessment, Counseling, Support NARTIS Nurse-led ART initiation in Swaziland NERCHA National Emergency Response Council on HIV and AIDS NCP Neighborhood Care Points NTCP National TB Control Program ODA Overseas Development Assistance OI Opportunistic Infections OVC Orphans and Vulnerable Children PCV Peace Corps Volunteer PEP Post Exposure Prophylaxis PEPFAR/S Presidents Emergency Plan for AIDS Relief/Swaziland PFSCM/SCMS Partnership for Supply Chain Management/Supply Chain Management System PHC Primary Health Care PHU Public Health Unit PITC Provider Initiated Testing and Counseling PLHIV People Living with HIV PMTCT Preventing Mother-to-Child Transmission PNC Post Natal Clinic POART PEPFAR Oversight and Accountability Response Teams POC Point of Care POCT Point of Care Testing 3 | P a g e PP Priority Populations PPP Public Private Partnership PrEP Pre-exposure Prophylaxis PSNU Priority Sub-National Unit QA Quality Assurance QI Quality Improvement QM Quality Management QMS Quality Management System RA Regional Administrator RASTA Region Age Sex Testing/Treatment Attribution RHM Rural Health Motivator RHMT Regional Health Management Team RPM Regional Planning Meeting RTK Rapid Test Kit SAPR Semi-Annual Program Report SGBV Sexual and Gender Based Violence SHIMS Swaziland HIV Incidence Measurement Survey SI Strategic Information SIAPS Systems for Improved Access to Pharmaceuticals and Services SID Sustainability Index Dashboard SIMS Site Improvement through Monitoring System SOP Standard Operating Procedures SNAP Swaziland National AIDS Program SNU Sub-National Unit SRH Sexual Reproductive Health SRHU Sexual Reproductive Health Unit SWABCHA Swaziland Business Coalition on HIV/AIDS SWAGAA Swaziland Action Group Against Abuse SWAMMIWA Swaziland Migrant Mineworkers Association SWANNEPA Swaziland National Network of People Living with HIV/AIDS TA Technical Assistance TB Tuberculosis Tinkhundla Government Administrative Unit (Below Regional Level) T&S Test and Start TPT TB Preventive Therapy TSP Technical Support for PEPFAR Programs TWG Technical Working Group UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNICEF United Nations Children’s Emergency Fund USDF Umbutfo Swaziland Defence Force USG United States Government VL Viral Load VMMC Voluntary Medical Male Circumcision WAD World AIDS Day WHO World Health Organization WMIS Warehouse Management Information System 4 | P a g e Table of Contents 1.0 Goal Statement 2.0 Epidemic, Response, and Program Context 2.1 Summary statistics, disease burden and country profile 2.2 Investment profile 2.3 National sustainability profile update 2.4 Alignment of PEPFAR investments geographically to disease burden 2.5 Stakeholder engagement 3.0 Geographic and population prioritization 4.0 Program Activities for Epidemic Control in Scale-up Locations and Populations 4.1 Finding the missing, getting them on treatment, and retaining them 4.2 Prevention, specifically detailing programs for priority programming 4.3 Additional country-specific priorities listed in the planning level letter 4.4 Commodities 4.5 Collaboration, Integration and Monitoring 4.6 Targets for scale-up locations and populations 5.0 Program Activities for Epidemic Control in Attained and Sustained Locations and Populations 5.1 Cop18 programmatic priorities 5.2 Targets for attained and sustained locations and populations 5.3 Establishing service packages to meet targets in attained and sustained districts 6.0 Program Support Necessary to Achieve Sustained Epidemic Control 7.0 USG Management, Operations and Staffing Plan to Achieve Stated Goals Appendix A - Prioritization Appendix B - Budget Profile and Resource Projections Appendix C - Tables and Systems Investments for Section 6.0 5 | P a g e 1.0 Goal Statement 1.0 Goal Statement The overarching goal of the PEPFAR/Swaziland (PEPFAR/S) program is to support the Government of the Kingdom of Swaziland (GKoS) to achieve the HIV epidemic control and reverse the impact of HIV on the people of Swaziland. PEPFAR/S activities are guided by the new National Multi- Sectoral Strategic Framework for HIV and AIDS (NSF) 2018-2022 (see Appendix D Documents Library) to: 1. Find 95% of people living with HIV (PLHIV) and make them aware of their status, intensify same-day ART initiation and implement differentiated care models to target groups of missing populations; 2. Provide primary and combination prevention services to priority and key populations to prevent HIV transmission and acquisition to reduce new infections; 3. Address HIV related stigma and discrimination and ensure the right to access HIV services for all; and 4. Reduce the vulnerability of orphaned and vulnerable children (OVC) and address sexual and gender-based violence (SGBV). PEPFAR/S will work with GKoS to intensify program implementation in all four regions of this small high-prevalence country. The ambitious timeline to reach “attained” status for all age bands, sexes, and risk groups by the end of Country Operation Plan 2018 (COP18) through support for testing 242,488 people, initiating 15,918 people on treatment, is achievable. All four regions are classified as scale-up-to-saturation. In COP18, PEPFAR/S will scale up index case testing and HIV self-testing (HIVST) to find those who are unaware of their status and those who are aware of their status but not on treatment, particularly men, ages 20-39 and women ages 15-34. In COP18, approximately 36% of all PLHIV will be identified through index case testing and HIVST with a focus on males ages 25-34. Linkage to care and prevention services will be strengthened through the implementation of custom indicators. Priority populations (PPs) and key populations (KPs) will have access to comprehensive packages of health and social services in COP18. In order to ensure that those who are negative do not acquire HIV and those who are positive do not transmit, combination prevention interventions will be offered to men, ages 15-39, and traditional leaders will help link community members with interventions, testing and HIV services as well as addressing SGBV. The DREAMS package will focus on adolescent girls and young women (AGYW) ages 15-29 and orphans and vulnerable children (OVC), strengthening risk avoidance for 9-14 year olds. PEPFAR/S will scale-up demand for and provision of condoms and lubricants for all PP and KP, Pre-exposure prophylaxis (PrEP) for those at greatest risk and voluntary medical male circumcision (VMMC) focusing on men ages 15-29. Reducing SGBV, stigma and discrimination also continue to be a priority. 6 | P a g e PEPFAR/S will decongest facilities and increase access to ART refills through innovative mobile and community models for PPs and KPs as well as increase multi-month prescriptions. To minimize adverse drug reactions and lower the cost of treatment, Swaziland will transition to the use of a dolutegravir-based first-line regimen. PEPFAR/S, in conjunction with the Ministry of Health (MoH), will ensure that viral load (VL) and early
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