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Meeting Targets and Maintaining Epidemic Control (Epic) Project

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Meeting Targets and Maintaining Epidemic Control (Epic) Project Meeting Targets and Maintaining Epidemic Control (EpiC) Project Cooperative Agreement No. 7200AA19CA00002 CÔTE D’IVOIRE QUARTERLY PROGRESS REPORT JULY 1 TO SEPTEMBER 30, 2020 SUBMITTED BY FHI 360: OCTOBER 30, 2020 EpiC Côte d’Ivoire Quarterly Progress Report July 1 to September 30, 2020 A. SUMMARY OF KEY RESULTS This report covers activities and performance of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project in Côte d'Ivoire (EpiC CI) for quarter four (Q4) of FY20. The EpiC CI project is being implemented in eight health regions composed of 20 sites, each representing a health district or a commune. In Q4, the project continued to support local implementing partners in providing HIV prevention interventions to key populations (KP) and their sexual partners, as well as care and support to people living with HIV (PLHIV). HIV case finding, linkage to ART, and support for ART retention remained a priority of the project team despite the context of COVID-19. To ensure annual targets were met, the project team provided both virtual and physical technical suppors to implement index testing, and standard outreach activities at targeted hot spots in compliance with the PEPFAR COVID-19 guidelines. In Q3, the project had achieved over 70% of its contractual targets for all indicators except for index testing. To catch-up and meet the minimum requirements for index testing, the project conducted a refresher training for outreach workers who are authorized to perform HIV testing in the community. After the training, index testing implementation was accelerated to boost case identification and meet the annual HTS_TST_POS targets. During Q4, the project team was heavily involved in the preparation for COP 20 where eleven (11) new clinical sites will be transitioned to EpiC CI project from CDC supported sites. This involved site assessments to identify sites’ needs and gaps that may affect the performance and quality of services provided by those sites. USAID, CDC, and the Ministry of Health (MoH) played crucial roles in this activity. Details of the gaps and needs of the sites are provided in this report in a specific section about COP 20 readiness. Key Populations Investment Funds (KPIF) funding supported local implementing partners (IP) to ensure all HIV positive KPs and non-KPs were linked to ART, scale-up pre-exposure prophylaxis (PrEP) initiatives, support newly established Drop-In Centers’ (DIC) activities and services as well as supporting the transition to COP 20. Below is a summary of key results for Q4 FY20: • 2,672 female sex workers (FSWs), 2,313 men who have sex with men (MSM), and 3 transgender (TG) individuals (a total of 4,988) were reached with HIV prevention interventions; • A total of 2,274 people (913 FSWs, 1,015 MSM, 2 TG people and 344 members of Priority Populations (PP)) were tested for HIV and received their results; • 130 FSWs, 189 MSM, 1 TG person (a total of 320 KPs) and 74 members of PPs were tested positive for HIV and 99% of them were linked to health facilities for their ART initiation (125 FSWs, 189 MSM, 1 trans individual, and 74 members of PPs); • 236 (146 FSWs and 90 MSM) diagnosed with HIV were offered index testing services; from them, • 609 contacts were elicited and tested, 135 tested positive for HIV and all were initiated on ART within the quarter; • 2,318 HIV self-testing (HIVST) kits were distributed; • 189,764 male condoms, 14,912 female condoms, and 38,661 water-based lubricants were distributed to KP members and their sexual partners; • 104 individuals (26 MSM, 76 FSWs, 1 TG and 1 stable partners of FSWs) were referred to STI services, 22 individuals were screened and diagnosed (12 MSM, 8 FSW, 1 stable partner of FSW and 1 female sexual partner of a MSM) and 19 were treated (9 MSM, 8 FSW, 1 stable partner of FSW and 1 female sexual partner of a MSM); • 13 individuals (1 FSW and 12 MSM) were referred for GBV. EpiC Quarterly Report (July to September 2020) Cote d’Ivoire 1 Table 1. Percentage of FY20 annual targets achieved through Q4 (KP and All Pop) Achieved Annual % achievement Indicators Target # Q1 # Q2 # Q3 # Q4 Total – LOP thru Q4 Population KP_PREV 15,105 4,006 7,150 5,674 4,988 21,818 144% HTS_TST 11,673 2,445 4,705 3,233 1,930 12,313 105% HTS_TST_POS 1,514 199 552 433 320 1,504 99% 101% of annual p target achievement and Key poKey TX_NEW_VERIFY 1,438 172 520 440 315 1,447 96% linkage of new positive cases HTS_SELF 4,026 268 673 1649 2,318 4,908 122% KP_PREV 15,105 4,006 7,150 5,674 4,988 21,818 144% HTS_TST 12,420 2,614 2,847 3,621 2,280 11,362 91% HTS_TST_POS 1,682 247 582 519 394 1,742 104% All pop TX_NEW_VERIFY 1,598 216 517 429 389 1,551 97% HTS_SELF 4,026 268 673 1,649 2,318 4,908 122% Table 1 provides a summary of the EpiC CI achievements compared to the annual targets for the main project indicators: 1. KP_PREV: a total of 21,818 KPs were reached by the prevention interventions, representing an achievement of 144% to the 15,105 KPs targets for FY20. In Q3, the project had already surpassed the annual targets (111%) for KP_PREV but the project continued to offer prevention interventions to KP members to increase HTS_TST and HTS_TST_POS performance which were respectively 89% and 78% at Q3. 2. HTS_TST: a total of 12,313 KPs were tested from all testing modalities, representing 105% of the FY20 HTS_TST target; 3. HTS_TST_POS: a total of 1,504 KP members were diagnosed with HIV, representing an achievement of 99% compared to the FY20 targets. 4. TX_NEW_VERIFY & TX_NEW: 96% of the KPs identified HIV positive were successfully linked to ART during FY20. 5. HTS_SELF: a total of 4,908 individuals received HIV self-testing kits, representing a rate of 122% of HTS_SELF annual target. EpiC Quarterly Report (July to September 2020) Cote d’Ivoire 2 B. KEY RESULTS BY OBJECTIVE 1. Result 1. Attain and maintain HIV epidemic control among at-risk adult men, women, and priority populations (PPs) and Result 2. Attain and maintain HIV epidemic control among key populations (KPs) Reached KP members with HIV prevention interventions: Figure 1: Summary of the main direct service During Q4 FY20, the EpiC CI team provided regular technical delivery results among key populations, July to support to all 13 local CBOs/implementing partners to reach September 2020 and provide HIV prevention interventions to KP members in the community. In total, 4,988 individuals (2,672 FSWs, 2,313 MSM, and 3 trans individuals) were reached with HIV prevention interventions in Q4. KP members offered HIV testing services: In Q4, a total of 1,930 KP members (913 FSWS, 1,015 MSM, and 2 trans individuals) and 350 non-KPs (a total of 2,280) were tested for HIV through various modalities including 1,563 from standard outreach, 609 from index testing, 77 from the EpiC supported DICs,30 from clinical and 1 from Go Online in Q4. For HIVST, 43 tests were reactive and 42 were confirmed HIV positives. HIVST were used as an alternative testing option for KPs and PPs who declined testing from standard outreach and for those who are hard to reach such as partners of HIV positive KP members. EpiC Quarterly Report (July to September 2020) Cote d’Ivoire 3 1.1. Testing cascade analysis by testing modality (for all populations), July – September 2020 Figure 2: Variation in HIV case-finding rates by modality for all population. July – September 2020 1800 Tested Tested HIV positive Case-finding rate 120% Go Online Clinique DIC Index Testing Outreach 1563 1600 100% 100% 1400 2% 1200 80% 0% 3% 1000 The case-finding rate by type of population are 60% 800 14% for FSWs, 19% for MSM, 50% for trans, and 21% for other 609 600 populations 40% 34% 22% Number of KP membersNumberof 20% 400 17% 15% 20% 61% 200 77 1 1 30 6 13 135 239 0 0% Go Online Clinique DIC Index Testing Outreach Testing Modalities According to figure 2, the highest volume of tests and positive HIV cases were found through standard outreach. This contributed 61% of all HIV-positive cases identified during this reporting period. Index testing contributed 34% of HIV-positive cases, 3% for DIC, and 2% for partners offering clinical services. A total of 2,280 individuals, KPs and non-KPs (350 PP and 1,930 KPs), were tested for HIV in Q4, making a cumulative result of 13,362 individuals tested (1,149 PP and 12,213 KPs), and representing an achievement of 108% of the HTS_TST annual target (12,420). Of all KP and non-KP tested in this reporting period, 394 HIV positive cases were identified. Cumulatively for FY20, 1,742 HIV positive cases were identified , representing an achievement of 104% of the annual HTS_TST_POS FY20 targets (1,682) and a case finding rate of 13%. Of a total of 394 individuals tested HIV positive in Q4 (KP and non-KP), 389 individuals were successfully linked to ART. In total 1,678 HIV positive individuals were linked to ART in FY20, representing 96% linkage rate. KP specific data shows an overall case finding rate of 17 %.Among the 320 KP members newly diagnosed with HIV in Q4 315 (98%) were successfully linked to ART services and initiated on ART within the quarter.
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