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Côte D'ivoire (SHARM- CI): “HIV and Associated Risk Factors Among MSM in Abidjan, Côte D’Ivoire” (FHI 360 Report, January 22, 2013)

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Côte D'ivoire (SHARM- CI): “HIV and Associated Risk Factors Among MSM in Abidjan, Côte D’Ivoire” (FHI 360 Report, January 22, 2013) FY 2015 Cote d’Ivoire Country Operational Plan (COP) The following elements included in this document, in addition to “Budget and Target Reports” posted separately on www.PEPFAR.gov, reflect the approved FY 2015 COP for Cote d’Ivoire. 1) FY 2015 COP Strategic Development Summary (SDS) narrative communicates the epidemiologic and country/regional context; methods used for programmatic design; findings of integrated data analysis; and strategic direction for the investments and programs. Note that PEPFAR summary targets discussed within the SDS were accurate as of COP approval and may have been adjusted as site- specific targets were finalized. See the “COP 15 Targets by Subnational Unit” sheets that follow for final approved targets. 2) COP 15 Targets by Subnational Unit includes approved COP 15 targets (targets to be achieved by September 30, 2016). As noted, these may differ from targets embedded within the SDS narrative document and reflect final approved targets. 3) Sustainability Index and Dashboard Approved FY 2015 COP budgets by mechanism and program area, and summary targets are posted as a separate document on www.PEPFAR.gov in the “FY 2015 Country Operational Plan Budget and Target Report.” Côte d’Ivoire Country Operational Plan 2015 Strategic Direction Summary Revised September 17, 2015 Table of Contents Goal Statement ........................................................................................................................................................... 3 1.0 Epidemic, Response, and Program Context............................................................................................4 1.1 Summary statistics, disease burden and country or regional profile ...................................................4 1.2 Investment Profile ..................................................................................................................................... 11 1.3 National Sustainability Profile ................................................................................................................ 12 1.4 Alignment of PEPFAR investments geographically to disease burden ............................................... 13 1.5 Stakeholder Engagement ........................................................................................................................ 15 2.0 Core, Near-Core and Non-Core Activities ............................................................................................. 16 3.0 Geographic and Population Prioritization ............................................................................................. 17 4.0 Program Activities for Epidemic Control in Priority Locations and Populations ......................... 18 4.1 Targets for priority locations and populations ..................................................................................... 18 4.2 Priority Population Prevention ............................................................................................................... 26 4.3 Prevention of mother to child transmission (PMTCT) ........................................................................ 27 4.4 HIV Testing and Counseling ...................................................................................................................29 4.5 Facility and Community-Based Care and Support ............................................................................... 30 4.6 Tuberculosis and HIV co-infection (TB/HIV) ........................................................................................ 31 4.7 Adult Treatment ....................................................................................................................................... 32 4.8 Pediatric Treatment ................................................................................................................................. 34 4.9 Orphans and Vulnerable Children (OVC) ............................................................................................. 35 5.0 Program Activities to Maintain Support for Other Locations and Populations ............................. 37 5.1 Maintenance package of services in other locations and populations ............................................... 37 5.2 Transition plans for redirecting PEPFAR support to priority locations and populations ................ 38 6.0 Program Support Necessary to Achieve Sustained Epidemic Control ............................................. 39 6.1 Laboratory strengthening ....................................................................................................................... 39 6.2 Strategic information (SI) ....................................................................................................................... 47 6.3 Health System Strengthening (HSS) ...................................................................................................... 51 7.0 Staffing Plan ................................................................................................................................................. 56 APPENDIX A ............................................................................................................................................................. 58 APPENDIX B ............................................................................................................................................................. 63 B.1 Planned Spending in 2016 ............................................................................................................................... 63 B.2 Resource Projections ..................................................................................................................................... 64 2 | P a g e Version 6.0 Goal Statement The PEPFAR program in Côte d’Ivoire will contribute to achieving the UNAIDS 90:90:90 goals embraced by the Ivoirian government and multilateral stakeholders by increasing coverage of quality combination prevention services feeding into the clinical cascade. The two-year vision established in COP 2014 guides COP 2015 toward reaching 80% saturation of adult treatment and 40 percent coverage of pediatric treatment in select high-impact geographic areas based on current Ivoirian treatment guidelines with a ≤350 CD4 threshold. The program is currently focused in 14 of 20 health regions that represent approximately 80 percent of people living with HIV (PLHIV). Further epidemiologic, demographic, and program data analysis, combined with budget considerations and discussions of “core, near-core, and non-core” activities, have led to targeting 39 districts for scale-up to reach 90:90:90: 16 “saturation” (by FY 2017) districts, and 23 “aggressive scale-up districts. The “saturation” districts represent 42% of the estimated disease burden in country, have the largest current patient cohorts, and are among areas most likely to be sources of new infections. Bolstering pediatric treatment services is also central to the COP 2015 approach, furthering the goal established in COP 2014 to attain 40% coverage. In the 23 “aggressive scale-up” districts the program will continue to make new diagnoses of PLHIV and increase linkages into the clinical cascade, efforts initiated in COP 2013 to improve quality of service delivery and retention of patients on treatment. The remaining 40 districts will be considered “sustained” districts (note that clinical services in the remaining three districts in country are being supported by the Global Fund to fight AIDS, Tuberculosis and Malaria [GF, or “the Global Fund”]) where the primary shift will be virtual elimination of service demand creation, no new sites, and increased reliance on systems and services provided by the Ivoirian government’s health infrastructure. Patients currently being served through higher-yield PMTCT and ART sites will be maintained on pre-ART and treatment, and the minimum package of care for orphans and vulnerable children (OVC) will continue in these regions throughout COP 2015 implementation. In line with OGAC guidance, routine testing services for PMTCT at sites in sustained districts will no longer be PEPFAR-supported, but women testing positive will access prophylaxis, ART and care services with PEPFAR support. Eliminating demand creation efforts will substantially reduce targets across program areas in these regions and will contribute to a shift in funding to high impact areas. The refined high- yield testing strategy will result in increased efficiencies, reducing the number of tests provided, but identifying and retaining a higher proportion of HIV positive individuals. PEPFAR and the Ivoirian government are finalizing transition plans for low-yield and no-yield HTC and PMTCT sites at the ≤4 threshold (four or fewer PLHIV identified in the previous reporting year) during COP 2014, and are discussing further refinement of this strategic shift informed by available yield, costing data and absorptive capacity of GOCI and other stakeholders/funders. This discussion over the next year will also include a determination of the threshold for “low-volume” ART sites and development of an approach to better serve populations currently in a low-volume site. Hub-and-spoke and centers of excellence models are under consideration for the transfer of clients to more effective higher volume clinics in their area. PEPFAR has supported conversations between the Ambassador and 3 | P a g e Version 6.0 key members of the Ivoirian government, including the Prime Minister, regarding
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