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Eswatini Country Operational Plan 2019 (COP19) Strategic Direction Summary 05 April 2019

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Eswatini Country Operational Plan 2019 (COP19) Strategic Direction Summary 05 April 2019 Eswatini Country Operational Plan 2019 (COP19) Strategic Direction Summary 05 April 2019 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 COP19 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 Appendix D – Minimum Program Requirements Appendix E – Faith and Community Initiative (as applicable) ii | P a g e Acronym and Word List AE Adverse Event AG Adolescent Girls AGYW Adolescent Girls and Young Women ALHIV Adolescents Living with HIV ANC Antenatal Clinic ARV Antiretroviral ART Antiretroviral Therapy C/ALHIV Children and Adolescents Living with HIV CAGs Community Adherence Groups CANGO Coordinating Assembly of Non-Governmental Organizations CCM Country Coordinating Mechanism CMIS Client Management Information System CMS Central Medical Stores CoAg Cooperative Agreement CQI Continuous Quality Improvement CS Civil Society CSO Civil Society Organization DBS Dried Blood Spot DQA Data Quality Assessment DMPPT Decision Makers Program Planning Toolkit DREAMS Determined, Resilient, Empowered, AIDSfree, Mentored, and Safe DSD Differentiated Service Delivery DTG Dolutegravir EID Early Infant Diagnosis EQA External Quality Assessment iii | P a g e ENAP Eswatini National AIDS Program EU European Union FDC Fixed dose combination FP Family Planning FSW Female Sex Workers GBV Gender Based Violence GKoE Government of the Kingdom of Eswatini GF Global Fund to fight AIDS, Tuberculosis and Malaria GDP Gross Domestic Product GNI Gross National Income HCWs Health Care Workers HR Human Resources HRH Human Resources for Health HSS Health Systems Strengthening HTC HIV Testing and Counseling HTS HIV Testing Services HIVST HIV self-testing ICT Index Case Testing IEC Information, Education and Communication IM Implementing Mechanism Inkhundla Government Administrative Unit (Below Regional Level) IP PEPFAR Implementing Partner KP Key Population KPLHIV Key Populations Living with HIV LES Locally Employed Staff LGBTIQ Lesbian, Gay, Bisexual, Transgender/Transsexual, Intersex, Queer LTFU Lost to Follow Up iv | P a g e 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 MTAD Ministry of Tinkhundla and Administration 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/E President’s Emergency Plan for AIDS Relief/Eswatini Partnership for Supply Chain Management/Supply Chain Management PFSCM/SCMS System v | P a g e PHU Public Health Unit PITC Provider Initiated Testing and Counseling PLHIV People Living with HIV PMTCT Preventing Mother-to-Child Transmission POART PEPFAR Oversight and Accountability Response Teams POC Point of Care PPs Priority Populations PPP Public Private Partnership PrEP Pre-exposure Prophylaxis QA Quality Assurance QI Quality Improvement QMS Quality Management System RA Regional Administrator RASTA Region Age Sex Testing/Treatment Attribution RTK Rapid Test Kit 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 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 vi | P a g e SWAMMIWA Swaziland Migrant Mineworkers Association TA Technical Assistance TB Tuberculosis Tinkhundla Government Administrative Units (Below Regional Level) T&S Test and Start TLD Tenofovir/Lamivudine/Dolutegravir TPT TB Preventive Therapy TSP Technical Support for PEPFAR Programs TWG Technical Working Groups UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS VCT Voluntary Counselling and Testing VL Viral Load VMMC Voluntary Medical Male Circumcision WMIS Warehouse Management Information System vii | P a g e 1.0 Goal Statement Despite facing the world’s highest HIV prevalence, Eswatini stands on the brink of reaching epidemic control. As we push to close the remaining gaps to achieve 95-95-95, we find that lingering unmet needs are not confined to any one region or population in the country. The overarching goal of the PEPFAR/Eswatini (PEPFAR/E) investments is to support the Government of the Kingdom of Eswatini (GKoE) to achieve epidemic control, provide high quality HIV services to people living with HIV, and continue to rapidly and sustainably reduce the number of new infections. The program activities are guided by and aligned with Eswatini’s National Multi- Sectoral Strategic Framework for HIV and AIDS 2018-2022. COP19 focuses on actively finding unidentified, untreated, or unsuppressed individuals while improving access to high quality services. The needs and approaches for finding cases vary by age, gender, and individual or family context. Strategically targeted testing will include fully scaled index testing to identify half of all new positives, scaled-up targeted self-testing, and elimination of non-targeted facility testing through full implementation of risk screening tools. Improvements in case finding increase prevention opportunities, including reaching HIV negative men with counseling on VMMC. Priority interventions include case identification for men aged 20 – 29 and youth aged 15-25, linkage to care for women aged 20-29 and men aged 25-39 who know their status but are not on treatment, and viral suppression for adolescents and young men and women. We will particularly focus on the hardest-to-reach KP subpopulations such as older MSM, younger and home-based FSW, and peri-urban marginalized mobile populations. Striving to reach 90% of all PLHIV on ART (the second 95%) in all ages, sexes and locations, all four regions are considered scale-up for case identification and linkage to treatment. Key strategies to increase linkage are same day initiation, expert client support, peer navigation, and improved access to ART services. As we seek to strengthen our focus on retention among all subpopulations, we will be pursuing targeted and population-focused strategies such as: differentiated service delivery approaches for reliable and convenient ART refills for subpopulations; multi-month scripting and dispensing; key communication interventions (such as undetectable viral load means the virus is untransmittable (U=U) segmented by population; and effective use of outreach workers, expert clients and step-up adherence counselors. In addition to increasing retention, a full transition to dolutegravir-based regimens, including the fixed dose combination of tenofovir/lamivudine/dolutegravir (TLD), will support the achievement of higher community viral suppression, implementation of which is made more urgent by high levels of ART resistance. This transition and implementation of revised pediatric treatment guidelines will improve the lagging viral suppression experienced by younger PLHIV. Tackling two of the most significant causes of mortality amongst PLHIV in Eswatini, COP19 will see full implementation of TB preventive therapy and cervical cancer screening and treatment. 1 | P a g e Priority and key populations will have improved access to high impact, integrated prevention services and programs through community- and facility-based settings. We will engage PP and KP to incorporate their perspectives, needs and feedback into the design and implementation of programs. With a substantial youth bulge, tailored HIV prevention programs are critical. Targeted sub-population specific approaches, especially for males 15-30 years old, will be employed to reduce barriers to testing, treatment, condoms, VMMC and PrEP; and to increase retention. The DREAMS package
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