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Maxart Early Access to ART for All. Implementation Study (2014-2018). Final Report

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Maxart Early Access to ART for All. Implementation Study (2014-2018). Final Report MaxART Early Access to ART for All. implementation study (2014-2018). Final Report. Colophon MaxART Early Access to ART for All implementation study (2014-2018) Final Report Published: December 2018 Author: MaxART consortium Photos: Adriaan Backer (cover, page 8, 9, 13, 15, 17, 19, 21, 41, 45, and 53) SWANNEPHA (page 24) James Oatway (page 27) Marcus Rose/IAS (page 47) Maureen Sellmeijer (page 30, 36 and 39) Design: de Handlangers, Utrecht MINISTRY OF HEALTH KINGDOM OF SWAZILAND For more information on the MaxART programme visit: www.aidsfonds.org/maxart MINISTRY OF HEALTH KINGDOM OF SWAZILAND World’s second-largest private charity donor The Swaziland Ministry of Health, STOP AIDS NOW!, and the Clinton Health Access Initiative (CHAI) initiated the MaxART programme in Swaziland. The programme partners include the Swaziland Network of People Living with HIV and AIDS (SWANNEPHA) and the Global Network of People Living with HIV (GNP+), the National Emergency Response Council on HIV/AIDS (NERCHA), national and international non-governmental organisations including the Southern Africa HIV & AIDS Information Dissemination Service (SAfAIDS), social scientists from the University of Amsterdam and researchers from the South African Centre for Epidemiological Modelling and Analysis (SACEMA). The MaxART Consortium gratefully acknowledges the extensive contributions of all partners who support initiatives within the project as well as broader efforts to strengthen health outcomes across Swaziland. These include, but are not limited to, PEPFAR/CDC/USAID, WHO, UNAIDS, PSI, EGPAF, ICAP, MSH, URC, Baylor, FLAS, AHF, M2M, Lusweti, and World Vision. 2 MaxART Early Access to ART for All implementation study (2014-2018) Final Report Table of contents Executive Summary ...........................................................................................................5 1. Introduction .................................................................................................... 10 1.1. Rationale .................................................................................................................10 1.2. The MaxART programme .......................................................................................11 2. Study overview ............................................................................................. 12 2.1. Study Aim and Objectives ......................................................................................12 2.2. Study Design ...........................................................................................................12 2.3. Multidisciplinary Consortium and Study Components .......................................14 2.3.1 Early Access to ART for All implementation activities ......................................................15 2.3.2 Early Access to ART for All research components...............................................................15 3. Early Access to ART for All implementation activities ................. 18 3.1 Health system support activities .............................................................................18 3.1.1 Clinical mentoring ...........................................................................................................................18 3.1.2 Laboratory support .........................................................................................................................19 3.1.3 Data management ..........................................................................................................................21 3.2 Communication strategy ..........................................................................................22 3.3 Community Mobilization ..........................................................................................23 3.4 Support groups of people living with HIV ...............................................................24 3.5 Community Advisory Board ......................................................................................24 4. MaxART Early Access to ART for All implementation Study Results ................................................................................................. 26 4.1. Clinical Research Results ........................................................................................26 4.2. Economic Evaluation Results .................................................................................26 4.3. Social Science Research Results .............................................................................28 4.4. Incidence Modelling Results ..................................................................................32 4.5. Community Leaders Research Results ..................................................................36 4.6. Community Advisory Board Research Results......................................................39 5. MaxART Study Conclusion and Recommendations ...................... 42 5.1. Conclusion ...............................................................................................................42 5.2. Recommendations .................................................................................................44 6. Linking, Learning & Lobby ....................................................................... 46 Appendix 1: MaxART Consortium and governance ...............................................................48 Appendix 2: Study Data collection details ..............................................................................49 Appendix 3: Overview of Presentations, Events, Scientific Articles and other learning products ................................................................................................54 Appendix 4: MaxART newsletters edition 6-10 ......................................................................64 Table of contents 3 List of abbreviations ART Anti-retroviral therapy ARV Anti-retroviral drugs CAB Community Advisory Board CBO Community Based Organization CBV Community Based Volunteer CHW Community Health Worker CHAI Clinton Health Access Initiative CHSS Community Health Systems Strengthening CSS Community Systems Strengthening DBS Dry blood spot DSMB Data and Safety Monitoring Board EAAA Early Access to ART for All GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GNP+ Global Network of People living with HIV HCW Health Care Worker IEC Information Education Communication LTFU Lost to follow-up MaxART Maximizing ART for Better Health and Zero New HIV Infections M2M Mothers to Mothers MSF Médecins Sans Frontières MOH Ministry of Health NERCHA National Emergency Response Council on HIV/AIDS NGO Non-governmental organization NRL National Reference Laboratory NSTS National Sample Transport System PLHIV People Living with HIV RHM Rural Health Motivator SACEMA South African Centre for Epidemiological Modelling and Analysis SAfAIDS Southern Africa HIV and AIDS Information Dissemination Service SHIMS Swaziland HIV Incidence Measurement Survey SHLS Swaziland Health Laboratory Services SNAP Swaziland National AIDS Programme SOP Standard Operating Procedures SRM Senior Research Manager SSUTT Social Science of Universal Test and Treat Network SWANNEPHA Swaziland National Network of People Living with HIV/AIDS TasP Treatment as Prevention UvA University of Amsterdam 4 MaxART Early Access to ART for All implementation study (2014-2018) Final Report Executive summary The MaxART Programme The targets of phase 1 included dramatically scaling-up HIV testing to 250,000 people per year; improving access In 2011, Aidsfonds, in collaboration with six consortium to antiretroviral therapy (ART) so that 90% of those in need partners1 and under leadership of the Ministry of Health at the then current eligibility requirements (CD4 less than/ of the Kingdom of Eswatini (formerly Swaziland) launched equal to 350) were on treatment and reducing loss-to- the pioneering Maximizing ART for Better Health and Zero follow-up of clients on treatment from 22% to 10% by 2014. New HIV Infections (MaxART) programme in Eswatini. The By the end of phase 1, the country had indeed achieved ambitious goal of the programme was to improve the lives the ambitious targets of the MaxART programme, with of people living with HIV and prevent new HIV infections over 250,000 people tested annually for HIV, 91% of people in Eswatini by dramatically improving the uptake of HIV eligible for ART (at CD4 count of ≤350cells/ml) on treatment testing, care and treatment services and demonstrating that and loss to follow up of people living with HIV reduced from early access and initiation on antiretroviral treatment (ART) 22% to 15%. The results achieved throughout the first phase can significantly improve clinical outcomes for people living of the MaxART programme showed how collaboration with HIV and reduce new infections. between government, civil society organisations, research institutes, healthcare workers and communities can produce The programme, which was made possible through the good results in terms of improving the health of the people generous funding from the Dutch Postcode Lottery’s Dream of Eswatini. More information on the results of phase 1 can Fund and the Embassy of the Kingdom of the Netherlands in be found in the MaxART Final Report Phase 12. Mozambique, was structured in two phases. The first phase of MaxART (2011-2014) supported a number of interventions and systems strengthening activities aimed to achieve universal access to HIV testing and treatment services, improving the health
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