Sauti Project
Quarterly Progress Report FY 19 Q2 Report January 1‐ March 31, 2019
Submitted: April 30, 2019
Sauti Project FY19 Q2 Progress Report i
Sauti Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Cooperative Agreement AID-621-A-15-00003. Jhpiego Corporation implements the Sauti Project with its partners, EngenderHealth, Inc., Pact, Inc., and the National Institute for Medical Research (NIMR). Sauti Project supports and advances implementation of the US President’s Plan for AIDS Relief by providing a package of core services to Key and Vulnerable Populations (KVP) in support of the Government of the United Republic of Tanzania’s commitment to HIV prevention.
This publication is made possible by the support of the American people through the US Agency for International Development (USAID) under the terms of Cooperative Agreement AID-621-A-15-0000-3. The contents are the responsibility of Jhpiego/Sauti Project and do not necessarily reflect the views of USAID or the US Government.
Sauti Project FY 19 Q2 Progress Report ii
TABLE OF CONTENTS
TABLE OF CONTENTS ...... iii
LIST OF ACRONYMS ...... v
EXECUTIVE SUMMARY ...... 7
FY19 Q2 ACHIEVEMENTS ...... 8
Objective 1: Biomedical ...... 19 Objective 2: SBCC/Gender ...... 19 Objective 2: WORTH+ ...... 19 Objective 3: Research and Learning Agenda ...... 20 Objective 4: Engagement of CSOs, LGAs and Sustainability ...... 20 Objective 5: M&E ...... 20 DREAMS ...... 21 QA/QC ...... 22 KEY ACTIVITIES AND NEW STRATEGIES IN Q2, FY19 ...... 23
Objective 1: Implement a package of core and expanded biomedical HIV prevention and FP interventions, with enhanced linkages to care and treatment, and support services . 23 Objective 2: Deploy interventions designed to reduce individual risk behaviors and strengthen support for positive social norms and structures, and address gender at the community level ...... 26 SBCC AND GENDER INTERVENTIONS ...... 26 STRUCTURAL INTERVENTIONS ...... 32 Objective 3: Execute a Robust Research and Learning Agenda ...... 37 OBJECTIVE 4: Increase the sustainability of comprehensive HIV prevention services by strengthening engagement and ownership of host government, CSOs, and communities 43 Quality Assessment (QA) and Quality Improvement (QI) Services ...... 44 Support KVPFS at Government of Tanzania (GOT) health facilities under PPP (EJAF/OGAC) ...... 45 Objective 5: Build and deploy vigorous monitoring and evaluation systems ...... 47 Determined Resilient AIDS‐free Mentored Safe (DREAMS) Initiative ...... 49 PROGRAM MANAGEMENT ...... 53
Personnel ...... Error! Bookmark not defined. Regional Office Management ...... Error! Bookmark not defined. Procurement ...... Error! Bookmark not defined. Sub award Management ...... 53 Strategic Partnerships and Cost Share Opportunities ...... 53
Sauti Project FY19 Q2 Progress Report iii
Finance ...... 53 LESSONS LEARNT ...... 54
Biomedical...... 54 SBCC and Gender ...... 55 WORTH+ ...... 56 Research and Learning Agenda ...... 57 M&E ...... 57 DREAMS ...... 57 QA/QC ...... 57 CHALLENGES, OPPORTUNITIES AND WAYFOWARD ...... 58
Biomedical...... 58 SBCC and Gender ...... 59 WORTH+ ...... 59 Research and Learning Agenda ...... 59 M&E ...... 60 DREAMS ...... 60 QA/QC ...... 60 PLANNED ACTIVITIES FOR FY 19 Q3 ...... 60
Biomedical...... 60 SBCC and Gender ...... 61 WORTH+ ...... 62 Research and Learning Agenda ...... 62 Capacity Building/CSOs ...... 63 M&E ...... 63 DREAMS ...... 64 QA/QC ...... 64 APPENDICES ...... 65
Appendix 1: Success Story ...... 65 Appendix 2: FP Commodities requested and received ...... 66 Appendix 3: Regional Meetings Held in Q2 ...... 67
Sauti Project FY18 Q2 Report iv LIST OF ACRONYMS AGYW Adolescent girls and young women ART Antiretroviral therapy CBHSP Community based health service providers CBHTC+ Community-based HIV testing and counseling plus CHMT Council health management team CISP Comprehensive Institutional Strengthening Plan COE Center of excellence CSO Civil society organization CRF Client Register Form CT Care and Treatment CTC Care and treatment clinic D4D Data for development DC District Council DH Digital health DHIS District health information software DOT Digital Opportunity Trust DQA Data quality assessment DREAMS Determined, Resilient, Empowered, AIDS-free Mentored, and Safe EW Empowerment worker FP Family planning FSW Female sex worker FY Fiscal year GBV Gender-based violence GIS Geographic information system GOT Government of Tanzania HVCV Home based care volunteers HIVST HIV self-test HTS HIV testing services IEC Information, education and communication IGA Income generating activities IP Implementing partner IRB Institutional Research Board IUD Intrauterine device KK Kizazi Kipya KP Key populations KVP Key and vulnerable populations KVPFS Key and vulnerable population friendly services LGA Local government authorities MC Municipal Council MCT Management Committee Trainings M&E Monitoring and evaluation MOH Ministry of Health MOHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children MSM Men who have sex with men MUHAS Muhimbili University Health and Allied Science NACP National AIDS Control Program NIMR National Institute for Medical Research OHSP Other hot spot populations ONA Organization Network Analysis OVC Orphans and vulnerable children PFSW Partners of female sex workers PLHIV People living with HIV PO-RALG President’s Office – Regional Administration and Local Government PP Priority populations PPP Public private partnership
Sauti Project FY19 Q2 Progress Report v
PPT Periodic presumptive treatment PrEP Pre-exposure prophylaxis PSG Psychosocial support groups Q1, Q2 Quarter one, Quarter two QI/QA Quality improvement/quality assurance RCHS Reproductive and Child Health Section RHMT Regional health management team SBCC Social and behavior change communication SEEO Social and economic empowerment officers SIMS Site Improvement Monitoring System SNU Subnational units SRH Sexual and Reproductive Health STI Sexually transmitted infection TA Technical assistance TACAIDS Tanzania Commission for AIDS TC Town Council ToT Training of trainers UNAIDS Joint United Nations Programme on HIV/AIDS UNC University of North Carolina USAID United States Agency for International Development vAGYW Vulnerable adolescent girls and young women VAC Violence against children VETA Vocational Educational and Training Authority
Sauti Project FY18 Q2 Report vi EXECUTIVE SUMMARY From January to March 2019, the Sauti Project offered HIV testing services (HTS) to 107,477 KVPs (10,958 children and 96,519 adults), across 33 subnational units (SNUs) in 11 regions. Among 9,925 new HIV positive beneficiaries (298 children and 9,627 adults: 9.2% yield) found by the project, 8,886 (283 children and 8,603 adults) were confirmed to be enrolled into care and treatment (CT) services (90% enrollment rate). Majority of the HIV positive beneficiaries continued being sex workers and their partners. These achievements represent 21% and 27% of the quarterly targets for HTS and HIV positive, respectively; and 60% and 54% of the annual target for HTS and HIV positive, respectively. The success of the project in reaching the HIV positive semi-annual target without excessively over-testing has been driven by the index testing strategy, which in Q2 contributed to 38% of all tested by any modality and 69% of all new HIV positive beneficiaries diagnosed through any testing modality.
Among the innovative interventions, in Q2, Sauti started 91 FSW on pre-exposure prophylaxis (PrEP) (5% of the quarterly target and 29% of the annual target), distribute 3,226 HIV self-tests (HIVST) to key populations (KP) and their sexual partners (23% of the quarterly target and11% if the annual target), and transferred 3,582 new people living with HIV (PLHIV) into antiretroviral therapy (ART) outreach services in the community.
Again in Q2 FY19, 22,870 AGYW and 26,158 FSW received family planning (FP) services, which represents 44% and 29% of the FP quarterly target for vulnerable adolescent girls and young women (vAGYW) and FSW, respectively (91% for vAGYW and 80% for FSW of the annual target).
Through behavior change education, the project graduated 23,210 KPs and 46,454 vAGYW, representing 31% and 32% of the quarterly KP and priority population (PP) prevalence targets, respectively (62% of the KP Prev and 62% of the PP Prev annual targets).
The Sauti Project reached 13,278 beneficiaries with SASA! in four DREAMS councils (34% of the Gender Norms quarterly target; 65% of the annual target); graduated 14,232 vAGYW from parenting education; started 12,172 on saving and loaning services; graduated 13,073 from SBCC education, offered HTS to 7,474 vAGYW, identified 91 HIV positive vAGYW and supported the enrollment of 76 among them. These achievements represent 121%, 106%, 35% of the Parenting, Combination of Socio-economic, PP Prev, DREAMS quarterly targets, respectively (221%, 206%, 65% of the Parenting, Combination of Socio- economic, PP Prev, DREAMS annual targets, respectively).
As part of the Public Private Partnership (PPP) between EJAF and OGAC, this quarter, Sauti supported 2,049 KP with Periodic Presumptive Treatment (PPT) for sexually transmitted infection (STI) in five regions (Njombe, Iringa, Mbeya, Shinyanga and Dar es Salaam) and the 3 centers of excellence in Dar es Salaam and Dodoma, where it reached 1,513 new MSM with HTS, diagnose 103 new HIV positive (7% yield), and enrolled 61% of them into CT services; 89% of those tested were also screened for mental health, 14% screened positive and all received related services; 2,017 MSM started STI PPT.
Sauti Project FY19 Q2 Progress Report 7
FY19 Q2 ACHIEVEMENTS From January to March 2019, the Sauti Project offered HIV testing services (HTS) to 107,477 KVPs (10,958 children and 96,519 adults), across 33 subnational units (SNUs) in 11 regions; testing cumulatively 302,887 beneficiaries, since October 2018.
Among those who received HTS in this quarter, 9,925 HIV positive beneficiaries were newly diagnosed (9.2% yield) (298 children and 9,627 adults) and 8,886 (283 children and 8,603 adults) were confirmed to be enrolled into care and treatment (CT) services (90% enrollment rate). Out of those who were linked to CT, 42% were female sex workers (FSWs), followed by 28% partners of female sex workers (PFSW) and 13% other hot spot populations (OHSP). The remainder were adolescent girls and young women (AGYW), children, Other Hot Spot Populations Male (OHSPM) and men who have sex with men (MSM).
These achievements represent 21% and 27% of the quarterly targets for HTS and HIV positive, respectively; and 60% and 54% of the annual target for HTS and HIV positive, respectively. The success of the project in reaching the HIV positive semi-annual target without excessively over-testing has been driven by the index testing strategy, which in Q2 contributed to 38% of all tested by any modality and 69% of all new HIV positive beneficiaries diagnosed through any testing modality.
Sauti Project also continued supporting innovative interventions, starting 91 FSW on pre-exposure prophylaxis (PrEP) (5% of the quarterly target and 29% of the annual target), distributing 3,226 HIV self- tests (HIVST) to key populations (KP) and their sexual partners (23% of the quarterly target and11% if the annual target), transferring 3,582 new people living with HIV (PLHIV) into antiretroviral therapy (ART) outreach services in the community and cumulatively reaching 6,644 stable clients with care and treatment.
In Q2 FY19, the project also reached 22,870 AGYW and 26,158 FSW with family planning (FP) services, which include female and male condoms, oral contraceptive pills including emergency contraception, injectables, implants, intrauterine device (IUDs) and permanent methods. This achievement represents 44% and 29% of the FP quarterly target for vulnerable adolescent girls and young women (vAGYW) and FSW, respectively (91% for vAGYW and 80% for FSW of the annual target).
In Q2, 23,210 KPs (20,685 FSW and 2,525 MSM) and 46,454 vAGYW graduated from behavior change education through individual and group education; these beneficiaries were either offered HTS or referred to health facility-based testing services. Such achievements represent 31% and 32% of the quarterly KP and priority population (PP) prevalence targets, respectively (62% of the KP Prev and 62% of the PP Prev annual targets).
Figures 1 to 4 describe the progress to target for PEPFAR, Determined, Resilient, Empowered, AIDS- free Mentored, and Safe (DREAMS) and EJAF-OGAC public private partnership (PPP) indicators.
The project met the Q2 target on HTS, HIV positive, as well KP and PP Prev targets. The PrEP target was not met, due to the geographic and sample size restriction of the national study protocol, for which an amendment was approved only in February 2019. Furthermore, the PrEP achievement was also affected by the shortage of medication which lasted until end of January 2019, and which has thereafter been addressed by officially including PrEP into the national supply system.
8 Sauti FY18 Q2 Report Family planning targets were exceeded, for both populations of AGYW and FSW, as result of high demand at community level and high continuation rates among those initiated in the previous fiscal year (FY) (Figure 1).
Figure 1. Progress to PEPFAR Targets (HTS, HIV+, HIVST, PrEP, FP, KP Prev, PP Prev), Q1-2 FY19
New on PrEP 24% 5% 71% HIVST 23% 11% 66% PP PREV 30% 32% 38% KP PREV (MSM) 29% 29% 43% Q1 KP PREV (FSW) 31% 32% 37% Q2 FP (FSW) 51% 29% 20% Q3‐4 Remaining FP (AGYW) 47% 44% 9% HIV positive 27% 27% 46% HTS 39% 21% 40%
0% 25% 50% 75% 100%
The Sauti Project continued to conduct gender norm dialogues with men and women through SASA! community drama groups and workshops, reaching 13,278 beneficiaries in four DREAMS councils. Such achievement represents 34% of the Gender Norms quarterly target (65% of the annual target).
Also in Q2 and in DREAMS SNU, the Project graduated 14,232 vAGYW from parenting education, started 12,172 on saving and loaning services, graduated 13,073 from social and behavior change (SBCC) education, offered HTS to 7,474 vAGYW, identified 91 HIV positive vAGYW and supported the enrollment of 76 among them. These achievements represent 121%, 106%, 35% of the Parenting, Combination of Socio-economic, PP Prev, DREAMS quarterly targets, respectively (221%, 206%, 65% of the Parenting, Combination of Socio-economic, PP Prev, DREAMS annual targets, respectively).
All DREAMS related targets (Combination of Socio Economic, Parenting, PP Prev and Gender Norms) were also met in all SNU (Figure 2).
9 Sauti FY18 Q2 Report Figure 2. Progress to DREAMS Targets (Combination of Socio Economic, Parenting, PP Prev and Gender Norms), Q1-2 FY19
Parenting 100% 121%
Combi of SE 100% 106%
Gender Norms 31% 34%
PP Prev 30% 35%
HTS 34% 20%
0%50%100%150%200%250%
Q1 Q2 Q3‐4 Remaining
As part of the PPP between EJAF and OGAC, this quarter, Sauti supported 789 FSWs and 1,260 MSM with Periodic Presumptive Treatment (PPT) for sexually transmitted infection (STI) in five regions (Njombe, Iringa, Mbeya, Shinyanga and Dar es Salaam).
MSM-friendly service delivery continued at 3 centers of excellence in government health facilities in Dar es Salaam and Dodoma with the objective to increase ART initiation and retention among MSM. As result, in Q2, 1,513 new MSM received HTS, 103 tested HIV positive (7% yield), 63 (61%) were enrolled into CT services; 89% of those tested were also screened for mental health, 14% screened positive and all received related services; 2,017 MSM started STI PPT.
The following figures 3 and 4 describe the progress against the PPP targets, for STI PPT in five regions (Figure 3) and at the 3 MSM-friendly centers of excellence (COE) in three regions (Figure 4). The STI PPT targets for FSW and MSM were not met because of a delayed distribution of the medications in the 5 regions; this bottleneck was rapidly addressed and the demand creation for such service will be intensified from Q3 onwards., The same STI PPT target for MSM at COE was met at 34% for the same reason; the other COE-related progress was behind expectations due to challenges with demand creation by the CBHSP and therefore low testing rates in Dar es Salaam and low HIV positivity in all 3 COE. In Q2, the enrollment rate remained stable at 61%. Almost all MSM who received HTS in Dar es Salaam, also received mental health screening, compared to Dodoma where only half of those tested received screening; between 19% and 37% of those screened, reported a mental health problem and virtually all of them, received mental health services in all 3 COE.
10 Sauti FY18 Q2 Report
Figure 3. Progress to PPP Targets (STI PPT), Q1-2 FY19
FSW 16% 7% 77%
MSM 6% 10% 84%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Q1 Q2 Q3‐4 Remaining
Figure 4. Progress to PPP Targets (COE), Q1-2 FY19
41% Received mental health screening
34% STI PPT
11% ART retention
23% HIV+ 0% 25% 50% 75% 100%
SAPR Progress Remaining
When looking into the HTS by service delivery modality, in Q2, index testing represented 38% of the overall HTS and 69% of the overall HIV positive (Figure 5). As result, yield increased from 5% in Q1 to 9% in Q2, overpassing the overall yield target of 7%.
11 Sauti FY18 Q2 Report Figure 5. HTS and HIV positive contribution by testing modality, Q1-2 FY19
12.0% 23.0% 39.0% 61.0%
88.2% 77.2% 60.6% 39.0%
HTS HIV+ HTS HIV+ Q1 Q2
Mobile Index
Similarly, as in quarter one, in Q2 most of the HIV infected beneficiaries were FSW (43%), followed by PFSW (28%), as described in Figure 6.
Figure 6. Distribution HIV positive beneficiaries by population group, Q2 FY 19
2%
5% 13% AGYW FSW 7% PFSW 3% Peds 43% OHSP male OHSP female MSM 28%
In Q2, the overall yield was 9%; when comparing the yield by testing modality (index, mobile and other modalities) as described in Figure 7, we observed that in Q2 index yield was higher than mobile and other testing modalities yield (17% versus 5%), and the former increased by 1.5 times compared to Q1.
12 Sauti FY18 Q2 Report Figure 7. Yield comparison by index versus mobile testing, Q1-2 FY19
19%
10%
5% 4%
Q1 Q2
Mobile Index
The following figure 8 shows the index testing cascade: 35% of the elicited contacts received HTS, 22% of the sexual partners and 4% of the biological children tested HIV positive and 91% were enrolled into CT services.
Figure 8. Index testing cascade, Q2 FY191 90,000 82,627 80,000 70,000 60,000 50,000 40,000 29,634 30,000 20,465 21,121 20,000 12,257 6,485 6,324 6,421 5,714 10,000 249 230 ‐ Male and Female Children elicited elicited Tested Tested POS POS POS POS Female (15+) (<15) sexual biological sexual biological sexual biological sexual biological (15+) with with partner Child partners children partners children partners children with elicited elicited enrolled enrolled elicited children contacts in CTC in CTC contacts
Index clients (with elicited elicited contacts elicited contacts elicited contacts elicited contacts
In line with past reports, also in Q2, yield was higher among OHSP female (20%), mostly because they were sexual partners of HIV positive index clients, but also due to their engagement in transactional sex for those who weren’t contact clients; following population group reporting high yield was the FSW (13%); the MSM yield increased by more than two times, due to the index testing contribution which reported an HIV positivity rate of 17%. Generally yield by index testing was higher than through
1 this figure is the sum of monthly reports that include those index clients and contact clients from the reporting month plus those from the previous two months, as per USAID guidance 13 Sauti FY18 Q2 Report mobile testing across all populations(Figures 9 and 10).
Figure 9. Yield by population group, Q1-2 FY19 25%
20% 20%
15% 13% 12% 10% 10% 9% 7% 7% 5% 5% 5% 3% 3% 3% 2% 2%
0% AGYW FSW PFSW Peds OHSP male OHSP female MSM
Q1 Q2
Figure 10. HIV positive and Positivity Rate by testing modality and population group, SAPR FY19 FY 19 5,000 30% 4,500 26% 25% 4,000 3,500 22% 20% 3,000 17% 2,500 15% 15% 14% 2,000 10% 1,500 9% 8% 1,000 6% 5% 5% 5% 500 4% 4% 4% 4% 2% 2% ‐ 0% AGYW FSW MSM OHSPF OHSPM PFSW Peds KVP Peds non‐KVP
Mobile HIV+ Index HIV+ Mobile Positivity rate Index Positivity rate
The Q2 enrollment rate was 90%, compared to 82% in Q1 (Figure 11). Enrollment rates were higher when HIV positive beneficiaries were identified through index modality compared to mobile and other testing modalities (91% versus 86%, respectively) and they were higher among biological children (95% not showed data).
Figure 11. CTC Enrollment rates by testing modality, Q1-2 FY19
14 Sauti FY18 Q2 Report 12,000 92%
90% 10,000 90% 88% 8,000 86% 6,000 84% 4,000 82% 82%
2,000 80%
0 78% Q1 Q2
HIV+ Enrolled Enrollment rate
A significant increase of the enrollment rate was observed across all population groups, from Q1 to Q2 (Figure 12).
Figure 12. CTC Enrollment rates by population group, Q1-2 FY 19 4,000 100% 95% 91% 3,500 88% 89% 89% 88% 90% 90% 84% 85% 84% 83% 82% 80% 3,000 70% 68% 66% 2,500 60% 2,000 50%
1,500 40% 30% 1,000 20% 500 10% ‐ 0% AGYW FSW PFSW Peds OHSPM OHSPF MSM
Q1 Q1 Enrolled Q2 Q2 Enrolled Q1 Q1 Enroll rate Q2 Q2 Enroll rate
When analyzed by region (Figure 13), half of the regions reported enrollment rates over 90% and 4 regions reported enrollment rates above 95% (red dotted line in Figure 13). Higher enrollment rates were due to a closer supervision to the providers engaged in the enrollment, increased involvement of the HBCV in the escorted referral, and to the fact that many of the HIV positive beneficiaries were identified through index testing and hence they felt the urgency to start ART given the HIV status of their sexual partners; a significant increase of the enrollment rate was observed in Dar es Salaam (from 60% to 84%) and in Kilimanjaro (from 59% to 90%) as result of intensified supervision and mentoring to the biomedical providers.
15 Sauti FY18 Q2 Report Figure 13. CTC Enrollment rates by region, Q2 FY19
100% 98% 97%
95% 94% 94% 92% 90% 90% 88% 87% 86% 85% 85% 84%
80%
75%
So, in Q2, the team will continue working on reaching the 95% enrollment rate target; underperforming regions will be prioritized for increasing the frequency and intensity of the support. Compliance to the enrollment procedures will be enforced with focus on improving the quality of disclosure counseling and increasing the frequency of the follow-up counseling for those who won’t enroll on the same day.
Plans with the facility-based partners have been initiated to start offering community- based ART initiation to the backlog of HIV positive Sauti clients, as well prospectively to any new HIV positive KVP.
PrEP service delivery continued serving the FSW who were initiated in FY18 and Q1 FY19 and initiating 91 new FSW on PrEP in Q2 FY19; overall the project initiated 4,688 since May 2018 at 35% continuation rate (Figures 14 and 15). Overall progress on New on PrEP was below expectations due to the restricted geographic coverage and sample size of the national study protocol which was not amended until February 2019, and the medication shortage, lasted until end of January 2019.
A new amendment to the protocol was also drafted by the national technical working group and submitted to National AIDS Control Program (NACP), requesting to remove PrEP from the study and offer it as standard of care, part of the national policy.
16 Sauti FY18 Q2 Report Figure 14. New on PrEP by SNU, Q1-2 FY19 300 128% 140% 123% 117% 250 120%
100% 200 80% 150 60% 100 40% 57 50 20 20% 9 0% 0 0 0% Kinondoni MC Temeke MC Iringa MC Njombe DC
PrEP New Target New on PrEP Q1 New on PrEP Q2 % PrEP New Progress to target
Figure 15. Cumulative and current on PrEP by SNU, Q2 FY19
5000 90% 100% 4500 90% 4000 80% 3500 70% 3000 60% 47% 45% 2500 42% 50% 2000 40% 1500 30% 1000 20% 500 10% 0 0% Kinondoni MC Temeke MC Iringa MC Njombe DC
Commulative enrolled in PrEP PrEP CURR % Currently on PrEP
HIVST also continue being supported (Figure 16 and 17) and offered as assisted and unassisted modality by biomedical providers and community based health service providers (CBHSP); as result in Q2, 2,229 KP (71% being FSW and 29% MSM) and 997 peers and sexual partners received an HIVST; test result was available only for 21% of the KP who received the HIVST directly; their HIVST reactivity rate was 4% (3% among FSW and 7% among MSM). Overall progress was below expectations due to the restricted geographic coverage and sample size of the national study protocol which was also amended in February 2019. Also, challenges in tracking the test results remained since the system to anonymously upload test result free of charge through SMS was not set up yet: as result, 45% of the FSW and 30% of the MSM HIVST were found through the peer network.
Figure 16. HIVST Cascade on primary/direct distribution to KP, Q1-2 FY19
17 Sauti FY18 Q2 Report 1,800 1,589 1,600 1,404 1,400 1,200 940 1,000 800 640 466 600 393 400 271 200 25 16 64 21 1 ‐ HIVST HIVST result HIVST HIVST HIVST result HIVST distributed available reactive distributed available reactive primary/direct FSW primary/direct MSM
Q1 Q2
Figure 17. HIVST Cascade on secondary/indirect distribution to peers and sexual partners of KP, Q1-2 FY19
4,000 3,672 3,500 3,000 2,500 2,000 1,500 1,187 1,000 780 217 500 22 ‐ 2 ‐ ‐ HIVST distributed HIVST result HIVST distributed HIVST result available available secondary/indirect FSW peers/sex secondary/indirect MSM peers/sex partners partners
Q1 Q2
Sauti continued engaging with the CT team to transfer stable clients (defined as having taken 6 months of ART and being virally suppressed) into ART outreach services at community level, where ART adherence was monitored on monthly basis by expert stable clients and medical checks and ART refills were provided on quarterly basis by trained biomedical providers. As result, 6,644 stable clients from Q1 FY19 continued receiving the service and 3,582 new stable clients were initiated on ART outreach services in Q2 FY19 (Figure 18). The new clients were mostly from Shinyanga and Iringa regions made possible by the availability of ART outreach in the community.
Figure 18. Stable Clients enrolled into ART Outreach in the community, by region, Q1-2 FY19
18 Sauti FY18 Q2 Report 1,600 1,411 1,400 1,207 1,200
1,000
800 677
600 494 476 412426 400 262 183207 191 208 131 200 87 130 34 59 49 ‐ Arusha Dodoma DSM Iringa Kilimanjaro Morogoro Mtwara Shinyanga Tabora
Q1 Q2
Objective 1: Biomedical Newly diagnosed 103,104 HIV infected KVP and enrolled 25% of them; met 27% of the HIV positive quarterly target Initiated 87 FSW in PrEP in 5 SNUs (i.e. Kinondoni MC, Temeke MC, Iringa MC, Njombe DC and Kigamboni MC) and continued 2,045 in SNUs; met 29% of the new PrEP quarterly target Distributed 3226 HIVST to KP and their sexual partners; met 11% of the HIVST quarterly target Started 3582 stable HIV infected clients into ART outreach in the community in 25 SNUs and continued offering services to 6,992 stable clients from FY18 Certified 77% of the biomedical providers trained on FP in previous quarter
Objective 2: SBCC/Gender Graduated 46,454 AGYW, 20,685 FSW and 2525 MSM from SBCC groups and individual education; met 32%, 32% and 29% of the quarterly targets, respectively Reached 14,450 (8,480 males and 5,980 females) with gender norms education through SASA! activities; met 38% of gender norms quarterly targets Formed 2 PrEP and 75 ART outreach psychosocial support groups (PSGs) Conducted Gender Equity Assessment at mobile biomedical sites to improve provision of gender sensitive and respectful services Conducted community events to mark Zero Discrimination day and Internationals’ Women’s day and advocacy for friendly KVP services Conducted the consultation with KVP in 23 districts and 10 regions to understand beneficiaries’ perceptions on barriers and enablers to HIV prevention services Designed ART cards to enhance early HTS and ART initiation
Objective 2: WORTH Recruited and trained 37 new empowerment workers (EWs) in preparation for WORTH activities in PrEP groups in FY19. 37 EWs have received training in Village Banking module 19 Sauti FY18 Q2 Report Established 662 new groups and 13,724 vAGYW enrolled in WORTH+ groups (cumulatively 4,292 groups and 100,172 vAGYW since FY16) Graduated 226 vAGYW from Digital Opportunity Trust training under My WORTH application pilot in Temeke MC to enhance their marketing and sales skills using mobile devices and for learning new skills online Linked 1,549 (2,636 cummulative) vAGYW with agricultural extension officers for training support Conducted MCT and LVT training to 242 EWs in Shinyanga and Kyela Conducted employability training to 242 EWs in Shinyanga and Mbeya Registered 375 WORTH+ groups at the District level to strengthen group sustainability. Thus bringing a cumulative total of 405 WORTH+ groups registered at the District to ensure sustainability of the groups Awarded VETA scholarships to 2,420 vAGYW who are attending courses. Conducted 5-day menstrual hygiene training to 25 EWs in Dar es salaam with Elea pads trainers to enable them to support the all-round development of vAGYW and helping them burst myths and misunderstandings around menstrual hygiene management Distributed 320 new mobile devices to the vAGYW in Temeke making a cumulative of 1920 Devices distributed Conducted PrEP WORTH start up training for 36 EWs and 17 CSO staff making a total of 55 (F 49 and M6)
Objective 3: Research and Learning Agenda 17 manuscripts developed, 9 under first author review, 3 under co-authors review, 3 received editorial comments and 2 published 5 abstracts developed for submission to IAS-2019 and 3 accepted as Poster exhibition 500 MSM participants were recruited in STI-PPT study in Dar es Salaam region Completed data collection for Gender Based Violence (GBV) and Violence Against Children in 10 regions of Tanzania under study Preparation of round 4 data collection for CARE study in Shinyanga and ongoing data management process from the previous rounds.
Objective 4: Engagement of CSOs, LGAs and Sustainability Facilitate annual experience sharing workshop/Jukwaa for civil society organizations (CSOs) Identified two pairs of CSOs that will implement South to South mentorship approach Initiated meetings with John Snow Inc, Data for Development (D4D) project and USAID Tulonge Afya for possible collaboration in supporting CSOs Review of Comprehensive Institutional Strengthening Plan (CISPs) for CSOs All 17 Sauti CSOs were supported to implement capacity development plans Coaching Sauti regional teams on capacity development strategies and Sauti Sustainability Plan Joint supportive supervision for CSOs
Objective 5: M&E 20 Sauti FY18 Q2 Report Sauti generated KP cascade tracking them with CTC ID for all clients enrolled to CTC to get the outcomes of their linkage Orientated all regional Sauti and data teams on new interventions and indicators introduced in the program such as PrEP, HIVST, EJAF and AGYW_Prev. M&E continued to support the printing of tools for backing up the electronic data management system and distribute them to the regions which are yet to start using Commcare. Sauti M&E team conducted data verification for clients who were initiated on PrEP in Dar es Salaam region from May up to date. The purpose of this verification was to confirm the validity of data that was reported through the districts and whether the system adequately addresses basic determinants of data quality at each stage of routine health information processes in the individual client level data (excel file). Digital Health (DH) team has worked on Commcare- DHIS2 integration for project data reporting and visualization. The DH team continued with finalization of the Client Register Form (CRF) as part of a broader NACP request for a comprehensive PrEP/HIVST database, an initiative started in the last project year. The KVP system is functional and in use by stakeholders and handed over to NACP. The DH and monitoring and evaluation (M&E) team worked on Sauti Bi-directional SMS Management Platform requirements to ensure better reach out to its clients for variety of activities such as refill appointment for PrEP, Community ART and FP; collection of the results for HIVST from those clients whose phone numbers are available. The RFP is with the procurement department. All six CSOs implementing DREAMS were oriented on capturing and reporting new indicators (AGYW prev, and OVC SERV) in Q2. Data verifications were done in all seven DREAMS districts (Kahama Town Council [TC], Msalala District Council [DC], Ushetu DC, Shinyanga MC, Shinyanga DC, Kyela DC and Temeke MC) in collaboration between central and regional M&E teams. The Sauti project strengthened M&E system in 20 government facilities for Key and Vulnerable Population Friendly Service (KVPFS) in Iringa and Morogoro, and 3 government facility COE in Dar (Roundtable and Magomeni health centres) and Dodoma (Makole Health Centre). The Sauti project supported NACP to review a data quality assessment (DQA) tool that enables service delivery points to conduct data verification by spot-checking and crosschecking their performance. Support on PrEP and HIVST data analysis and report writing. Preliminary findings were shared with NACP for follow-up action. Sauti participated in a workshop to have a nationally standardized Onsite Data Verification tool.
DREAMS Graduated 13,703 vAGYW from SBCC education at Sauti Project’s safe spaces, with 2991 accessing computer-based SBCC content Offered HTS to 7,025 vAGYW, with 82 tested positive and 69 linked to CTC Provided 22,870 vAGYW with modern family planning methods of their choice through Sauti Project’s integrated Community-based HIV testing and counseling plus (CBHTC+) package, with 13,301 receiving condoms
21 Sauti FY18 Q2 Report Supported 853 vAGYW ambassadors to actively represent their peers part in international, national and regional fora
QA/QC Supported supervision visits by regional and council health management teams (R/CHMT), NACP and Tanzania Commission for AIDS (TACAIDS) in 5 regions Continued supporting 20 government health facilities in Iringa and Morogoro regions, so to ensure they provide KVPFS. Continued supporting 3 MSM friendly COEs: reached 103 HIV infected MSM and enrolled 61% of them (met 19% of the HIV positive and 11% of the enrolment target); offered mental health screening to 1,346 MSM, identify 195 MSM with mental health disorders and offered services to 100% of them (met 30% of the mental health target); initiated 479 MSM on STI PPT (met 28% of the STI PPT target)
22 Sauti FY18 Q2 Report KEY ACTIVITIES AND NEW STRATEGIES IN Q2, FY19
Objective 1: Implement a package of core and expanded biomedical HIV prevention and FP interventions, with enhanced linkages to care and treatment, and support services
1.1 Provide differentiated biomedical services at 32 districts and 11 regions
During the second quarter, Sauti Project continued to offer combination preventions services to KVP and other hot spot populations in 11 regions and 32 SNUs Tanzania. In an effort to increase effectiveness on identification of HIV positive KVP and meet the semi-annual target without over-testing, the project rolled out index testing in all SNUs and only few clients were tested through mobile or other testing modalities.
The Sauti and KK projects collaborate to ensure that OVC who are identified by KK project receive HTS and linkage to CT service through Sauti project. In order to target the highest risk OVC with HTS, the KK project administered a standardized screening tool with all enrolled OVC and through a chi-square analysis, identified four criteria as statistically associated with HIV infection: living with one or more HIV-positive household members (p<0.001), poor health in the last 3 months (p=0.029), being sexually active (p=0.045, and both biological parents being deceased (p=0.046). The Sauti project was then requested to offer community-based HTS to those OVC living with one or more HIV- positive household members (single criteria). As result, Sauti offered HTS to 427 OVC who were meeting such criteria, 1 tested HIV positive and was enrolled into CTC. Given the very low positivity rate, Sauti suggested layering additional criteria on the basis of the statistical analysis, therefore additional 109 OVC meeting those criteria received HTS, but yet none tested HIV positive (table 1).
Table 1. OVC tested and tested HIV positive, 11-31 Mar 2019
HTS HIV+ yield
single criteria2 427 1 0.2%
layered criteria3 109 0 0.0%
Such findings suggest that further discussions should take place about the validation of the screening tool; but also emphasize that the performance of a screening tool depends on the prevalence of HIV and the prevalence of the factors that constitute the screening tool; this is context-specific and the prevalence of the factors might likely change over time. Also in Q2, biomedical providers, commodities and supplies continued coming from the national system to support Sauti services in all SNUs, while CSO continued to support demand creation, and peer navigation by using trained CBHPS. The project continued supporting home base care volunteers (HBCV) to support index testing, as they were paired to the biomedical providers when tracing the
2 ≥1 HIV+ household member
3 OVC aged 0‐10 and aged 18‐19 with HIV+ household member; OVC aged 11‐14 with HIV+ household member AND had poor health in the last 3 months OR sexually active; OVC aged 15‐17 with HIV+ household member AND one or both his/her biological parents are deceased
Sauti Project FY19 Q2 Progress Report 23 contact clients to offer HTS.
1.2 Support FP-HTS integration
The Sauti Project continued to offer FP/HIV integration services to AGYW, FSW and OHSP. CBHSP continued creating demand for FP services, by mobilizing beneficiaries enrolled into WORTH+, SBCC, PrEP and ART groups.
1.3 ART outreach
In this second quarter, the Sauti Project continued to support ART outreach services as per the National Guidelines for the Management of HIV and AIDS. In order to ensure outreach services reached stable clients, Sauti Project continued to engage LGAs during the recruitment phase. Stable clients were transferred to ART outreach services in the community and they were served by trained government health care providers, based on 3-months prescription. Expert clients - under the supervision of the awarded CSO conducted monthly follow-up visits to clients’ homes until next refill appointment; also as result of the presence of ART outreach teams in the community, 30 clients who had defaulted from care and treatment services, approached such teams and were supported to successfully restart ART at facility-based care and treatment clinics (CTC) with them aim to transfer them to outreach services as soon they will meet the eligibility criteria.
82 RHMT and CHMT members and health care providers from Wanging’ombe DC and Njombe TC participated to a 3-day orientation on ART outreach and identified the eligible stable clients from 8 high volume Mother Care and Treatment sites. They selected the CBHSP who will be receiving the training using the national curriculum in Q3.
The project supported HVL sample collection and transportation for 2,754 clients of 2,919 (94%) who were due to test; the remainder will be completed in Q3.
1.4 Roll out innovative HIV prevention services
Sauti Project continued to support provision PrEP and HIVST services according to the study protocol. In Q2, the amended protocol (that included additional SNUs and a higher sample size) was approved by the Institutional Research Board (IRB). As a result, Sauti Project has begun working with the NACP to scale up services from Q3. The roll out plan will also include new population groups, such as MSM and AGYW. Existing WORTH+ and SBCC groups will be used for recruiting and refilling AGYW, while the COE under the PPP will serve as platform to enroll and serve MSM. Furthermore, saving and loaning services will be integrated into the existing peer support groups of FSW who are using PrEP.
1.5 Partner with other regional organizations to ensure continuum of care and reduced HIV transmission
The project continued working under the leadership of MOH, and particularly with TACAIDS and NACP, as well the R/CHMTs. During the reporting quarter, R/CHMT-led joint supportive supervision visits with facility based CT implementing partners (IP), took place. The supervision focused on verifying the enrollment of HIV positive beneficiaries. Furthermore, Sauti and facility IP agreed to collaborate on tracing those lost to follow-up at CTC, as well as sharing of lists of index clients for offering HTS to their elicited sexual partners and biological children. The teams also conducted regional quarterly partners’ meetings during which data reports, best practice and strategies to achieve targets were discussed.
A massive effort also was supported to ensure that all beneficiaries who tested HIV positive through Sauti Project, were accurately documented into the MOH District Health Information Software (DHIS). 24
1.6 Supply chain management
During Q2, Sauti Project continued to order and receive family planning commodities, HIV test kits and PrEP medications from the government health facilities through the existing national supply chain system. Country-wide condom stock out at the medical store department was notified. Therefore, the project directly distributed condom stocks received from Population Services International to close the gap.
1.7 Train biomedical team on key clinical services
During this reporting quarter, the Sauti Project conducted FP post-training follow-up to 91 Government biomedical providers from 7 regions, who were trained on FP/HIV integration; the training was conducted using the national curriculum; the objectives of the post-training follow up were as follows:
To ensure the link between training and performance at the work place To strengthen and reinforce integration of FP skills of CTC service providers at their health facilities To identify problems and challenges faced by providers during FP/HIV integration of services and assist them to solve the problems Gather information on the performance of service providers and the conditions that influence performance, to improve the implementation of FP/HIV practices Assessing FP trainees’ competency for certification for certifications
The post-training follow-up participants were 23 from Iringa, 18 Morogoro, 6 Dodoma, 23 Dar-es- salaam, 4 Mtwara, 8 Kilimanjaro and 09 Arusha. Among the 91 biomedical providers who participated to the training, 70 (77%) qualified for certification. So, following these biomedical providers after the training allowed facilitators not only to score their capacity, but also to correct malpractices and misunderstandings, conduct onsite mentorship and identify FP champions among the certified biomedical providers, who can continue with the coaching activities.
1.8 Support quality control and assurance for HIV rapid test
To maintain quality of the services provided by the project, the team continued to work with R/CHMTs in conducting quality assurance of the HIV test kits, in accordance to the national testing algorithm and guidelines.
1.9 Provide technical assistance to Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), NACP & Reproductive and Child Health Section (RCHS), and TACAIDS in the provision of preventive and clinical services to KVP
The Sauti Project provided technical assistance to NACP on the review of the National Guidelines for the Management of HIV and AIDS as well as the National ART training package. Among the key changes of the revised guidelines are: Three months’ prescription and six months’ clinical review for stable clients Transition from Tenofovir/Lamivudine/Efavirenz to Tenofovir/Lamivudine/Dolutegravir Use of CD4 testing for immunological monitoring Use of Flucytosine as antifungal medication in combination with Amphotericin B Routine use of Lipoarabinomannan to screen for active TB in HIV-positive patients Routine use of Cryptococcal Antigen Lateral Flow Assay test for clients with WHO stage 3 and 4 Strengthening Community ART by increasing outreach services to facilities without CTC, upgrading Option B+ sites, using trained ART nursing 25
Consensus was not reached on ART initiation at community level.
Objective 2: Deploy interventions designed to reduce individual risk behaviors and strengthen support for positive social norms and structures, and address gender at the community level
SBCC AND GENDER INTERVENTIONS
2.1. SBCC interventions to create demand for HTS and HIVST at high yield Project-supported CBHSPs continued to update the hotspots (eg. bars, local brew shops, plantation sites, brothels, massage parlors and ghettos) with information on how to access biomedical services such as HIV testing, family planning, TB, GBV, STI and drugs-alcohol screening. In Q2, the CBHSPs and the HBCV supported the Sauti biomedical team to identify contacts of HIV positive beneficiaries to enroll them into CT services.
In order to improve key messaging on early HIV testing and same day enrolment to treatment, a counseling support card was designed. This support card includes key testimonial messages to emotionally influence clients and support service providers during pre- and post-test counseling. The design framework incorporates behavioral economics principles, specifically the principle that demonstrates people are more likely to change behavior to avoid losses and secure future benefits. The card takes into consideration that people can process, absorb, and recall a limited amount of information at one time. Thus, a central tenet in the design makes it as simple as possible for people to act upon the specific information. The card also includes a space for the service provider to record the Project’s phone number for continued support; and for those who refrain from enrollment, they can continue to be reminded of the importance of early enrollment into CT services. The support cards are expected to be pretested in Q3, and will be updated, printed and rolled out in all SNUs immediately following.
Figure 19. ART Card
Towards the end of Q2, the Sauti Project conducted KVP consultation on HIV Prevention and treatment services across 10 regions and 23 districts, except Mtwara. The objective of the consultations was to understand beneficiaries’ enablers and barriers to access HIV prevention services and how the project should continue refining services so to increase demand. Thirty-three (33) focus group discussions (FGD) to 328 participants were led by the regional SBCC program officers. The participants included 122 FSW, 133 vAGYW, 33 MSM, 16 men and 24 stable HIV positive clients receiving ART outreach. The findings will help to improve programing in next quarter. Key findings include: Community-based and friendly services were reported by the participants to have played an important role on services’ uptake Participants did not report any issues with the waiting time 26
SBCC education was perceived as very useful because it helped them to make informed decisions in their lives in relation to their health Participants recommended total community inclusion when it comes to HIV services to increase awareness and reduce the spread of HIV infections within communities. Participants were concerned with the sustainability of the services and wished such service to continue beyond the project’s lifetime.
Figure 20. Consultative meeting with FSW in Dodoma facilitated by SBCC & Gender POs
2.2. SBCC Interventions to create demand for PrEP and reach high continuation rates
In Q2, 2 new PSGs were formed and cumulatively 45 PSG were supported. The CBHSPs conducted PrEP PSGs sessions to improve beneficiaries’ adherence. Side effects like nausea were among the most common topics of discussions. In the course of improving PrEP services, the Sauti Project conducted a beneficiary consultation in Dar es Salaam with PrEP beneficiaries (FSWs) in February. Please refer to the section on lessons learned for additional detail.
Figure 21. A session of PrEP beneficiaries presenting their challenges to Ms. Reuben, from PEPFAR (first seated in front), accompanied by Sauti M&E Director (second seated in front) and other regional staff and beneficiaries.
2.3 SBCC Interventions to create demand for early ART initiation and reach viral load suppression
During Q2, 334 PSGs (70 new) were supported to maintain stable clients’ high adherence to ART. Some PSG used the meeting opportunity to start Income Generating Activities (IGA). They meet monthly 27 whereby the trained expert client facilitates the topic of the day and helps to answer challenges group members are getting while using ART. In Iringa, 5 groups were linked with a horticulture farming project.
Figure 22. SBCC & Gender PO speaking at PSG Meeting with stable clients receiving ART Outreach service at Tambalale – Simbo Ward of Igunga DC, Tabora region
2.4. Implement SBCC interventions for HIV sexual risk reduction
During this reporting month, through the CBHSP under the CSO supervision, Sauti continued providing SBCC education to KP and vAGYW. During these sessions, condoms demonstration and distribution were conducted and SBCC print materials were used to supplement the curriculum led sessions. Biomedical services were integrated and particular focus was placed on identifying those HIV positive beneficiaries who did not enroll yet and link them to CT services.
Figure 23. AGYW CBHSPs delivering SBCC session during group education in one of the sessions in Kaliua district of Tabora region
Figure 24. AGYW graduating from SBCC in Morogoro MC
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2.5. Increasing gender equity in HIV programs and services, including reproductive health The Sauti team continued to conduct gender standards assessments at biomedical sites in Shinyanga, Morogoro, Arusha, and Kilimanjaro regions to improve gender-sensitive and respective care services to all. From the assessment, 97% of the standards were met, compared to 86% in Q1, as result of intensified support and mentoring to the providers. Sauti continued to implement the Support and Action phase of SASA! to challenge community gender norms surrounding HIV and AIDS and violence against women in the 7 DREAMS SNUs. Trained drama groups and community activists reached communities with gender and HIV messages. In an effort to make programmatic use of data collected from baseline and mid-term surveys, the Sauti team also engaged in further data analysis along with interviews of Regional SBCC Gender Program Officers, community activists, champions and drama groups, to better understand their perception of the roll out of SASA! services. The Analysis Report will be available and disseminated in Q3.
Figure 25. Drama performance at Tandika ward, Temeke MC
2.6. Preventing, detecting and responding to gender-based violence GBV screening continues to be conducted at biomedical sites, and SBCC and WORTH+ groups by trained biomedical providers, CBHSPs, and EWs, respectively. The following table 1 describes the screening cascade to AGYW at SBCC groups. Compared to Q1, proportionally slightly more AGYW were screened; the survivor rate was similar across the two periods (50%); eligibility for referral was higher in Q2, though a decline of the linkage to referral services was observed. Further investigations are taking place to better understand the bottlenecks for such findings.
Table 1. GBV screening cascade to AGYW at SBCC groups 29
Enrolled GBV GBV Eligible GBV Linked GBV group screened survivors referral referral Q1 1,397 202 112 88 73 Q2 978 257 128 110 63 Q1 14% 55% 79% 83% Q2 26% 50% 86% 57%
2.7. Create enabling environment supportive to KP access to HIV prevention and FP services
The Sauti Project continued to conduct GBV sensitization meetings with the top police officers and other stakeholders to create a supportive environment for KVPFS. In this reporting period, a total of 214 law enforcement officers attended the meetings including Officer Commanding District (OCDs, police officers, gender desk police officers, Town Medical Officer, Social Welfare Officer, District Community Development Officers(DCDO, Ward Community Development Officers (WCDOs) and ward Executive Officers(WEOs)
Figure 26. Presentation from Police Gender Desk officer during GBV sensitization meeting in Shinyanga region
Commemoration of Zero Discrimination Day and Women’s Day On March 1, 2019, Sauti staff joined the Government and other national and international organizations around the world to commemorate Zero Discrimination Day, as recognized by the United Nations. Sauti staff, CSO colleagues, and volunteers demonstrated solidarity in addressing all forms of barriers to health services among KPs. This involved creating awareness among the community, local government officials, and within Jhpiego offices on the UNAIDS 90-90-90 goals in order to not leave any one behind. Figure 27. Sauti Chief of Party (Left) led all Sauti Staff to create awareness on Zero Discrimination. All staff participated, including Sauti Senior SBCC Program Officer (Right)
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On March 8, 2019, the Sauti Project commemorated International Women’s Day through its participation in Government-led national events and Project-led community events to further our efforts in addressing all gender related norms that hinder women, girls, men and boys from accessing sexual and reproductive health services and rights.
Figure 28. (Left) Dr. Tulia Ackson, the Deputy Speaker for the Tanzania National Assembly, and (Right) the District Commissioner for Shinyanga visited the Sauti booth displaying activities by the project clients in Mbeya and Shinyanga respectively
Figure 29. Mass community events -Sauti Beneficiaries during Commemoration of International Women’s Day at Mlimani City Dar es Salaam
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STRUCTURAL INTERVENTIONS
2.1 WORTH+ Group Start-up Activities
In Q2, the social and economic empowerment officers (SEEO) conducted 5-day Management Committee Trainings (MCT) and Volunteer Trainings to 249 new EWs (Table 2). The purpose of the trainings was to equip EWs with knowledge of how to manage village bank meetings, open and close bank cycles, conduct dividend sharing, determine group health status and document group loans. EWs were also trained on how to support literacy volunteers on how to use ‘Our Group manual’ in facilitating literacy classes, especially to adolescent youth and adults. EWs then rolled out this training to group leaders and literacy volunteers.
Table 2. Participants to MCT and LVT 5 days training by SNU Figure 30. EWs doing a group activity during MCT and LVT District Number of EW Kahama TC 39 Msalala DC 29 Shinyanga DC-SHDEPHA 60 Ushetu DC 28 Shinyanga MC 25 Shinyanga DC-RAFIKI 60 Kyela 8 Total 249
As part of the roll out of saving and loaning services to the PrEP beneficiaries (FSW), 36 EWs were recruited and received training on Village Banking to better support the savings and lending activities of the group and encourage economic activities and wellbeing. The program also hired 4 new SEEO to support new SNUs now providing WORTH+ to PrEP groups. A total of 55 participants participated in the training including data managers as WORTH+ was not implemented in these SNUs previously.
Table 3: Participants to 6-day village banking and WORTH+ start up training, by SNU Number of Name of the training Region District participants curriculum Kilombero DC Kilosa DC Morogoro Morogoro DC 5 Morogoro MC Mvomero DC Kigamboni Dar Temeke MC 20 Kinondoni MC Iringa MC Iringa Mafinga TC 5 Mufindi DC Village banking and Moshi MC WORTH start up training Kilimanjaro 2 Moshi DC Arusha CC Arusha 1 Arusha DC Igunga DC Kaliua DC Tabora 8 Tabora MC Uyui DC Shinyanga Kahama TC 4
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Msalala DC Shinyanga MC Ushetu DC Kyela DC Mbeya 4 Mbarali DC Dodoma Dodoma MC 1 Njombe TC Njombe 5 Wanging'ombe DC Total 55
Youth employability and entrepreneurship training was also conducted this quarter for 238 EWs. These skills will enable EWs assist newly formed groups to establish sustainable businesses with the prerequisite skills; and for those less inclined to becoming entrepreneurs, assist them in sourcing and applying for employment.
Table 4: Participants to 5-day Youth employability and entrepreneurship training by SNU
District Number of participants Shinyanga MC 23 Shinyanga DC Rafiki 60 Shinyanga DC SHDEPHA+ 59 Msalala DC 27 Ushetu DC 28 Kahama TC 41 Total 238
2.2 Roll out WORTH+ Groups
EWs facilitated the formation of 662 new WORTH+ groups (4,292 groups, cumulatively LOP with 100,172 vAGYW, cumulatively) across the 6 DREAMS districts. The AGYW vulnerability index tool was administered to enroll eligible AGYW in WORTH+ groups.
vAGYW in WORTH+ groups received education on Financial literacy and community banking (23,715), and Better parenting (26,041), SBCC and gender transformative HIV prevention (23,715).
MCT and leadership training was being rolled out to the group leaders and literacy volunteer trainers.
2.3 Support economic empowerment innovations
Working with LGA to provide economic opportunities to vAGYW Great efforts are being made to ensure vAGYW are aware and have access to existing opportunities that they can tap into within their respective local governments. In Kyela, 5 business plans were submitted as part of the applications received by the LGA for their 10% funding dedicated to women, youth and those living with disabilities (4%, 4% and 2% respectively). As result, the LGA has selected the 3 youth-focused proposals and the budgets are currently under review. The proposals submitted are valued at 87 million TZS and are for starting small scale processing plants for soap manufacturing (liquid and bar soaps), rice milling and fish drying and packaging plants. Similar efforts are being done in Shinyanga and Dar es Salaam, but the outcome of the proposal submission is yet to be known.
Partnerships for expanded economic empowerment impact In Q2, the partnership with Digital Opportunity Trust (DOT) came to an end. However, 226 vAGYW were able to receive the DOT training to enable them to understand economic opportunities that existed at their fingertips with the help of the smart phone devices received for the MyWORTH pilot. The trainings have proven to be a big success with girls now using digital platforms to not only market and sell their goods but also to learn and enhance different financial and business skills needed for their business growth.
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In order to strengthen mentorship opportunities for vAGYW, Sauti reached out to Ndoto Hub under which 18 Ndoto sisters have been linked to 36 AGYW as mentors in Dar es salaam. The Ndoto sisters identified are those that are doing similar businesses to the Sauti AGYW and are also their peers who have been guided and mentored by Ndoto hub to grow their businesses.
In a bid to link girls to employment opportunities, Sauti also reached out to Ekihya through their Niajiri platform to see the possibility of having vAGYW being considered to their recruitment platform as they have a wide network of employers under their ambit but have never worked with out of school girls. Niajiri is an online platform curated to serve the needs of entry level talent. They prepare youth for new careers and open doors to job opportunities. They link employers to job seekers. Through great negotiations and deliberations vAGYW have been accepted into the portal and in Q2, 5 vAGYW have already undergone interviews and are awaiting their results. Employability trainings are helping vAGYW understand the importance of a curriculum vitae and applying for the right jobs. Not only that, also preparing for interviews.
Digitalization of group-level recordkeeping The MyWORTH mobile application has been helping the vAGYW in Temeke to use their digital devices to record their transactions thus reducing errors and increasing efficiency. Data on savings habits are periodically collected, monitored and analyzed. There has been an increase in savings in groups that are using the device, mainly because the groups are progressively much more aware of savings opportunities and have real time data on balance amounts.
To enhance the functionality of the application, the consultant worked with Tigo to finalize the integration of mobile money into the app. By Q3 the integration should be functional and it will make the exchange of money much more convenient, reducing the burden to carry cash and increasing safety.
2.4 Addressing Sustainability
WORTH Groups registration 375 groups have been registered at district level. As a sustainability measure, SAUTI has been working closely with the LGA to vet groups eligible for registration and apart from the 4,292 groups registered through the project, the LGA has provided a registration waiver to 50 strong groups in Temeke.
Apprenticeship Training In Q2, the project apprenticeship Standard Operating Procedures were finalized, along with the tools; 45 vAGYW were attached to successful business people within their communities to learn from a skilled and experienced person. The apprenticeships are an opportunity for the vAGYW to learn a new skill while on the job but to also meet with future prospective clients and in the process learn how to interact with them.
Age Appropriate Economic Strengthening Activities
1,105 AGYW were linked with agricultural extension officers to learn different skills. During this reporting period, AGYW received training and guidance for rice cultivation, groundnut production, maize, cotton and rice production, pig farming etc. (Table 5).
Table 5: Trainings conducted by extension officers to vAGYW
CSO Council Wards Groups vAGYW Type of Agricultural activity
Cultivating Rice, groundnuts, and sweet TADEPA Kahama TC 7 7 204 potatoes RAFIKI Shinyanga MC 2 2 46 Vegetable garden and Paddy production HUHESO Ushetu DC 5 10 173 Maize, Cotton, and Rice cultivation Rice, tomatoes, onions, groundnuts and SHDEPHA Msalala DC 2 6 150 Maize cultivation 34
Pig and bee keeping, Rice, tomatoes, KIWOHE onions, groundnuts and Maize cultivation Kyela DC 10 17 532 DE and green vegetables. Shamba darasa for paddy farming Total 26 42 1,105
The following table 6 describes the number of groups established cumulatively as end of March 2019, as well the cumulative number of beneficiaries, the savings and loans volume and value.
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Table 6: WORTH groups and beneficiaries, savings and loans volume and value (in TZ Shillings) as of March 2019
NUMBER NUMBER OF OF BENEFICIARIE GROUPS TOT BENEFICIARIES CUMMULATIVE PROGRESS FY19 CUMMULATIVE PROGRESS FOR FY 16, 17, 18, GROUPS S FY 16, 17 & TOTAL REACHED FY AL FY 19 GROUPS & 19 REACHED 18 16, 17 & 18 FY 19
CSO District 15-19 20-24 15-19 20-24 15-24 15-19 20-24 15-19 20-24 15-24 (TZS) (TZS) accumulated accumulated Value of loans Value of loans Value # Loan provided provided # Loan provided # Loan Amount of savings Amount of savings
Shinyanga RAFIKI 206 271 76 88 641 5,877 5,501 1,366 1,640 14,384 24,178,000 723 19,380,700 572,515,050 17,096 669,720,350 MC Shinyanga RAFIKI 0 0 89 127 216 0 0 1,686 2,458 4,144 16,823,104 751 11,546,500 16,823,104 751 11,546,500 DC Shinyanga SHDEPHA+ 0 0 110 116 226 0 0 2,533 2,709 5,242 19,278,450 283 3,553,100 19,278,450 283 3,553,100 DC Msalala SHDEPHA+ 211 386 116 118 831 7,154 6,575 2,573 2,775 19,077 37,862,050 2,833 41,236,800 653,657,700 34,372 690,800,950 DC Kahama TADEPA 233 186 103 119 641 5,619 4,494 2,194 2,601 14,908 53,134,600 2,371 57,900,000 483,414,160 16,480 496,845,450 TC Ushetu HUHESO 216 264 101 115 696 6,394 5,418 2,439 2,674 16,925 36,404,100 1,981 44,957,450 488,942,750 22,598 588,050,356 DC
KIWOHEDE Kyela DC 167 247 42 50 506 4,433 5,893 1,027 1,245 12,598 26,633,600 2,029 43,699,500 410,012,849 27,077 679,798,100
Temeke ASUTA 218 317 535 6,217 6,677 12,894 188,943,000 2,412 99,797,900 MC 214,313,90 Total 1,251 1,671 637 733 4,292 35,694 34,558 13,818 16,102 100,172 10,971 222,274,050 2,833,587,063 121,069 3,240,112,706 4
Sauti Project FY19 Q2 Progress Report 36
Objective 3: Execute a Robust Research and Learning Agenda
Sauti provides a platform for innovative research and learning to continue improving the implementation of Sauti interventions aiming to prevent new HIV infections, increase access to care for those infected and affected, and improve uptake of reproductive health care services by KVPs. This section describes the implementation status of the research agenda as implemented by Sauti in collaboration with National Institute for Medical Research (NIMR) Mwanza and other partners utilizing the Sauti platform.
Of the 14 studies under the Sauti Project, one is complete and published in a peer review journal (details described below). Four studies are under manuscript reviews, five have completed data collection and the data collection is ongoing in three (Figure 31).
Figure 31. The status of implementing research activities by selected milestones
Systematic Review for FSW‐COP 100.0% Systematic Review for MSM‐COP 100.0% Mapping and Enumeration‐COP 90.0% Formative for MSM‐COP 90.0% Formative for FSW‐COP 90.0% Safe Conception Choices for FSW LWHIV ‐SOAR 90.0% FSW Community ART ‐SOAR 90.0% Behavioral Economics & Qualitative ‐UNC & Final 90.0% Cash Transfer‐ CARE study‐COP 80.0% Incentivising Mobile saving ‐CWM 60.0% GBV and VAC‐MUHAS 60.0% Human Centered Design ‐ M4ID 50.0% STI‐PPT‐EJAF 50.0% PrEP and HIV self‐testing ‐NACP 50.0%
0% 20% 40% 60% 80% 100%
The Key weight
IRBs approval granted 10% IRBs approval granted and data collection 40% IRBs approval granted, data collection complete and technical report written 60%
IRBs approval granted, data collection complete, technical report written and manuscript developed 90% IRBs approval granted, data collection complete, technical report written, manuscript developed and 100% manuscript published
3.1: Conduct Enumeration and Mapping of KPs In this quarter, the NIMR-Mwanza research team received comments from external reviewers for the draft manuscript titled "Determining the size of the female sex workers and men who have sex with men to inform HIV programming in Tanzania: A programmatic mapping and enumeration study". The first draft of the second manuscript on virtual mapping will be shared by end of June.
Sauti Project FY19 Q2 Progress Report 37
3.2: Formative research for MSM and FSW In this quarter, drafting of manuscripts from formative data continued. Two papers were developed using the formative data for FSW; the first on barriers and facilitators of linkage to care was submitted to BMC Public Health Journal, editor’s comments were received, reviewed and resubmitted to the journal consideration. The BMC journal was unable to get three reviewers to review the paper. The paper has been re-submitted to AIDS and Behaviour Journal for consideration. The second manuscript on HIV self-testing among FSWs has been re-drafted following comments from reviewers and has been re-circulated to co-authors.
3.3: Research on cash transfer interventions among vAGYW (CARE study) As an integral component of DREAMS-funded activities, Sauti through CARE study is evaluating the Cash Transfer to Adolescent Girls and Young Women to reduce sexual risk behaviour. Sauti has been implementing a cash transfer intervention in Kyela DC (Mbeya) and Msalala DC, Ushetu DC, Shinyanga MC, and Kahama TC (Shinyanga) since FY17, where vAGYW aged 15-23 years receive Tanzania Shillings $31.5 every three months through mobile money on their cellular phones donated by Tigo for a period of 18 months. The baseline findings show that 31% and 36% of AGYW (N=3,017), screened positive for anxiety and for depression respectively. There is a need to start initiation of mental health screening and referral among AGYW.
In this quarter, data management (including Audio Computer Assisted Self Interview (ACASI) data as well as transcription and translation of case study data), analysis of survey round three data, and manuscript development continued. The following draft manuscripts were developed: o CARE study protocol manuscript was submitted to the JMIR Research Protocols journal after receiving clearance for publication from the National IRB. o Depression and anxiety symptoms among vAGYW was submitted to PLOS ONE Journal. o Partner violence among vAGYW was submitted to PLOS ONE Journal.
Additionally, the team presented baseline results of the CARE study in the TACAIDS and UNICEF held symposium meeting titled “The role of Cash Transfers in Programming for AGYW: State of the Evidence” on February 7, 2019.
3.4: Pilot STI periodic presumptive treatment for female sex workers and men who have sex with men (EJAF supported activity)
The Sauti Project offers the PPT of STIs among high-risk populations including MSM, FSW and mining populations in Tanzania. The study seeks to assess whether there is a reduction in the prevalence of laboratory-confirmed combined STIs in MSM in Dar es Salaam and FSW in Shinyanga after six months of PPT. The study will also find out if the prevalence of symptomatic STIs in male mine workers in Shinyanga will be reduced after six months of PPT availability among FSWs. In this quarter, the Project completed data collection for round 2 in Dar-es-Salaam and trained for anticipated data collection in Shinyanga Region.
3.5 Publish results of desk reviews on KVPs in Tanzania, sub-Saharan Africa and beyond During this quarter, the manuscript titled, "Determinants of access to HIV Testing and Counselling Services among Female Sex Workers in sub-Saharan Africa: A Systematic Review" was published at (BioMed Central) BMC Public Health.
3.6: Operational Research Study In addition to research funded by COP, Sauti provides a platform for innovative research and learning to improve the implementation of interventions to prevent new HIV infections, to care for those infected and affected, and to improve uptake of reproductive health care services by KVPs. This section describes Sauti’s research agenda in collaboration with other international organizations to
38 implement cutting-edge research aimed at informing local and global KP-focused policies and guidelines.
Below is a description of Sauti’s research scope for all studies embedded within the project’s service delivery platform.
Support the Implementation and Expansion of Population Council–led Community ART Study among Female Sex Workers and HIV positive FSW’s sexual partners and children in Njombe Region
Built into the Jhpiego-led Sauti Project’s service delivery model, Population Council and Jhpiego through Project SOAR are implementing an intervention study evaluating the impact of community- based ART on linkage to care rates, retention and virologic suppression in HIV-positive FSWs in Tanzania. Community ART in Njombe Region is compared to facility-based ART in Mbeya Region. In intervention sites, the study enrolled 309 HIV positive FSW, who received ART and other laboratory investigations such as CD4, liver function, and Hemoglobin in the community from the Sauti Project. In this quarter the following activities were implemented: Completed the main FSW Community ART study and Submission of project Year 5 to Population Council Supported Population Council in the defense of FSW Dependent sub-study to the Mbeya IRB Finalize the implementation plan and budget for FSW Dependent sub-study only
Support the implementation of M4ID–led Next T study (innovating for easier access to HIV testing in Tanzania)
The Bill and Melinda Gates Foundation funded M4ID to implement Next-T project through the Sauti platform. The goal of the project is to design solutions that support HIV testing and linkage to care services for the vulnerable populations of adolescents and young adults in Tanzania by engaging beneficiaries to understand their preferences, fears and motivations towards HIV testing and linkage. This study will identify variables (from the project and even outside the project) and map them with stages of the mindshape model [1. Fatalist (unaware); 2. Aware but confused; 3. Understanding but afraid; 4. Activated; 5. Engaged (agency and self-efficacy)]. The project will explore various applications of the mindshape screening tool to Sauti programming and to similar interventions.
The tool is going to be applied in conjunction with the HIV screening tool and other program tools segment the beneficiaries in order to: Provide the basis of segmenting technique that will allow the project to group the beneficiaries into clusters on the basis of various psychographic characteristics that renders clusters internally homogenous. Segment Sauti beneficiaries across the various mindshapes and understand their HIV risk in each segment. Identify psychographic characteristics (composite or individual) that are more likely to be predictive of an increased risk of acquiring the HIV infection. Use the mindshape screening tool, to segment eligible PrEP clients across the mindshapes and identify those who are more likely to discontinue PrEP prior to initiation. This will enable the program to design specific intervention according to the beneficiary’s need.
In this quarter, the Sauti Project provided technical assistance to:
Design, refine and translate the Mindshape Screening Tool
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Pre-test the Mindshape Screening Tool to 120 respondents from three groups of MSM, FSW and AGYW in 2 districts of Temeke in Dar es Salaam and Shinyanga Municipal in Shinyanga region. Support a workshop with 5 representatives of each FSW, MSM and AGYW in Dar es Salaam to discuss if the questions and response options are clearly articulated, relevant, comprehensive, and mutually exclusive from the respondent’s point of view. Incorporate the Mindshape Screening Tool and design into the Sauti combination prevention umbrella protocol, and share with the Tanzania IRB for approval.
The Sauti Project supported the coordination of the Project Advisory Board meeting held February 15, 2019, by inviting key stakeholders such as MOHCDGEC, TACAIDS, NACP, USAID, IHI, and MUHAS to attend. Furthermore, Sauti also provided programmatic and policy technical inputs on the three solutions developed by M4ID Next T project: 1. Mindshape screening tool 2. Communication campaign 3. Counselling package
After the advisory board meeting, the Sauti Project facilitated the initial meeting between M4ID and NACP to discuss NACP engagement in the launch and pilot of the communication campaign. On February 27, 2019, the Project wrote a letter to the Permanent Secretary of MOHCDGEC requesting a platform to present progress of the Next T project before the NACP technical team.
The Sauti Project submitted the Mindshape Screening Tool to the IRB as part of the Project’s umbrella protocol. This will allow Sauti to provide a platform and participate in testing the tool. The tool will be piloted in conjunction with existing M&E tools in order to examine how the prototypes perform.
The Sauti project will collaborate actively on the preliminary data analysis along M4ID and participate and contribute to the development of a publication plan, as well as writing up manuscript(s) and results dissemination.
Support the implementation of the University of North Carolina/Final Mile–led qualitative and behavioural economics study to examine the effect of cash transfer
University of North Carolina (UNC)/Final Mile received funds from Bill and Melinda Gates Foundation to support a qualitative and behavioural economics study using Sauti platform. The study aimed at describing how the cash transfers that the young girls and young women receive as part of the DREAMS initiative affect the dynamics with sexual partners, as well as the impact on decision-making with respect to compensated and intergenerational sex. In Q2, the study team in collaboration with Sauti Project drafted peer review manuscript titled “Understanding the decision-making processes and spending patterns of adolescent girls and young women enrolled in a cash transfer project in Tanzania: Implications for SRH”
Support the College of William and Mary–led Study on incentivizing Mobile Money as a Financial Savings Instrument among Young Women in Tanzania
The College of William and Mary with support from BMGF to implement another behavioral economics study (embedded within the Sauti/ DREAMS platform) in non-CARE study sites. This study is looking at the effectiveness of an innovative digital savings product disbursed to beneficiaries in advance using Tigo-Pesa mobile money platform over ordinary paying interest over time.
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Support the Muhimbili University Health and Allied Science (MUHAS)–led Assessment of Coordination, Prevention and Response to Gender-Based Violence and Violence Against Children in Mainland Tanzania
The overall goal of this assessment is to analyse and document existing institutional mechanisms for prevention and response to GBV and violence against children (VAC) and provide recommendations for improvement. This will include (but not limited to) assessment of coordination and the role of institutionalized response structures like police gender and children desk in the prevention and response to GBV and VAC. The assignment will inform stakeholders on the current GBV landscape and interventions, improve collaboration and communication strategies, facilitate cross-learning between stakeholders (such as government ministries, agencies, and departments; community-based organizations; UN agencies; and other development partners and donors) and strengthen coordination between institutions mandated to respond to GBV. In this quarter the following were implemented: Data collection Data transcriptions and Translation Drafting report on going
HIVST and PrEP IRB Sauti, in collaboration with NACP, is implementing HIVST and PrEP through existing HIV testing, prevention, and care and treatment programs. This intervention is implemented in the following SNUs: Kinondoni MC, Temeke MC, Njombe DC, Njombe TC, Iringa MC, Morogoro MC, Dodoma MC, Tabora MC and Arusha CC. In Q2, Sauti in collaboration with other implementing partners implemented the following: Continued monitoring the progress of the protocol implementation Solicited amendment clearance certificate to: o Include MSM, FSW, AGYW, PWID, Partners of KVP, HIV negative of sero-discordant couples on both PrEP and HIVST o Increase targets of HIVST from 56,718 to 135,6060 and PrEP from 12,092 to 16,062 o Include Dar es Salaam, Arusha, Dodoma, Geita, Kagera, Mwanza, Iringa, Mbeya, Morogoro, Njombe, Ruvuma, Songwe, Tabora, Kigoma, Mara, Pwani, Simiyu, Tanga, Kilimanjaro, Shinyanga, Rukwa and Katavi on both PrEP and HIVST Solicited an extension from March 2019 to March 2020 Prepared an amendment to exclude PrEP component from HIVST and PrEP protocol o The decision is made based to allow more SNUs and more population categories to receive PrEP
Learning agenda through study specific findings and a detailed analysis of routine information
This quarter, the Sauti project continued focusing its efforts on consolidating and disseminating lessons from the completed research studies and routine data to inform programming within the Sauti Project and beyond. The table below summarizes the Sauti dissemination work through conference abstracts and peer review journals.
Table 7. Conference Abstracts and Peer Reviewed Journals Title Journal Status A PUBLICATION OF PEER REVIEW ARTICLES
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Title Journal Status Consistent Condom Use and Dual Protection Among Female Received Sex Workers: Surveillance Findings from a Large-Scale, AIDS and 1 comments from Community-Based Combination HIV Prevention Project in Behavior the Journal Tanzania Determinants of Access to HIV Testing and Counseling BMC Public 2 Services among Female Sex Workers in sub-Saharan Africa: A Published Health Systematic Review. Participants’ accrual and delivery of HIV prevention BMC Public 3 interventions among men who have sex with men in sub- Published Health Saharan Africa: a systematic review The Prevalence and Factors Associated with Contraception Use among Female Sex Workers in Tanzania: Results from 4 TBD Internal review Monitoring and Evaluation Data Collected as Part of the Sauti Project Implementation. Female sex workers perspectives toward HIV self-testing: BMC Public 5 Internal review evidences from exploratory study in Tanzania Health Prevalence and predictors of partner violence among BMC Public 6 adolescent girls and young women: evidence from a cluster TBD Health randomized trial in Tanzania Under 7 Geographical mapping and KPs size estimate Mapping TBD development Under 8 Virtual Mapping TBD development Anxiety and depression symptoms and their correlated among Under 9 TBD AGYW analysis from cluster randomized trial-CARE development HIV and HSV2 baseline assessment of cluster randomized trial Under 10 TBD among AGYW (CARE) development 11 Protocol for a cluster randomised controlled trial TBD Internal review Facilitators and Barriers to Linkage to HIV Care among FSWs Received BMC Public 12 Receiving HIV testing Services through Sauti Project in editorial Health Tanzania: A qualitative study comments Psychometric Properties of PHQ-4 Anxiety and depression 13 screening scale among out of school adolescent girls and TBD young women Prevalence of HIV and STIs among men who have sex with 14 TBD men in Dar es Salaam Prevalence of HIV and STIs among female sex workers in 15 TBD Shinyanga region Factors associated with HIV seropositivity among men who have sex with men, male partners of female sex workers and 16 TBD other adult men at risk: Analysis of HIV service program data from 12 regions of Tanzania HIV serostatus conversion among repeat testing female sex 17 workers in large scale community prevention care and TBD treatment program in Tanzania B CONFERENCE ABSTRACTS Title Conference Status Factors associated with HIV seropositivity among high-risk Presented Mar 1 CROI-2019 men in Tanzania 2019 HIV serostatus conversion among repeat testing female sex Presented Mar 2 CROI-2019 workers in Tanzania 2019 Male Sexual Partners of Adolescent Girls and Young Women Accepted as 3 IAS 2019 at High Risk for HIV Acquisition in Tanzania poster 42
Title Journal Status Retention rates among stable clients provided with ART 4 IAS 2019 Rejected mobile outreach services in the community, in Tanzania 5 Peer support intervention to facilitate linkage to HIV care IAS 2019 Rejected among newly tested HIV-positive in a large scale HIV combination prevention program in Tanzania. 6 Success of peer-led gender based violence screening among IAS 2019 Rejected female sex workers and adolescent girls and young women in Tanzania 7 Perceptions on ART outreach services in the community IAS 2019 Accepted as a among stable and expert HIV-Positive clients: a qualitative Poster focus group discussion from Tanzania. 8 Impact of a community-based antiretroviral therapy (ART) IAS 2019 Accepted as a delivery program for female sex workers (FSWs) in Tanzania Poster – results of a quasi-experimental
OBJECTIVE 4: Increase the sustainability of comprehensive HIV prevention services by strengthening engagement and ownership of host government, CSOs, and communities
4.3. Operationalize the Five-Year Sustainability Plan to guide the transfer of responsibility and ownership of HIV Prevention/ FP Interventions to LGAs, CSOs, and KVPs
Collaborate with other IPs on the implementation of the Sauti sustainability plan
The Sauti Project organized meetings with two USAID IPs (D4D and John Snow Inc) to collaborate to support CSO capacity development. Initial discussions indicated that the IPs have capacity development interventions that can be implemented jointly with Sauti. Discussions will continue to develop joint plans for CSOs in Tabora, Shinyanga, Iringa, Njombe and Mbeya regions.
4.4. Empower local CSOs, KVP networks/groups, (including KVP PLHIVs) and communities to meaningfully participate in all project elements
Support CSOs to establish South to South (S2S) mentorship approach to capacity development In Q2, the Sauti project prepared for South to South mentorship for CSOs. This mentorship approach is a capacity development strategy where CSOs are learning from each other. Sauti will provide an initial orientation on the approach and details on how to implement. Eventually, CSOs will continue learning from each other without external reliance. Groups of CSOs have been identified for initial phase of implementation: SHDEPHA+ will pair with HUHESO Foundation, Rafiki SDO will pair with TADEPA, TAHEA with KIWOHEDE, and HACOCA with COCODA.
Coach and mentor regional level organizational development teams in capacity development to support capacity strengthening of CSOs The Sauti regional team in Tabora was oriented on capacity development strategies, the Sauti Sustainability Plan, and its PMP. Regional teams are supporting CSO capacity development and are implementing Sauti Sustainability Plan, so must be well versed in the topics.
Quarterly review of CSO CISPs to assess progress of activity implementation The Sauti Project reviewed CISPs for all 17 CSOs in Q2, including following up with physical visits and e-mail communications. The review indicated that all CSOs are making good progress towards CISP implementation, except for a few CSOs that hired new Program Managers or experienced changes within high level positions. These include: TADEPA, KIWOHEDE, Rafiki SDO and COCODA. New Program Managers continue to receive orientations on their roles in coordinating capacity development initiatives. Table 8 below presents an updated status of CISP implementation for all CSOs. 43
Conduct joint quarterly supervision visits The Sauti capacity development team joined the Amsha Institute and Shinyanga regional teams to carry out supportive supervision visits. In Q2, the team visited TACEDE and JIDA in Tabora to review CSOs project management. Areas of concern with TACEDE include: the CSO Director is also the Sauti Program Manager and the Board does not meet as planned and as stipulated in the constitution. As a result of these findings, TACEDE agreed to hold Board meetings as required. In the March Board meeting, members appointed one of Sauti Project Staff to be the Program Manager. It was also found that the JIDA office was underutilized by staff. Following this finding, JIDA agreed to have all staff members utilize the office to be accessible to beneficiaries. Staff members continue to use the office as discussed.
Facilitate annual experience sharing workshop/Jukwaa for CSOs In March, the Sauti Project coordinated the CSOs Jukwaa Forum in Dodoma. The forum brought CSO staff, and the Sauti project team together to share achievements, best practices, challenges and next steps. During the forum, CSOs were encouraged to more closely monitor their expenditure burn rate and try new strategies to reach targets on indicators that were lagging, including: HIV positive targets, linkage to CTC, AGYW Prev and OVC serv, and DREAMS indicators including AGYW Prev were lagging. Together, Sauti project and CSO staff brainstorm methods to meet targets and implement according to plan, including working closely with other service providers to improve linkages.
Table 8: Summary of partners’ CISP Actions
Cumulative Percentage of Total CISP CISP actions CISP actions CISP Actions Organization actions (May completed/on completed/on completed/on 2018) track track track HACOCA 16 11 14 88% KIWOHEDE 17 6 14 82% MBEYA HIV NETWORK 13 6 12 92% TZ COCODA 12 6 10 83% TAHEA 13 5 10 77% JIDA 18 3 13 72% TDFT 19 2 6 32% TACEDE 19 7 17 89% SHIDEPHA+ 15 6 14 93% Rafiki SDO 11 1 9 82% HUHESO 22 7 11 50% TADEPA 12 6 9 75% PHRSF 7 2 5 71% WASO 14 6 7 50% TAWREF 8 4 4 50% ASUTA 9 4 5 55% MUKIKUTE 18 3 15 83%
Quality Assessment ሺQAሻ and Quality Improvement ሺQIሻ Services The Sauti project continued to support QA and QI activities in Q2. CSOs (WASO, MKIKUTE, PHSR
44 and HACOCA) participated in monthly QA/QI in DSM, Dodoma and Morogoro regions, along with the QI central, regional, and district teams.
Some of the strengths observed during the field visits to CSOs include: Beneficiary engagement plan is in place and KVP contribute to services provision, planning and implementation; KVP are consulted on making services more accessible and receive multiple services within single visit; Client beneficiary records are well maintained and categorized; Peer educators are regularly evaluated for performance of small group session facilitations; HIV intervention sessions are based on current curriculum; and Outreach service data is processed and shared with peer educators
Additionally, regional work plans were developed to address the following key challenges: In case of sexual violence, GBV guidance does not include an explanation to the victim about the importance of going to health facility to access PEP within 72 hours of sexual violence. To address, SBCC POs will ensure all referrals are well documented and include an explanation about sexual violence and emphasize the importance of going to HFs to access PEP to patients . Nutritional assessments are not comprehensively done. Only weight and height is recorded, and MUAC tools are also missing. The team plans to orient all providers on comprehensive nutritional assessment counselling and procure and distribute NACS tools to ensure each KVP has opportunity to be assessed on other components of nutritional counselling. CTC enrollment of KVP who test positive is lower than expected., To address, case managers and an M&E focal person will ensure onsite enrolment of eligible clients to CTC is done on time and make close follow up to all CTC sites to track lost follow up and link to the CTC in the same week.
The MOHCDGEC held a TWG quality management meeting in Q2. The agenda included updates on IPC guidelines, point of care testing, policy commitments for 2019/20 and POA for TWG-QM, regional hospital standards, assessments, results and recommendations that recommended the development of a community QI framework; client charter for health facilities and compliant, compliment and suggestion guideline.
Additionally, a National Community Quality Improvement Framework was developed to provide guidance on the provision of quality health and social welfare services at community level.
The QA/QI department of MOHCDGEC organized 5 days TWG including 25 participants from Training medical intuitions, national QI trainers, HIV IP and beneficiaries; objective was to finalize the OI curriculum for health workers.
Support KVPFS at Government of Tanzania ሺGOTሻ health facilities under PPP ሺEJAF/OGACሻ
The Sauti project continued supporting GOT providers, KP expert nurses, case managers, data clerks and CBHSP in 20 KVPFS health facilities and 3 MSM-friendly COE in Q2.
During the reporting period, Sauti project staff and R/CHMT conducted supportive supervision visits in 10 health facilities in Morogoro region. Key findings and action items include: Mentoring providers who didn’t receive the KVPFS training is key to ensure the entire facility 45
team is able to serve the KVP; Ensuring availability of flexible clinic hours, such as after routine working hours and during weekends is important to increase access; A recommendation to support KVP in enrolling into the community health fund was placed; and There is a need for more supervision and guidance to CBHSP and weekly meetings to discuss providers and project performance.
Following KVPFS training in Kenya through LVCT, a training to share knowledge and skills gained during the exchange study tour was organized. Twenty Health Care Providers and 6 KP Expert Nurse from 3 COE attended. A work plan was developed based on findings during the study tour to address the gaps observed in the COEs compared to best practices observed during the learning exchange visit in Kenya.
A training on linkage and retention to 15 CBHSP from 3 COE was conducted with to increase knowledge on ART, adherence and retention and capacitate CBHSP on ART adherence counselling. The training also aimed to increase understanding of stigma and discrimination, guide CBHSP on how to address it, and enable CBHSP to facilitate linkages between facility and community-based services.
MSM consultations to identify barriers and enablers to access HIV prevention services at the COE were conducted with MSM who accessed the service, MSM who refused to access the COE, CBHSP and KP expert nurses (refer to section on Lessons Learnt for findings).
PSGs for HIV positive MSM were started, with two PSG were established in Dar es Salaam.
Furniture, desks, computers, and racks for keeping reading materials were procured for the three resource centers which are under renovation. Sauti information, education and communication (IEC) materials on HIV prevention to KVP was printed for the COE. Samples of pill containers were shared with the MSM community to select the preferred one. Selection criteria included size, to allow storing the container in a pocket, and sufficient space to store ARV medication. A container-model was selected and it will be purchased in Q3.
The Sauti project continued to provide support to 3 COEs service delivery and identify areas of improvement to ultimately improve the service provision. In Q2, the Sauti project together with R/CHMTs, CSOs and other partners, conducted a quarterly assessment of the 3 COEs and recommended: Health facility management should develop a plan to motivate staff to work beyond working hours and on weekends Health facility management team will collaborate with CHMTs to conduct monthly assessments on provision of KVPFS Trained staff will transfer knowledge on KVPFS to untrained staff in order to make sure most facility staff are capacitated to offer KVPFS Increase demand creation for accessing facility-based services
A total of 25 participants from CSOs from Dar es Salaam, Dodoma, Iringa and Morogoro supporting KVPFS and COEs attended a workshop on provision of KVPFS. This orientation provided an opportunity share challenges and develop an action plan to address them.
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Figure 31. Courtesy call to RMO, Morogoro Figure 32. Visit to Dumila HC by Sauti project Region by Sauti Project Team team including regional team (DAC, Team leader and case manager) and Dumila HC KVPF team
Figure 33. Sauti technical team conducting Figure 34 Makole Dispensary teams’ minutes from quarterly assessment and SS visits to Makole weekly meeting to discuss performance, share Dispensary COE success, discuss challenges and prepare a way forward to improve KVP friendly service delivery
Objective 5: Build and deploy vigorous monitoring and evaluation systems
5.1 Conduct Geographic Information System (GIS) mapping of the new councils, update the current maps with new hotspot data, and map reach and saturation Since there have been changes in the SNU for FY20, it was agreed that we re visit the decision to conduct GIS mapping at this point in time. Therefore, this activity has been postponed to next FY 20 under activity No. 5.1.1.
5.2 Implementing and strengthen service data management and referral-tracking systems to inform KP cascades progress During this reporting period, the Sauti project generated cascade tracking KP with CTC ID for all clients enrolled to CTC to get the outcomes of their linkage. Through quarterly meetings with CT implementing partners, Sauti discussed enrolment progress and outcome status. The program also developed monthly positive enrolment data details to ensure we collect information beyond enrolment. This includes recording information on the reasons for non- enrolment, time between enrolment and initiation and monitoring the client for 3 months once initiated.
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In addition, the team conducted an orientation to regional Sauti project staff and data team on new interventions and indicators introduced in the program such as PrEP, HIVST, EJAF and AGYW_Prev. The team had a refresher on all data collection tools and Commcare. The team was also oriented on the use of different functionalities in daily report. An action point from this meeting was to ensure that knowledge is cascaded to CSO Data Managers. . Furthermore, the Sauit project M&E team continues to print of tools to back up the electronic data management system and distribute them to the regions which are yet to start using Commcare due to unavailability of enough working tools. In this reporting quarter, the Sauti project team conducted data verification for clients who were initiated on PrEP in Dar es Salaam region to date. The purpose of this verification was to confirm the validity of data that was reported through the districts and determine whether the system adequately ensures data quality at each stage of the process at the individual client level data (excel file). Results from the data verification helped identify methods f to improve quality of data and targeted decision-making informed by data. From April to June 2018 we under reported by 30% due to delay in submission of HSST forms from the field. This gap was further by tagging the provider with a performance based payment. In April to June 2018, there was over reporting by 10% due to due to mismatch of UIC which contributed to double counting of HSST forms. Also, some clients were found to have a follow-up card but no initiation had been counted as continuation clients. The Digital Health (DH) team worked on Commcare-DHIS2 integration of project data reporting and visualization. This work was started utilizing internal resources and support from the Jhpiego HQ and Kenya teams, who supported Commcare reporting, API and DHIS2 integration needs for a fully functional Commcare system. DH and M&E teams are working on indicators, developing a side table for Organisation Units (locations) to accommodate regions, districts and wards names as they appear in DHIS2. Currently, basic reports on providers performance, individual client information, etc can be derived from Commcare. The DH team continued finalizing the CRF as part of a broader NACP request for a comprehensive PrEP/HIVST database. The KVP system is functional, in use by stakeholders and handed over to NACP. The DH and M&E teams worked on Sauti a bi-directional SMS management platform requirements to ensure better outreach to clients for variety of activities such as refill appointment for PrEP, Community ART, FP, and collection HIVST results from clients whose phone numbers are available. The planned SMS system will include the ability for a two-way communication between the client and the system for capturing inputs. Other uses include reminders on behavior change, and service availability, including type of services and locations. The related proposal is being advertised to solicit qualified vendors to develop this system.
5.3 Building capacity of regional teams and CSO on data quality and data utilization All six CSOs implementing DREAMS were oriented on capturing and reporting new indicators (AGYW prev and OVC SERV) in Q2. CSO participants included data managers, Social Economic Empowerment Officers, SBCC POs, DREAMS officers and program managers. After orientation, the team agreed data cleaning will be done by CSOs and cascaded orientation to EWs during the February monthly meetings. Data verification was done in all seven DREAMS districts (Kahama TC, Msalala DC, Ushetu DC, Shinyanga MC, Shinyanga DC, Kyela DC and Temeke MC). The exercise was participatory to ensure CSOs understand data quality aspects and how to run verifications during their normal supervisions visits. A total of 36 wards (30 Shinyanga, 4 Mbeya and 2 Dar Es Salaam) were selected by considering performance, geographical locations and previous verification coverage. 48
Variances observed for Combination and Parenting indicators range from 1% - 8% while AGYW prev primary (a new indicator) had 13% variance, which is beyond the data quality tolerable threshold. The team also identified condom unavailability as a major setback to achieving AGYW prev indicator targets in Shinyanga. Other identified gaps were attributed to capacity needs for EWs, CSO data verification mechanisms and enhancing supportive supervisions to address data quality needs. In this reporting period, the Sauti project strengthened M&E system in 20 government facilities for KVPFS in Iringa and Morogoro, and 3 government facility COE in Dar (Roundtable and Magomeni health centres) and Dodoma (Makole Health Centre).The M&E team focused on data collection tools (KVP Quarterly report, and client card) reporting system (data flow, data collection using CommCare, and preparation of daily report), and conducted DQA and facility data analysis in 23 targeted facilitieswith Regional M&E Officer/Data Managers, Case Managers, Data Clerks, and KVP focal person in the specifies facility.
5.4 Support ministry in the establishing use of the national recording and reporting tools for Key population In this reporting period, the Sauti project supported the Ministry, including:
Supported NACP to review DQA tool that enables service delivery points to conduct data verification by spot-checking and crosschecking their performance; Supported PrEP and HIVST data analysis and report writing. Preliminary findings were shared with NACP for follow-up action. Participated in a workshop to have a nationally standardized Onsite Data Verification tool. The aim was to ensure that the tool facilitate Health Care Providers to be able to timely assess the errors they commit, the findings of which should trigger the fruitful discussions amongst themselves, Implementing Partners and the National level Supervisors, in efforts to alleviate the situations impending quality of data right at the source.
Determined Resilient AIDS‐free Mentored Safe (DREAMS) Initiative
D.1 Increase vAGYW uptake of SRH services by reducing stigma and positively branding service delivery points For DREAMS districts in Q2, out of 7,025 total vAGYW tested, 82 vAGYW tested positive (1%) and 69 were linked to CTC (84%). This is favorable in comparison to 148 (1.34%) tested positive and 55.4% linked to CTC in Q1. This improvement has been the result of continuous capacity building of volunteer structures (CBHSPs, EWs) to target the most vulnerable girls, better individual-level HIV positive AGYW tracking, regular data reconciliation meetings, and engagement of facility IPs. The following table 8 shows the Q2 reach for HIV testing and care and treatment services, by SNU
Table 9. HIV testing Cascade for vAGYW in DREAMS Districts in Q2, FY19
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Also, 5,965 vAGYW received FP services in DREAMS districts and 44,979 male and female condoms were distributed to 2597 vAGYW.
In addition, in order to impact negative norms around vAGYW Sexual and Reproductive Health (SRH) choices, in Q2 the project distributed 21,206 Shujaa campaign materials which were excitedly received by vAGYW, most of whom continue calling themselves “Shujaa”, the campaign brand name. It was noted that t-shirts, caps, and tops assisted recruitment and visibility, as parents and other AGYW would request more information from those wearing the materials due to positive changes observed (eg. less risky behaviors, more economically productive activities).
Figure 35. vAGYW after receiving Shujaa wearables
D.2 Support Civic and Technological Inclusion of vAGYW through Establishment of Safe Spaces for vAGYW In Q2, at established safe spaces, 12,508 vAGYW received SBCC group education covering gender and comprehensive SRH, including self-efficacy to protect themselves against HIV (e.g. condom use demonstrations) using the adapted Stepping Stones curriculum as well as access HTS and other biomedical services. The table 10 below quantifies by district.
Table 10. vAGYW ages 15-24yrs completed minimum package of SBCC education in Q2, FY19 Temeke Kyela Kahama Msalala Shinyanga Shinyanga Ushetu SNU Total MC DC TC DC DC MC DC vAGYW 387 396 863 899 1433 803 930 5711 15-19yrs vAGYW 413 370 1119 866 1948 1056 1025 6797 20-24yrs
In addition, 2,991 vAGYW accessed offline educational content including from reading materials, videos, audio clips and games on SRH at 12 Sauti-established computer safe spaces—more than a two-fold increase compared to Q1 where 1,093 vAGYW accessed. This increase is due to engaging parents, community leaders, and word of mouth from AGYW themselves.
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Table 11. vAGYW ages 15-24yrs who accessed SBCC content in Sauti computer labs in Q2, FY19 Temeke Kyela Kahama Msalala Shinyanga Shinyanga Ushetu SNU Total MC DC TC DC DC MC DC vAGYW 800 766 1982 1765 3381 1859 1955 12508 15-24yrs
AGYW have shared positive feedback about the utility of learning using videos and games as a way to remember content from SBCC group education. Some also expressed learning computer use as a skill that could increase their employability or provide a business opportunity such as opening a cyber café.
Figure 36. vAGYW at Sauti-run computer labs in Msalala DC and Shinyanga DC
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In Q3, the project will hold recognition ceremonies for all community leaders and members who offered their offices/ homes as safe spaces for vAGYW to meet.
D.3 Support vAGYW to Voice Their Concerns at Multilevel Fora and Support Central Government Authorities to Create Awareness and Advocate Change Around vAGYW Concerns
In Q2, Sauti selected and oriented 20 AGYW Ambassadors per district who held 26 ward-level events attended by 1,934 community members with topics varying from GBV, AGYW’s need for FP, and community support to improve AGYW agency.
AGYW in Shinyanga region held two experience sharing Shujaa Jukwaas to showcase how the Sauti Project has assisted them to overcome difficult odds on the trajectory towards achieving their dreams.
Figure 37. vAGYW giving moving testimonials at the Shujaa Jukwaas
District Youth Officers were the guests of honor at the Shujaa Jukwaas, accompanied by more than 400 invited guests comprising community development officers, social welfare officers, ward and village executive officers, parents, spouses and peers. These platforms proved useful for hearing voices of adolescents living with HIV and their experiences. An additional 463 and 250 vAGYW participated in Zero Discrimination Day March 1st and International Women’s Day March 8th respectively.
D.4 Support vAGYW Enrolled in Cash Transfer Program in Select DREAMS Initiative Wards of Shinyanga and Mbeya
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Ongoing physical verification was successfully conducted for 6,960 vAGYW to resolve simcard/ phone related issues and support release of subsequent payments. Twenty-three village and ward meetings were held and attended by 682 leaders and community members. Apart from requesting support for those with adverse events (eg. lost phones), the overwhelming majority of attendees praised the intervention for changing vAGYW’s mindset, making them proactive in investing and starting businesses, and giving them hope for the future. All attendees were reminded that CTP will end after the 6th installment and that they should support AGYW to continue on their positive trajectory.
Unfortunately, the 5th installment, planned for March 2019, was delayed to technical challenges with the project’s electronic funds disbursement system, but is expected to be disbursed in Q3.
A continuous process of success story collection is ongoing to support a photo story booklet to be developed and distributed in Q4 during district CTP closeout meetings.
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PROGRAM MANAGEMENT
Sub award Management Sauti continued to engage and build capacity of CSOs (local NGOs/CBOs) to implement the Sauti Project. In Q2, Sauti recieved approval from to increase the ceiling of 10 CSOs and expand the period of performance of all 17 CSOs to October 31, 2019 in order to respond to the increase in targets and geographic expansion. Once this request is approved, CSOs will be able to implement the project in the full fiscal year while also preparing for project close out by end of October.
To increase efficiency and performance of sub recipients, the Sauti project conducted the Jukwaa forum (learning and experience sharing among CSOs). Through this forum, CSOs were able to share strategies and approaches that yield results to be replicated to other CSOs. Through this forum, the Sauti grants management team also reviewed the progress for each CSO and expenditure analysis, which informed the project and our partner areas to focus on resolving some challenges associated.
Strategic Partnerships and Cost Share Opportunities
During Q2, the Sauti project submitted an additional $2.3M of cost share documentation, for amount of $7.7M of cost share documented to date. Items documented during this reporting period include: government provider time and a TOMS shoe donation. Additionally, all consortium partners are submitting cost share documentation in line with their obligation.
This is 86% of the total cost share required based on current expenditure, and a cost share plan is in place to meet the full amount. During Q2, a process to quickly and efficiently document provider time was put in place. Moving forward, provider time will be documented as cost share the month following a provider’s service.
Finance The obligation as at March 31, 2019 stands at US $104,199,999 which is 100% of the current TEC. Overall project expenditure through March 31, 2019 is US $90,537,266 (pipeline US $13,662,733 - representing a 86% burn rate). The total expenditure to March 31st, 2019 does not include any accrued expenses.
Table 12. Summary of Sauti Funding and Expenditure through March 31, 2019
DESCRIPTION AMOUNT (USD$) Original obligation 8,828,983 Additional obligation - FP/HIV (FY16 and FY17) 2,900,000 Additional obligation – DREAMS 5,442,764 Additional obligation – Mod 6 7,200,000 Additional obligation – Mod 7 6,708,667 Additional obligation – Mod 8 11,756,220 Additional obligation – Mod 10 5,481,600 Additional obligation – Mod 11 1,500,000 Additional obligation – Mod 12 11,613,895 Additional obligation – Mod 13 5,660,687 Additional obligation – Mod 15 20,901,707 Additional obligation – Mod 16 16,205,476 Total Obligations as of MArch 31st 2019 104,199,999 Expenditures to March 31st 2019 90,537,266
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Pipeline as of March 31st 2019 (Overall) 13,662,733
Cost Share required (10% of Expenditures) 9,053,726 Cost share reported as of March 31st 2019 $7,781,351 Cost Share met (%age of actual expenditure) 86% Cost share required (10% of obligated amount) 10,420,000 Cost Share met (%age of obligated amount) 68%
LESSONS LEARNT
Biomedical Survey on Index and Enrollment Standards: An Index HTS and Enrollment standards survey was developed by the project to assess compliance of services to the recommended procedures by the project and by the national guidelines. Sauti regional teams were oriented on the survey by the central level biomedical team and they were requested to self-assess their performance. Each standard was scored as follows and each score was given 2, 1, 0 points: always met; sometimes met; never met. The overall score was calculated against the expected score if all standards would have been met. Region-specific responses when the standard was not or sometimes met, were analyzed to understand the bottlenecks and prioritize interventions to improve the service. Key findings: almost all regions did not always offer enrollment on the same day and one third of the regions did not always offer escorted referral; half of the regions did not always use barriers/facilitator job aide at follow up of a non-enrolled HIV+ contact client. In about 70% of the regions, if contact client test HIV+, index testing was not always offered on the same day. In one third of the regions, if HIV+ client refused enrollment on the same day of diagnosis or if the CTC was closed, then the biomed provider/HBCV/CBHSP did not always plan to meet the client within one week. In one third of the regions, if the HIV+ client opted for self-referral, s/he was not always told that a transport allowance was available and the HIV+ client was not always given a NACP referral form with UIC and Sauti written on it; when given, the NACP referral form was not always stored at CTC by CTC staff. Following such survey and findings, the technical team at central level engaged in conversations with the regional teams to better understand and to develop strategies to address the bottlenecks for not being able to meet the standards at all times
FP Consultations and data analysis: Following the massive roll out of index testing over the mobile testing modality, Sauti Project wanted to assess whether the former service delivery modality would impact on provision or uptake of FP services. Therefore, a data analysis from routinely collected data was conducted and consultations with biomedical providers who offered FP service and with beneficiaries who receive FP services, were rolled out. The consultations aimed to understand enablers and barriers to access FP methods, in relation to the service delivery modality. The following table describes the number of beneficiaries who were consulted disaggregated by population and type of consultation.
Table 12. Number of Beneficiaries Consulted
biomedical type of consultation AGYW FSW providers* group 20 8 0 individual 5 1 4 *purposely consulted only individually to avoid desirability bias of their answer
The following summarizes the key findings from the consultations with beneficiaries. Most of beneficiaries received first time FP methods from the Governments health facilities 54
Majority of beneficiaries received FP services through Sauti services and as a part of HIV testing; FP services were as well received during SBCC education Beneficiaries perceived the Sauti FP services as friendly and easily accessible compared to facility based services; this was particularly true for FSW Beneficiaries received the FP methods of their choice when accessing Sauti services and in the event such methods was not available, the biomedical providers referred them to the facilities No concerns were expressed by the beneficiaries about accessing community-based implants; however, during individual consultations fears were raised about safety of receiving implants in the community Majority of the beneficiaries were able to differentiate between the long and short term family planning methods The beneficiaries are aware of dual protections, and most of them are able to explain the rationale for using condoms in additional to another family planning method
The following summarizes the key findings from the consultations with biomedical providers. Most of the providers offered FP services in tents in ghettos, at SBCC classes, in rented rooms, at beneficiaries’ residence etc FP services were offered at all times, regardless of the testing modality that the biomedical provider was offering Biomedical providers reported interrupted availability of FP methods as they are received through the national supply system; lately, this was particularly true for condom Challenges in complying with infection control and prevention measures were reported by the biomedical providers, when the FP service was offered at the beneficiary’s residence Biomedical providers reported that during index testing the service-venue is chosen by the beneficiaries while during mobile testing, the venues have to be chosen among those available at the hotspot Majority of the biomedical providers were conversant and comfortable to talk about all FP methods regardless of the testing modality that they were offering; when asked to list the key topics of the FP counselling, they were able to articulate them all Majority of biomedical providers offered escorted referrals for Intra Uterine Device (IUD) and to the less extents for Permanent Methods and Implants From the data analysis, the number of AGYW and FSW receiving FP methods through mobile services had halved in both age groups, as result of the project’s temporary slow-down of the mobile testing modality to increase index testing efforts in Q2. However, proportionally, the index and mobile contribution to the number of beneficiaries who received FP services remained stable across the first two quarters (2-5% index and 95-98% mobile/other). If in February 2019, a decrease in number of beneficiaries receiving FP through mobile service was observed, this was not true for implants uptake among young ages; also, an increase of the proportional contribution by index on injectable uptake, was observed. SBCC and Gender CBHSPs are receiving recognition and support from the community especially community leaders who do provide support in terms of venues for the Sauti services, as well they support and address violence. FGD with FSW PrEP users took place with the objectives to understand the modalities how PrEP service was accessed; understand benefits and weakness of attending PSG; understand HIV prevention strategies in seasons of PrEP supply shortage; understand other PrEP distributions and use in the community. A total of 23 participants participated to the consultations, as described in the table 13. 55
Table 13. Participants to PrEP FGD, by type of consultation, individual or group Type of consultation Temeke district Kinondoni district Total Group 12 6 18 Individual 1 4 5
The main findings from the group and individual consultations are summarized below: PrEP service was accessed through the groups formed by peers under Sauti Project and to date, there were no other non-Sauti site in where beneficiaries could access PrEP Groups were seen as an informal and friendly way of offering the services where beneficiaries can share their success and challenges about PrEP the CBHSP group leaders were known by all participants and were reported to be a useful point of contact for asking any PrEP related question and/or reporting concerns, and for being reminded about the regular clinical visits; the participants were reached by the group leader through phone calls, SMS and physical encounters Service quality, venue and days and times of the services were scored as satisfactory by all participants; none raised concerns about the waiting time; regular HTS was welcome. Some of the groups did not conduct PSGs meetings as the venue wasn’t meeting privacy and confidentiality standards, but also to avoid other community members would start enquiring on the reasons of such meetings Recommendation to ensure uninterrupted availability of PrEP, condoms, injectable was placed; as well, the participants recommended STI and cervical cancer screenings to be integrated and implants to be offered at the site The participants also recommended to expand access to PrEP to everyone in the country because they have been approached by male partners, female in transactional sex and other family members seeking to share their PrEP tablets PrEP users reported increasing appetite and requested nutritional support to address it; also they were highly concerned on the current packaging of PrEP as it resemble the ART packaging; hence they would prefer having a PrEP package which is very different from the ART package; they would also like to receive the tables in blisters rather than in bottles so to avoid the rattling of the pills. Some participants suggested to reduce the frequency of the follow up visits from 2 to 3 months Some of the PrEP users reported violence since when they started using PrEP; they believed this was due to lack of knowledge in the community about the availability of medications that can prevent HIV and their misconceptions that PrEP is actually for treating HIV; so, the participants recommended to increase knowledge about PrEP in the community at large.
WORTH+ Finding formal employment opportunities for vAGYW in the current set up is challenging due to high unemployment rates and shortage of job opportunities even for those who are graduates. Niajiri platform is an innovative employment portal that links graduates to skilled job opportunities by providing career guidance and relevant skills trainings. In a bid to raise voices of youth that are not necessarily graduates but could provide relevant non graduate required skills like AGYW in SAUTI program, Niajiri platform has opened up its procedures to enable non graduates to also be part of their portal. This was a result of negotiations and ensuring the leadership of the platform understand the actual need to vulnerable youth in Tanzania and not only those who had opportunities to go to school and finally graduate. Looking at program data and understanding the SAUTI project aims after several meetings,
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Niajiri hopes to work closely with SAUTI to ensure that their portal serves the most vulnerable by linking them to relevant jobs and assisting them with the right skills set necessary for successful employment. Regular updates of job opportunities are shared with Economic strengthening team who in turn circulate among beneficiaries and encourage them to apply through close monitoring. We hope this partnership shall provide opportunities for those less entrepreneurial to gain meaningful employment. Not all AGYW are interested in becoming entrepreneurs, others find more meaning in being employed.
Research and Learning Agenda Published a manuscript titled “Determinants of Access to HIV Testing and Counseling Services among Female Sex Workers in sub-Saharan Africa: A Systematic Review” on BMC Public health Journal. Presented at CROI 2019 two abstracts namely o Factors associated with HIV seropositivity among high-risk men in Tanzania o HIV serostatus conversion among repeat testing female sex workers in Tanzania Receive acceptance of 2 abstracts to IAS 2019 namely o Retention rates among stable clients provided with ART mobile outreach services in the community, in Tanzania o Male Sexual Partners of Adolescent Girls and Young Women at High Risk for HIV Acquisition in Tanzania
M&E Yield of tested clients increased from 5% in Q1 to 9% in Q2, this is due to effort to insist providers to index modality and moving the focus from other modality to Index only. Involvement of biomed and SBCC (i.e. team leader and SBCC POs) in data verification proved helpful in improving data quality.
DREAMS vAGYW have a LOT of positive experiences to share related to their journey towards better health, economic independent, confidence, self-worth and self-expression. The project should continue identifying opportunities and platforms for sharing so it may also benefit other vAGYW who may lack role models or feel it is not possible. Electronic SBCC may act as a great supplement to group education topics that are mired in myths and misconceptions such as FP uptake, living positively with HIV etc. Computer safe spaces may also be attractive as places AGYW can learn other life skills through audiovisual contents.
QA/QC Motivation to CBHSPs is vital to enable them reaching their peers and mobilize them to come and receive the services at the facilities Stigma and discrimination, social exclusion and lack of a supportive environment often limit the access to and utilization of comprehensive HIV prevention, treatment, care, and support services by MSM Consultation meeting was to identify barriers and enablers to access EJAF-supported HIV prevention services at the COE took place with MSM beneficiaries, KP expert nurses and CBHSP. The participants were grouped into four separate groups as described in the table X below.
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Table 14. Participants of COE consultations Dar es Participants Dodoma Total Salaam MSM beneficiaries who experienced the service at the COE 10 6 16 MSM beneficiaries who refused to receive service at the 10 10 20 COE KP expert nurses who offered the service at the COE 4 2 6 MSM community based HIV service providers who 5 2 6 supported the service at the COE
Following were the key findings from the consultations: MSM beneficiaries who accessed the COE were satisfied with the services and welcomed the availability of a competent multidisciplinary team composed by CBHSP, case managers and KP expert nurses IEC materials and more information about the safety, friendliness and quality of the services at COE through the peer network, condoms and STI PPT availability at all times were seen as facilitators to access COE by those who were already receiving services, as well by those who refused access; hence the project should work to secure uninterrupted availability of these supplies; SBCC education by the CBHSP should also be enhanced; though transport costs remains a challenging barriers to access the COE As well, KP expert nurses emphasized that more mobilization of the MSM community was required to increase access to the COE Willingness to pay out of pocket for medications which are not supplied by the project (eg. mental health medications, STI medications besides PPT) was shared by the beneficiaries, provided that the cost would be below 5,000 TZH Extending the opening hours to the evening and including entrepreneurship education and care and treatment for anal prolapse were among the recommendations placed by the KP expert nurses, the CBHSP, the MSM beneficiaries who accessed the COE as well by those who didn’t; hence, options to address these needs will be explored, though the current project doesn’t cover the cost associated with these activities KP expert nurses appeared to be competent and confident in their role; as well they well understood about their responsibilities in relation to other team members more supervision and mentoring to the KP expert nurses and the CBHSP was reported as an important enabler to improve their skills and the quality of the services
CHALLENGES, OPPORTUNITIES AND WAYFOWARD
Biomedical Using the pool of HIV positive beneficiaries from Sauti Project, might not be sufficient to meet the index testing target in all SNU, since most of the HIV positive beneficiaries from Sauti are female sex workers and their sexual partners and therefore to reach their sexual network is more challenging than other populations; often only some sexual partners are elicited, not all sexual partners are found during the tracing activities and contact information are also not always correct. The enrollment rates reported by Sauti Project refer to the crude enrollment. However, a recent analysis from October 2018 to 19 February 2019, on the reasons of non-enrollment have shown that 5% of the HIV positive beneficiaries died shortly after the diagnosis, 11% transferred to an area outside Sauti Project’s mandate, 22% opted for self-referral, 9% refused to enroll, 32% were not found at follow up and the remainder 20% were alive and still on counselling. Meaning that, the adjusted enrollment rate would increase from 74% (crude rate) to 85% when adjusted for all
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factors (Figure 38).
Figure 38. Enrollment rates by Crude versus Net, 9 SNU, FY19 as 19Feb
88% 85% 86% 84% 82% 80% 77% 78% 76% 74% 74% 72% 70% 68% 66% CRUDE enroll rate NET enroll rate without death NET enroll rate without death and transfer to other areas and transfer to other areas and refused and self‐referred
SBCC and Gender As result of the massive project’s effort on index testing, the Sauti team directed CBHSP efforts to complement the HBCV work on tracing the sexual partners and biological children of index clients and facilitate their enrollment into CT services. Hence, being index testing a relatively new service area for the CBHSP, and anticipating that some of them might drop out due to lack of understanding about the new role, the Sauti team started engaging in conversations with the CSO to ensure that the CBHSP are familiar with their new tasks and are capacitated to successfully accomplish them.
WORTH+ The age criteria initially set for Vocational Educational and Training Authority (VETA) enrollment through KK was for AGYW of ages 15- 18. However, in this reporting period the age criteria was reduced from 18 to 17 thus leading to many AGYW in SAUTI not being eligible for enrollment. They also restricted married girls and/or teenage mothers from being eligible which further restricted the enrollment of SAUTI AGYW who are mostly teenage mothers with a larger percentage, especially in Kyela and Shinyanga being married.
These restrictive criteria for enrolling vAGYW into VETA scholarship lead to reach fewer AGYW from Sauti supported groups. (15-17 AGYW who are unmarried). Also, number of wards covered by the Kizazi Kipya Project is small compared to Sauti Project, hence the majority of vAGYW miss this scholarship opportunity. We are however in talks with Kizazi Kipya to increase coverage beyond Kizazi Kipya SNUs and cover all Sauti SNUs. Talks so far have been fruitful.
Research and Learning Agenda Delay of receiving IRB clearance certificate from Mbeya IRB o Sauti in collaboration with Population council is actively following up with Mbeya IRB Interrupted provision of STI PPT to MSM in Dar es Salaam and FSW in Shinyanga that may potentially affect measuring the impact of STI PPT study. The interruption was due to change of HTS modality from mobile testing to index testing modality. o Active follow up with the regional team and engaging of beneficiaries to improve the provision of STI PPT uptake.
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M&E Poor documentation of PNT register from the biomeds providers, however, this has been addressed by ongoing training and orientation conducted to all team leaders. Rotation of government providers in Sauti interventions which involve longitudinal data like PrEP created challenges in client monitoring system and is one reason for data quality an possibly poor continuation rate. Insufficient supply of KVP client cards from the government to health facility slowed down the documentation process during the recording quality information since there are some providers used counter books to record the client information. Insufficient tablets/phones which affected the Commcare rollout process Unable to download DAMES data in excel due to limitations of raw and review the data completeness. Moving data to DHIS2 will be helpful.
DREAMS CTC linkage in the urban district of Temeke was a challenge, and the project will continue engaging case managers for improved counseling and clinical IPs to track self-referrals. For CTP, the project’s shift of financial management/ funds disbursement systems led to delayed payments as a result of batch transfers. This has been rectified and payments are expected to be made in early April 2019. In some parts, such as Shinyanga DC, most wards lack electricity thus posing a problem for setting up computer labs. The project shall continue working with LGA to identify alternatives spaces with reliable solar power in rural areas. Highlighting AGYW achievements to peers and community members goes a long way towards creative a supportive environment and positive connection with the project
QA/QC Having COEs only in big cities makes it difficult for those MSM who are from far away locations to access the facilities; hence increasing coverage might increase access The startup of the facility-based services faced initial challenges as the team wasn’t use to work against specific targets and activities, also their understanding of the data report was limited; through intensified technical support and more frequent visits, Use of weekly progress reports for programming was seen as a tool to increase team understanding on data use for programming and led to the development of weekly progress reports that are discussed by the facility-based team and shared to the Sauti team at central level for further guidance
PLANNED ACTIVITIES FOR FY 19 Q3
Biomedical
Provide differentiated biomedical services Offer Syphilis testing and treatment, and STI PPT to KPs Continue supporting 156 Sauti and 200 GOT biomedical providers Provide national training for biomedical providers on Index testing services Roll out the validated HTS screening tool Review district level monthly operational plans Support Implementation of community-based mobile and Index testing services and CTC enrollment Support use of vAGYW Index at mobile and index testing service sites 60
Support provision of escorted referrals for HIV+ KVPs, FP (Permanent and IUD) and post GBV survivors. Develop and send automated SMS for FP / ART / PrEP refill reminders, LTFU, enrolment etc. Offer Syphilis testing and treatment, and STI PPT to KPs
Roll out ART outreach to HIV+ Stable clients Continue supporting 5 ART coordinators Continue supporting 127 GOT biomed providers and 2 Sauti providers for ART outreach Continue supporting 1,273 ART expert patients (from FY18 and newly enrolled in FY19) Hire vehicles for community ART team Conduct lab test for biochemistry and hematology and VL Reach Community ART PSG Groups with FP method mix
Roll out Pre-Exposure Prophylaxis (PrEP) for FSW, MSM and AGYW Train 60 Sauti and government providers on PrEP national package, including M&E Roll out PrEP Intro Meetings Conduct PrEP-related lab test (CrCl) Procure tubes and cool boxes for PrEP-related Lab test sample collection (CrCl)
Roll out HIV Self-Testing (HIVST) to FSW and MSM, peers and partners Train biomed providers on HIVST national package, including M&E Roll out HIVST intro meetings Roll out HIVST Services
Support quality control and assurance for HIV rapid tests (HTS) Ensure uninterrupted availability of supplies for HTS and FP and ARVs and other medical commodities Engage Sauti biomedical providers in the national provider’s certification exercise Train providers providing HIVST kits on proficiency and how to best explain the procedure to clients Conduct IQC for HIV test kits upon reception of test samples from district lab technician
Integrate FP into Biomedical Services Provide FP counseling and method mix services to vAGYW and FSW and PLHIV Clients during ART outreach Review and strengthen the FP part of the SBCC curriculums. FP/HIV Training to governments providers offering ART outreach in Njombe.
Integrated into biomedical package VMMC team Collaboration with Sauti
Provide technical assistance to MOHCDGEC (NACP & RCHS) and TACAIDS in the provision of preventive and clinical services to KVP Support KVP, Community ART, HIVST, HTS, and PrEP TWG meetings Support PMTCT, FP, ART, GBV, and HIV-FP integration TWG
SBCC and Gender Print and pilot early ARVs Treatment counseling cards Print flip chart for PLHIV support groups. Finalize and Print curriculum for training Comm. ART CBHSPs Hire a creative agency to document real life stories of men 35 + using HIV services and supporting their partners to use family planning services Print male specific IEC material to create norm for HIV and Family Planning services 61
Conduct Quarterly gender equity assessment at biomedical service delivery points Develop and implement improvement plans based on gender equity assessment at biomedical service delivery points (CBHTC+) Monitor progress of the biomed sites towards gender standards by using a standardized tool Roll out SASA! Action package in DREAMS wards Provide technical assistance to MOHCDGCE and TACAIDS to build capacity of LGA on KVP programing Provide technical assistance to MOHCDGCE and TACAIDS by participating in all relevant technical working group meetings and forum; developing material
WORTH+ Continue supporting existing WORTH+ groups and establish new groups Roll out of WORTH+ to FSW using PrEP Conduct Employability and entrepreneurship TOT and training to vAGYW in Kyela Roll out of My WORTH tigo integrated app and data analysis on savings impact Facilitate registration at district for WORTH+ groups Continue to support linkage of AGYW to extension officers and facilitate the expansion of agribusinesses in the DREAMS SNUs through age appropriate economic strengthening activities Facilitate the enrollment of AGYW ages 15-17 into market driven vocational training at VETA)through Kizazi Kipya Facilitate the enrollment of newly recruited FY19 AGYW ages 15-24 into apprenticeship programs with successful businessmen in the districts Conduct graduation assessment for groups to determine eligible groups for graduation in fY19 Conduct a sustainability exit strategy workshop to ensure a sustainable exiting of groups at project close out
Research and Learning Agenda
Main activities Sub Activities Prepare findings on vulnerability index tool to present to the meeting 3.2. TAG Meeting Prepare findings on Sauti Impact Evaluation to present to the meeting 3.3. Conduct research on cash Planning for round four data collection transfer interventions among Drafting of manuscripts for publication VAGYW (CARE)
3.4. Implementation of STI Data collection for round two data collection periodic presumptive treatment Training of data collection team for round two in Dar es Salaam. for female sex workers and men Data collection for STI PPT in Dar es Salaam who have sex with men, evaluate, Testing of lab specimens collected for the for STI study and disseminate results participants in Dar es Salaam and Shinyanga Data management and analysis for STI PPT phase two in Dar es Salaam 3.5. Review, analyze, and prepare for publication of the results of Data quality assuarance for VAGYW index tool the roll out of the VAGYW Index Manuscript writing workshops and other project interventions
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3.6. Evaluation of Incentivizing Mobile Money as a Financial Savings Instrument among Young Finalize data cleaning and analysis Women in Tanzania ‐ CWM STUDY 3.7. Project SOAR‐ a study to Soliciting IRB clearence from Mbeya region evaluate community based ART Finalize implementation plan and budget on dependent study
3.8 MUHAS ‐ Assessment of Coordination, Prevention and Finalize report writing Response to Gender Based Dissemination of the findings to the key stakeholders Violence and Violence Against Children Technical oversight on piloting of the mindshape screening tool 3.9. M4ID Plan for Manuscript writing
Publishing a manuscript on Understanding the decision-making 3.10. UNC and Final Mile processes and spending patterns of adolescent girls and young women enrolled in a cash transfer project in Tanzania: Implications for SRH Submit ammendment protocol excluding PrEP from HIVST and 3.11 HIVST and PrEP PrEP protocol
Capacity Building/CSOs
Collaborate with other IPs on the implementation of the Sauti sustainability plan Coach and mentor regional level organizational development teams in capacity development to support capacity strengthening of CSOs Tailored technical assistance and program management support in response to CSO support requirements Conduct monthly sustainability operational plan monitoring at district/municipal level Review quarterly CSO CISPs to assess progress of activities implementation Conduct Organization Network Analysis (ONA) workshop for KVPs, LGAs and CSOs (to be done at national level) Support CSOs to establish South to South mentorship approach to capacity development Conduct joint supportive supervision to all CSOs Conduct financial reviews to CSOs
M&E Generate daily Report, DATIM reports, monthly reports and other routine reports using data collected in Commcare once all the data is transferred into DHIS2. Furthermore, more efforts will be put in to improve the dashboards and visualizations in DHIS2 and Power BI respectively. Ongoing data verification with facility IP’s for positives and enrollment Track the KP cascade with CT partners: through facilitate quarterly review meetings and the sharing of CTC ID numbers for clients enrolled to CTC to get the outcomes of their linkage started ART, current ART status, Lost to follow up that Sauti can support tracing for, and viral load data. Conduct supportive supervision (Regional M&E staff conduct monthly supportive supervision visits to CSOs and mobile teams and Central M&E staff conduct quarterly supervision to regions and CSOs. All these supervisions will be based on need, with reference to reports of previous supervision outcomes) Participate in Technical working groups meetings organized by the ministry or other partners 63
Conducting supportive supervision to COE and KVPFS facilities. Commcare system documentation Commcare quality assurance testing Finalizing Commcare system rollout in the remaining SNUs Pushing all Commcare data in DHIS2 Commcare Dashboard and Visualization Bi-directional SMS Management Platform implementation System Audit to be guided by HQ
DREAMS Distribute DREAMS Shujaa materials, targeting negative norms around vAGYW SRH choices during activities and events Hold a biannual recognition ceremony for owners of safe spaces and vAGYW ambassadors Hold weekly computer lab sessions at computer safe spaces (Shuga episodes, education on use of computers, exploring education content in the computers etc.) by a knowledgeable CSO staff Organize ward-level symposia and participate in district-level events to allow vAGYW ambassadors to lead and voice their concerns, opinions, and solutions Hold bi-annual experience sharing Shujaa Jukwaas for vAGYW who have overcome difficult odds on the trajectory towards achieving their DREAMS Hold district-level vAGYW ambassadors quarterly meetings and attend DREAMS IPs district coordination meeting Conduct a 1-day meeting in each ward where the cash transfer program will take place Disburse cash/subsidies to vAGYW and continue physical verifications and village and ward level check-in meetings
QA/QC
Conduct QA/QI Activities o Support Quarterly SS visits by MOH (NACP, TACAIDS, RCHS) from central level to regions, districts o Develop and monitor QI plans for each SNU and intervention o Support national QI TWG to pretest the revised QI training package to Health Care Providers. o Participate to National QI TWG meeting organized by MOHSWGEC o Participate and join SIMS assessment organized by USAID. Support KVPFS at GOT health facilities o Continue supporting GOT providers, case managers, data clerks and CBHSP in 20 KVPFS health facilities o Conduct Quarterly Assessment to 20 KVPFS health facilities o Continue supporting CBHSP, case managers and data clerks seconded to GOT health facilities Support MSM friendly COE o Quarterly MSM Consultation with MSM to discuss on modality for providing PrEP via COE. o Recruit MSM for receiving and refilling PrEP from COE in Dar and Dodoma o Finalize purchasing and distribution of ART pills and other STI medications containers for MSM. o Procurement of containers and refurbishment of resource corner. o Continue supporting KP expert nurses, CBHSP, case managers and data clerks seconded to COE o Quarterly joint supportive supervision visits with National Partners and RCHMTs (NACP; RHCS; TACAIDS; TAMISEMI etc) o Continue support of CBHSPs on linkage and ART retention o Continue Offering Mental Health services to MSM attend at COEs 64
o Continue Support already established Peer Support Groups to each COEs o Continue Supportive Supervision to COEs o Plan and conduct refresher training for the HCPs and CBHSPs o Distribute printed IEC and SBCC materials to all COE.
APPENDICES
Appendix 1: Success Story
Sauti Boosted my HIV Prevention Skills
Beatrice Mgaya is a 35 year old woman lives at Igwachanya village at Wanging’ombe ward in Njombe. Beatrice sells chips at Igwachanya market and is also involved in agricultural activities. Like many women and men in the community, she was living without knowing her HIV status because she felt healthy, but was also afraid to know her status in case the results indicated she was HIV positive.
In January 2019, a COCODA community-based health service provider convinced Beatrice to attend Sauti supported social behaviour change communication sessions. At the end of the sessions, Beatrice willingly tested for HIV together with other SBCC group participants. Beatrice’s HIV test results were negative, and she is now very happy to know her status. Now, she is an ambassador among her peers, promoting others to access Sauti services. She is very grateful to the Sauti Project because it helped her know her status and inspired her to make more of an effort to prevent HIV. “I am very grateful because during these sessions, I Beatrice at her work place after receiving HTC service. received an education about safe sex, how to use condoms, prevention and treatment of sexually transmitted infections, and mostly important regular HIV testing,’’ Beatrice recapped.
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Appendix 2: FP Commodities requested and received
During Q2, the Sauti Project continued to monitor stock of family planning commodities received through the national supply system in 11 regions and 32 SNU. Sauti, in collaboration with the government health facilities, ensured uninterrupted supply of family planning commodities by collaborating with the district and regional reproductive and child health coordinators during the forecasting and the development of the reports to order the required volume of FP methods through the Medical Store Department (MSD). In Q2, overall, on average 78% of the ordered FP methods were received except for condoms for which only 24% of the order was delivered as result of country-wide shortage. Figure 39 compares Q1 to Q2 on the percentage of commodities received against the volume which was ordered, by type of FP method. Figure 39. Percentage of commodities received against the volume which was ordered, by type of FP method and by quarter, FY19
100% 100% 98% 90% 85% 79% 80% 70% 70% 70% 60% 50% 47% 40% 30% 24% 20% 10% 0% COC POP ECP Depo Implanon Implanon Jadelle Condoms Provera NXT
Q1 Q2
Progesterone pills were not received in Morogoro and Mtwara and under-received in Tabora and Dar es Salaam (6% and 36%, respectively). Implants like Jadelle were also under-supplied in Arusha and Dar es Salaam (20% and 39%, respectively). Such under-supplies have been the result of insufficient stock in the zonal stores of the medical store department or incomplete files from the regional order. As result, the Sauti team continue providing technical assistance to the regional and district Reproductive and Child Health teams. Lignocaine, which is used during implant insertion and removal services, was not received in Dar es Salaam and Mtwara again and only 38% of the ordered supply was received in Njombe, so the Project closed the gap by ordering this commodity.
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The under refill rate was generally addressed during supportive supervision with respective R/CHMTs and the Project ensured uninterrupted provision of FP services by redistributing commodities within SNU and regions.
Appendix 3: Regional Meetings Held in Q2
Region Title of the meeting and Organizer Venue and Date Arusha Regional USAID Boresha Afya planning meeting with Arusha January 28-30, 2019, held in Arusha R/CHMTs, which used as platform to discuss about various issues Region related to identification of positive cases from the community, referrals to CTC, data verification and retention to care and treatment among other issues. Arusha Quarterly TB/HIV Data analysis Workshop January 7-11, 2019, held at Golden Rose in Arusha Launching of USAID Tulonge Afya Project under fhi360 at Olasiti February 5, 2019, held at Olasiti garden garden in Arusha Region in Arusha Region
Regional stakeholders’ meeting held at Gold Crest Hotel in Arusha February 7, 2019, held at Gold Crest organized by Hand in Hand Eastern Africa Hotel in Arusha
Kilimanjaro Regional coordination meeting organized by global fund to share February 19-2, 2019 best practices in increasing care and retention at the HFs
Regional stakeholders meeting organized by Sauti to share best March 15, 2019, held at Uhuru Hostel practices and rollout ART outreach services in Moshi Municipal Council Dodoma, Regional Technical Meeting to update Regional HIV and AIDS Feb, 2019, in Dodoma and Iringa Iringa and Strategic Plans supported by Sauti program and Coordinated by respectively Morogoro TACAIDS District Advisory Committee Meetings for Kyela and Mbarali March 2019, at Sauti Regional Offices Mbeya Regional Technical Meeting to update Regional HIV and AIDS February 18 – 19, 2019, held at Strategic Plans supported by Sauti and Coordinated by TACAIDS Christian Youth Centre
Regional stakeholders’ meeting organized by RAS office January 19, 2019, held at Open University Hall Njombe RHMT/CHMT SDM/ART outreach orientation meeting organized by February 19, 2019, held at Open RMO office University Hall Pediatric stakeholders meeting organized by BAYLOR and UNICEF 22 – 23, 2019, held at Glory Hotel Regional Stake holders Meeting organized by RMO office January 19, 2019, held at RC Conference Hall Regional DREAM partners meeting organized by TACAIDS February 23, 2019, held at Shinyanga Shinyanga DC Conference Hall Kizazi kipya project sensitization meeting organized by PACT March 27, 2019, held at Submarine Hotel Collaborative meeting with Facility partner organized by Sauti and January 29, 2019, held at EGPAF Office EGPAF Regional IPs collaboration Meeting organized by RMO office 28 -29, 2019, held at Gland Penta Tabora Hotel Meeting with VAWC district comitee Kaliua, Igunga and Tabora MC February 2019, held at Zetaki hotel, organized by Sauti program Millennium city and TDFT hall, respectively
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