Zimbabwe HIV Care & Treatment Project FY17: Q3 PROGRESS REPORT Cooperative Agreement Number: AID-613-A-00009 A PRIL 1 – J UNE 3 0 , 2 0 1 7 Prepared for: Dr Tendai Nyagura, AOR Submitted by: Donald Harbick, Chief of Party Family Health International (FHI 360) 65 Whitwell Road, Borrowdale West| Harare | Zimbabwe This report was prepared with funds provided by the U.S. Agency for International Development under Cooperative Agreement No. AID-613-A-00009. The contents of this report are the sole responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government. April 1 – June, 30 2017 | FY17 Q3 Progress Report Table of Contents FY17 Q3 RESULTS ........................................................................................................... 6 1. INTRODUCTION ..................................................................................................... 7 2. Q3 RESULTS AND ACHIEVEMENTS ........................................................................ 7 HIV Testing Services ....................................................................................................... 7 Symptom screening ...................................................................................................... 11 Defaulter tracking ......................................................................................................... 11 PLHIV receiving ARVs through CARG .......................................................................... 12 Quality assurance for household index testing ............................................................ 12 3. PERFORMANCE INDICATOR SUMMARY ............................................................. 13 4. LABORATORY SERVICES STRENGTHENING ........................................................ 14 5. MONITORING AND EVALUATION ...................................................................... 14 Site support and supervision ........................................................................................ 14 Knowledge Management ............................................................................................. 14 Database Systems ......................................................................................................... 14 6. FHI 360 Q4 PRIORITIES ........................................................................................ 14 April 1 – June, 30 2017 | FY17 Q3 Progress Report 3 Table of Figures Figure 1: ZHCT HIV Testing Cascade .............................................................................................................. 8 Figure 2: Chipinge District Performance ......................................................................................................... 8 Figure 3: HIV Services by Age Category ...................................................................................................... 9 Figure 4: HIV cascade for clients aged 20 - 30 years ............................................................................. 10 Figure 5: HTS_TST_POS performance by month ........................................................................................ 10 Figure 6: ART defaulter tracking ................................................................................................................... 11 Figure 7: PT results for FHI 360 nurse testers .............................................................................................. 13 Figure 8: VL testing at labs supported by FHI 360 ................................................................................... 14 List of Tables Table 1: TB symptom screening ...................................................................................................................... 11 Table 2: CARGs (March 2016 to March 2017) ......................................................................................... 12 Table 3: Q3 indicator performance table: April 1- June 30, 2017 ...................................................... 13 Cover Photos Top: Outreach Workers at a refresher training in Chipinge district. Credits, Sibochiwe Manase, FHI 360 Chipinge District Team Leader Bottom: Female CARG members awaiting VL specimen collection in Kwekwe district. Credits, Elizabeth Tauya, FHI 360 Kwekwe District Team Leader April 1 – June, 30 2017 | FY17 Q3 Progress Report List of Acronyms APHL Association of Public Health Laboratories AR&P Annual Review and Planning ART Antiretroviral Therapy ARVs Antiretroviral medicine AWP Annual Workplan CARG Community ART Refill Group CATS Community Adolescent Treatment Supporters CHO Community Health Officers COP Country Operational Plan CPF Community Program Facilitator DATIM Data for Accountability, Transparency and Impact DREAMS Determined Resilient Empowered AIDS-Free Mentored and Safe DCT Data Collection Tool DHIS2 District Health Information System version 2 DMO District Medical Officer EQA External Quality Assurance FHI 360 Family Health International 360 GOZ Government of Zimbabwe HTS HIV Testing Services LTFU lost to follow up MOHCC Ministry of Health and Child Care OW Outreach Worker PEPFAR President’s Emergency Plan for AIDS Relief PMD Provincial Medical Director PMP Performance Monitoring Plan PLHIV Persons Living with HIV PSI Population Services International QA Quality Assurance SOP Standard Operating Procedures UNAIDS Joint United Nations Programme on HIV/AIDS USAID United States Agency for International Development VL Viral Load ZHCT Zimbabwe HIV Care and Treatment Project April 1 – June, 30 2017 | FY17 Q3 Progress Report 5 FY17 Q3 RESULTS 39% 47 11 Yield Rate People tested for HIV and received their results 40% 1854 FHI 360 progress towards HTS_POS COP16 Target Newly identified people living with HIV 98% 1338 ART initiation rate People living with HIV enrolled into 100% care TB screening of all new HIV positive clients 1306 People living with HIV initiated on ART 72% 97% Enrolment rate CARG members with suppressed viral load 100% Proficiency Test rate amongApril nurse 1 – June testers, 30 201 7 | FY17 Q3 Progress Report 1. INTRODUCTION This report reviews progress made by FHI 360 during the quarter three of FY17 (April 1 – June 30, 2017) in implementing the USAID funded five-year Zimbabwe HIV Care and Treatment (ZHCT) project. The ZHCT project complements FHI 360 implements the ZHCT project the government of Zimbabwe (GOZ)’s efforts to strengthen as the prime partner in partnership with health facility and community linkages for HIV care and Plan International as the sub-awardee. treatment services provision. The goal of the project is to increase the availability and quality of comprehensive care and treatment services for persons living with HIV (PLHIV), primarily through community-based interventions. The ZHCT project accomplishes its overall goal by meeting the following specific objectives:- a) To increase the availability of quality comprehensive care and treatment services for HIV- positives at community level; through community-based household index testing with linkage to care and symptom screening including TB screening with referral. b) To strengthen community-level health systems to monitor, track and retain persons living with HIV (PLHIV) in care through ART defaulter identification and tracking, and adherence support for PLHIV through formation of CARGs. The ZHCT project is a comprehensive community-based intervention designed to provide sustained linkages between the community and health facilities. ZHCT will contribute towards Zimbabwe’s attainment of the first and the third 90s of the UNAIDS 90-90-90 Strategy. At the end of May 2017, FHI 360 received an additional obligation of US$1 million to support recruitment of additional locum nurses and improve mobility in the field through procurement of four hard-top vehicles suitable for the rough terrain in some districts. During the period under review, the ZHCT project was implemented in ten districts across three provinces (Midlands, Masvingo and Manicaland). Plan International, with FHI 360 technical oversight, is implementing ZHCT activities in Masvingo province. 2. Q3 RESULTS AND ACHIEVEMENTS This section presents a summary of the key highlights from the ZHCT project from April 1to June 30 2017. HIV Testing Services A total of 4711 people were tested for HIV resulting in 1854 being newly identified as HIV positive. This is a yield rate of 39% (1854/4711) as shown in Figure 1 below. The project achieved 49% (1854/3815) on HTS_Pos against the quarterly target and 40% (6078/15262) against the annual target. The project has started combining testing modalities so that more individuals are tested in order to identify the remaining PLHIV who do not know their status. April 1 – June, 30 2017 | FY17 Q3 Progress Report 7 Figure 1: ZHCT HIV Testing Cascade Of the newly identified HIV positives, 72% (1338/1854) were linked to care (enrolled in pre-ART register). The linkage rate in Chipinge improved from 40% reported during the semi-annual period to 84% (133/159) achieved in the period under review as shown in Figure 2 below. This is attributed to the development of a linkage database which has allowed FHI 360 to retrospectively track newly diagnosed PLHIV for linkage into care. This database is also being utilized in all the project implementation districts in order to improve enrolment in care of the newly identified HIV positive clients. Other contributing factors include coordinated supervision of Outreach Workers, community sensitization on the importance of early ART initiation