The CQUIN Learning Network Second Annual Meeting Report November 5-7, 2018 Addis Ababa, Ethiopia HIV LEARNING NETWORK The CQUIN Project for Differentiated Service Delivery Table of Contents Executive Summary ................................................................................................ 2 Introduction ............................................................................................................ 6 Agenda .................................................................................................................... 7 Opening Reception ................................................................................................ 9 Day 1 ..................................................................................................................... 11 Setting the Scene ........................................................................................................................................... 11 Monitoring DSD Scale-Up with DSD Review Meetings ........................................................................ 12 Peer Learning with South-to-South Visits................................................................................................. 13 Optimizing National DSD Scale-up Plans ................................................................................................ 14 Day 2 ..................................................................................................................... 15 Monitoring DSD Scale-up with Routine M&E ........................................................................................ 15 Differentiated Testing –part 1 ..................................................................................................................... 16 Differentiated Testing –part 2 ..................................................................................................................... 17 Data for Decision-Making About DSD Scale-up .................................................................................... 18 Day 3 ..................................................................................................................... 19 Country Status Reports ................................................................................................................................ 19 Are Recipients of Care Sufficiently Engaged in DSD Scale-up? ........................................................... 20 Tools Lab and Demonstrations .................................................................................................................. 21 Optimizing Scale-Up for DSD ................................................................................................................... 23 Closing Remarks .................................................................................................. 23 Participants ........................................................................................................... 24 Posters ................................................................................................................... 64 DSD Models .................................................................................................................................................. 64 National Programs ........................................................................................................................................ 68 Partners ........................................................................................................................................................... 79 Videos ................................................................................................................... 85 CQUIN is made possible with funding from the Bill & Melinda Gates Foundation. The findings and conclusions contained within this report are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. Executive Summary Background ICAP at Columbia University launched the HIV Coverage, Quality, and Impact Network (CQUIN) in March 2017 to foster the scale up of differentiated HIV service delivery (DSD) in sub-Saharan Africa, with support from the Bill and Melinda Gates Foundation. The first CQUIN annual meeting was held in February of 2018 in Maputo, Mozambique. Recognizing that November was a more optimal time in which to convene all stakeholders, CQUIN held its second annual meeting from November 4 -7, 2018 in Addis Ababa Ethiopia. The workshop included all eleven network member countries (Cote d’Ivoire, Eswatini, Ethiopia, Kenya, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), as well as global and regional stakeholders. CQUIN’s second annual meeting is the sixth multi-country workshop hosted by the network since its launch. CQUIN has also hosted three satellite meetings at international conferences; supported six south-to-south visits for eight countries; convened four virtual communities of practice focusing on monitoring and evaluation of differentiated services, systematic identification of patients at high risk for HIV disease progression, DSD for adolescents, and DSD coordinators, and launched four catalytic research projects to address knowledge gaps related to male engagement in community ART refill groups in Zimbabwe, adolescent preferences for DSD in Kenya, DSD models for HIV and hypertension in Eswatini, and patient and provider responses to appointment spacing in Ethiopia. In addition, CQUIN has seconded national DSD coordinators to selected ministries of health, supported national DSD review meetings, provided focused technical assistance, and launched a website, webinar series, e-newsletter, and journal club. CQUIN has also introduced the CQUIN DSD Dashboard, a self-assessment tool that helps ministries of health and their partners describe the stage of DSD scale-up in their countries and prioritize gaps and challenges. The second annual meeting enabled CQUIN member countries to review their progress towards DSD scale-up, share best practices and challenges, prioritize and plan for 2019, set new targets for DSD coverage, and describe their optimal mix of DSD models. Meeting Dates and Objectives Ethiopia’s Federal Ministry of Health hosted the second CQUIN annual meeting at the Hilton Hotel, Addis Ababa, from November 4 to 7, 2018. The objectives of the meeting were to: • Review member countries’ progress towards scaling up DSD for “stable” recipients of care • Facilitate exchange of knowledge, best practices, innovations, resources, and strategies for scaling up diverse DSD treatment models (DSDM) • Discuss differentiated testing strategies, best practices, innovations, and resources to achieving the “first 90” • Identify common gaps, challenges, and opportunities for future joint-learning, co-creation of tools and resources, and future south-to-south exchange visits Meeting Participants Representatives from the eleven network member countries (Cote d’Ivoire, Eswatini, Ethiopia, Kenya, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe) attended the meeting. Country teams included representatives from ministries of health (MOH), agencies and 2 implementing partners of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and civil society. In addition, global and regional stakeholders included representatives from ICAP at Columbia University, the Bill & Melinda Gates Foundation, the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Joint United Nations Programme on HIV and AIDS (UNAIDS), the Global Fund for AIDS, TB and Malaria (GF), CDC Africa, Médecins Sans Frontières (MSF), the International AIDS Society (IAS), the International Treatment Preparedness Coalition (ITPC), Boston University, and others. A full list of participants can be found in the Appendix. Key Themes The meeting included 13 sessions, including plenary and panel presentations, moderated discussions, breakout sessions, a “tools lab”, and poster walks. Key themes included: progress towards scale-up of DSD models for stable recipients of care; challenges and innovations for M&E of DSD programs; debates about the optimal mix of DSD models; and exploration of differentiated testing services. The annual meeting highlighted the progress made by network countries toward scaling up DSD for stable adult patients, as well as the challenges faced by each country. Using the CQUIN dashboard, each country team systematically described the maturity of their national DSD programs, and presented their progress in country posters (see Appendix). Following are a list of key takeaways: • Most countries have made substantive progress towards developing supportive DSD policies, scale-up plans, guidelines, and training materials. Many countries have also improved the coordination of DSD services via national DSD coordinators and technical working groups. • All countries have made progress in scaling up DSD for stable adult recipients of care, with increasing coverage at the facility and individual levels. Some countries are also working to scale up DSD models for adolescents, key populations, migrant and mobile populations, men, and others, however, these are more frequently found in the pilot stage. • Many countries have developed standard operating protocols, job aides, and monitoring and evaluation (M&E) tools, although comprehensive M&E of DSD remains a challenge for most CQUIN countries. • Country teams felt they were making good