Clinical & Community HIV & AIDS Services Strengthening (CHASS) Quarter 1, FY17 Progress Report LIFE OF PROJECT SUMMARY Implementing Partner: Family Health International (FHI 360) Activity Name: Clinical and Community HIV/AIDS Services Strengthening Project (CHASS) Activity Goal: CHASS’s goal is to improve the quality, coverage, and effectiveness of high-impact, evidence-based HIV/AIDS interventions in four provinces. Activity Objectives: To contribute toward HIV/AIDS epidemic control in Mozambique, CHASS seeks to: 1) Increase coverage of antiretroviral treatment (ART) to 90 percent. 2) Increase retention on ART to 80 percent and 70 percent at 12-month and 36-month follow-up, respectively. 3) Increase the average CD4 count at initiation of ART from 350 to 500 cells per cubic millimeter. 4) Complete tuberculosis (TB) treatment for 90 percent of people living with HIV (PLHIV) diagnosed with TB. 5) Operationalize viral load testing. Life of Activity (start and end dates): August 2010 – July 2018 Total Estimated Contract/Agreement Amount: US$137,982,152[1] Total Amount Obligated (to date): US$81,799,660.00 Current Pipeline Amount: US$12,474,245 Actual Expenditure through This Quarter: US$69,325,415 Estimated Expenditures Next Quarter: US$12,474,245 Geographic Focus: Niassa, Tete, Manica, and Sofala Provinces, Mozambique Report Submitted by: Dr. Joaquim Fernando Submission Date: February 3, 2017 [1] After de-obligation of funding for voluntary medical male circumcision. 2 FHI 360 Moçambique │ Rua Beijo da Mulata Plot # 5900 │ Somersheild, Maputo, Mozambique T: +258 21241100 │ F: +258 21485499 │ www.fhi360.org Contents LIST OF FIGURES .................................................................................................................................4 LIST OF TABLES ..................................................................................................................................5 EXECUTIVE SUMMARY .......................................................................................................................8 PROJECT OVERVIEW ......................................................................................................................... 12 PROGRESS BY INTERMEDIATE RESULT AND PROGRAM AREA ............................................................ 14 IR1: Strengthen facility-based HIV services ........................................................................... 14 HIV Testing and Counseling .............................................................................................................. 14 Care and Treatment ......................................................................................................................... 18 Pediatric Antiretroviral Therapy ....................................................................................................... 26 Laboratory Services .......................................................................................................................... 30 Pharmaceutical Care Systems and Services ....................................................................................... 32 Prevention of Mother-to-Child Transmission .................................................................................... 36 TB/HIV Integration ........................................................................................................................... 39 Nutrition Support............................................................................................................................. 42 Health System Strengthening ........................................................................................................... 43 Quality Improvement ....................................................................................................................... 46 IR 2: Strengthen community-based HIV services – access, quality, and retention ................... 48 IR 3: Strengthened referral/linkage systems between community and facility-based services 51 Strategic Information ....................................................................................................................... 54 Electronic patient tracking system ........................................................................................ 54 Community data systems ..................................................................................................... 56 Data use .............................................................................................................................. 56 PROJECT MANAGEMENT AND IMPLEMENTATION ............................................................................. 57 MAJOR PRIORITIES/ACTIVITIES PLANNED FOR NEXT QUARTER .......................................................... 61 ANNEXES ......................................................................................................................................... 63 Annex 1. Sites in need of particular attention ....................................................................... 63 Annex 2. Facilities that benefited from CHASS commodity management technical support .... 67 Annex 3. Table illustrating the number of facilities receiving the support as listed above ....... 68 Annex 4. HFs supported in management of FILAs and LRDA in the four provinces .................. 68 Annex 5. CHASS in-service training achievements over the quarter, FY17 Q1 ......................... 69 3 FHI 360 Moçambique │ Rua Beijo da Mulata Plot # 5900 │ Somersheild, Maputo, Mozambique T: +258 21241100 │ F: +258 21485499 │ www.fhi360.org LIST OF FIGURES Figure 1. HIV care and treatment cascade for all CHASS provinces combined, FY17 Q1 ............................. 9 Figure 2. PMTCT cascade, all CHASS provinces, FY17 Q1 ............................................................................. 9 Figure 3. Districts and health facilities supported by CHASS, showing level of support for districts and ART support for facilities ............................................................................................................................. 13 Figure 4. Performance against target in HTC, by sector, FY17 Q1 .............................................................. 15 Figure 5. HIV positivity yield by sector and quarter, life of project ............................................................ 16 Figure 6. Number tested over time through C-HTC, by province and quarter, life of project ................... 17 Figure 7. ART cascade for FY17 Q1 ............................................................................................................. 19 Figure 8. Number of patients newly enrolled in ART by quarter and province, FY17 ................................ 20 Figure 9. Number of new patients enrolled in ART compared with target, by province, FY17 Q1 ............ 22 Figure 10. Progress toward the annual target for patients newly enrolled in ART, by province and quarter, life of project ................................................................................................................................. 22 Figure 11. Number and percent of new HIV-positive patients eligible/newly initiated on ART in Q1 of FY17* ........................................................................................................................................................... 24 Figure 12. Number of infants born to HIV-positive women who received an HIV test within 12 months of birth, FY17 Q1 ............................................................................................................................................. 27 Figure 13. Number of children with advanced HIV infection newly enrolled on ART, by project over the life of the project ........................................................................................................................................ 28 Figure 14. ADR notifications rates by province, FY17 Q1 ........................................................................... 35 Figure 15. PMTCT cascade, FY17 Q1 ........................................................................................................... 37 Figure 16. Option B+ coverage among HIV-positive pregnant women, by province and quarter ............. 38 Figure 17. TB cascade, FY17 Q1 .................................................................................................................. 40 Figure 18. TB patients registered, by province and quarter ....................................................................... 41 Figure 19. Map of EPTS sites by year of hand over ..................................................................................... 55 Figure 20. Site accessibility by support type, FY17 Q1 ............................................................................... 60 4 FHI 360 Moçambique │ Rua Beijo da Mulata Plot # 5900 │ Somersheild, Maputo, Mozambique T: +258 21241100 │ F: +258 21485499 │ www.fhi360.org LIST OF TABLES Table 1. Performance on selected indicators at the end of FY17 Q1 ......................................................... 10 Table 2. Comparison of HTC DSD and TA targets from FY16 and FY17, by sector ...................................... 15 Table 3. Health facilities with highest levels of growth in new enrollees between FY16 Q4 and FY17 Q1 21 Table 4. GAAC enrollment by province, FY17 Q1........................................................................................ 26 Table 5. Number of patients enrolled in three-month dispensing