DSD in WCA: Perspective of the Global Fund Differentiated ART delivery approaches for West and Central Africa: From pilots to plans for scale-up ICASA 2019 Lee Abdelfadil The Global Fund 4 December 2019 www.iasociety.org
Outline • HIV funding landscape in WCA • Highlights of Differentiated Service Delivery for key populations • New funding cycle for 2021-2023 www.iasociety.org
Imperative of epidemic control in WCA • 7% of the global population • 17% of the world’s population living with HIV • 21% of new HIV infections • 30% of the world’s AIDS -related deaths. www.iasociety.org
Global Fund investments (2017-2019 allocation): USD$ 1.0 billion (USD$ 477 million allocated to CIV, DRC, Ghana, Nigeria) Treatment, care and support 52% Program management 18% All prevention programs 9% RSSH: HMIS and M&E 8% PMTCT 4% Increasing financial absorption rates over the years forecasted RSSH: PSCM to reach 95% from the current 3% allocation by 2020 HIV Testing Services 2% RSSH: HRH 1% Other RSSH Components 1% Reducing HR barriers 1% TB/HIV 0% www.iasociety.org
5 Great dependency on Global Fund support to the HIV response particularly in non-PEPFAR countries www.iasociety.org
WCA+HIA1+HIA2+SEAF+MENA: PLHIV that know their status vs PLHIV on ART 100% Targe Namibia 90% Cabo Verde Zimbabwe Rwanda Botswana Eswatini Algeria 80% Comoros Malawi Zambia Uganda Tanzania 70% Kenya Morocco Senegal Ethiopia PLHIV ON ART (%) 2018 Burkina Faso South Africa Togo 60% DRC Lesotho Lebanon Mozambique Mauritania Niger Nigeria Eritrea 50% Côte d'Ivoire Chad Cameroon Sierra Leone 40% CAR Congo Liberia Ghana Mali 30% Gambia Angola Mauritius 20% South Sudan Sudan 10% Madagascar *Please note that for Chad first 90, country data have been used in order to include the country in this analysis. 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 6 PLHIV WHO KNOW THEIR STATUS (%) 2018
WCA+HIA1+HIA2+SEAF+MENA PLHIV on ART vs PLHIV on ART who achieved VL suppression 100% Botswana Lesotho Namibia Eswatini Lebanon Malawi Morocco Targe 90% South Africa Uganda Comoros ts Tanzania Niger Rwanda PLHIV ON ART WHO ACHIEVED VIRAL LOAD SUPPRESSION Nigeria 80% Benin Eritrea Zambia Mauritius Côte d'Ivoire 70% Algeria Sierra Leone 60% Tunisia 50% Cabo Verde 40% 30% 20% 10% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 7 PLHIV ON ART
Challenges and DSD priorities • Low ART coverage • DSD for clinically stable juxtaposed with high clients investments • Extend ART refills • Health system • DSD for KPs: Refills constrains and psychosocial • Quality of care (ARD support by peers and and VL suppression) lay providers • Community based and • Decentralization and led services task-shifting • Key populations access www.iasociety.org
Building blocks of model for men who have sex with men- Ghana Clinical consultation Psychosocial support ART refills 6 months 3 months 6 monthly At the health facility At the facility of their OR in the community At community choice if it was community based testing Counsellors and Doctors/nurses Health care worker psychologists Adherence counselling ART refills Medical check + See examples to complete table in Decision Framework for ART delivery www.iasociety.org
Ghana: Outcomes for DSD model for MSM 160 100,00 90,00 140 80,00 In outreach 120 70,00 model, all 60 Rate of initiation/VL Suppression 100 MSM PLHIV 60,00 # initiated/retained initiated ART 80 50,00 and were 40,00 60 retained at 12- 30,00 months 40 20,00 20 10,00 0 0,00 Facility Outreach # Initiated # Retained %Initiation VL Suppression Rate Nagai, 2019 www.iasociety.org
Funding request requirements Prioritize interventions at Focus on both HIV treatment sufficient coverage and scale and HIV prevention to have an impact To save lives and reduce the incidence of HIV, the Global Fund urges applicants to propose funding requests that: Rapidly scale-up new and Address populations with innovative medicines and greatest HIV burden and technologies, as barriers to accessing services recommended by the WHO and other normative agencies www.iasociety.org
12 Global Fund and partner-recommended prioritized interventions across the HIV cascade 1 • HIV prevention pro rogram ams ad addressin ing g KPs in al all l epid idemic ic se settin ings gs, and AGYW and ad adole lescent boys an and me men in high prevalence settings • Comprehensive condom programming • PrEP rEP programs for populations with substantial HIV risk 5 • HIV testing servi vice ces strategy that uses up up-to to-date and regu gular arly revi viewed 2 dat ata a • A strat ategic c mix of differentiated approac aches, including self-testing, that Hum Human Rig Rights ts improve testing cove verage, testing yield and effici ciency of HIV testing services HI HIV Preventio ion • Interventions that ensure people across all age, sex and risk categories are linked to the services they need depending on their test results 1 • 3 Scal Scaled-up DSD DSD models that offer a mix of interventions at both faci acility and 4 community levels • Rap apid initiat ation for all people diagnosed with HIV and strong mechanisms to retain people across the cascade • Introduction at scale of optimal ARV regimens in line with WHO HI HIV Testing g HI HIV St Strategic recommendations • Advanced HIV disease pathways Ser Services Information • Optimize zed VL testing at scal cale as preferred treatment monitoring. • Monitoring of drug resistance through WHO-recommended surveys • TB preventive treatment (TP TPT) at scale in countries with high burden of TB/HIV HI HIV Trea eatment t 2 4 • Routine revi view of dat ata tracking people along the HIV prevention, testing and Car and are and treatment cascade 3 • HIV case surveillance • UNAIDS-endorsed ke key human rights components, scal aled up up and integrat ated 5 into prevention and treatment programs www.iasociety.org
DSD in the Global Fund information note 2019 • Scaled-up DSD models that provide people- centered services and offer an appropriate mix of interventions at both facility and community levels , including: i) Scaling up differentiated approaches with fidelity that address all age, sex and priority groups; ii) Rapid initiation of ART for people diagnosed with HIV including the offer of same-day initiation where there is no clinical contraindication; iii) For stable patients, adopting multi-month (3-6 months) scripting and standardized multi-month refills facilitated by improved capacity of respective procurement and supply management systems. www.iasociety.org
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