CATHOLIC RELIE SERVICES (CRS)
2020 HIV DIAGNOSTICS

3. Ensure all children of parents living with HIV are offered HIV testing services in collaboration with implementing partners and faith-based partners.

9. Prioritise integration of systems and device-sharing across HIV and TB programs, including mapping of systems and diagnostic network optimisation.

10. Work with Ministries of Health to improve and expand case-finding strategies and focus on priority entry points and index testing.

11. Incorporate LF-LAM and CrAg testing for infants and children with advanced HIV disease.

12. Continue to strengthen and expand case-finding through completion of studies of parent-assisted testing intervention in Zambia and Uganda and sharing quickly with WHO and other interested stakeholders.

Updates

Commitment 3:

April 2021

  • FASTER Nigeria supported Caritas Nigeria and Caritas Internationalis in the roll out the GRAIL III strategy which focuses on galvanizing religious leaders to include HIV messaging in their sermons for accelerated HIV case identification and linkage to pediatric antiretroviral therapy (ART) including viral load (VL) suppression. FASTER is supporting trained faith leaders/institutions to support pediatric HIV case identification and linkage to treatment through church/religious structures, including medical outreaches led.  

  • FASTER Uganda supported MOH and implementing partners to conduct mentorship of 860 health care workers and lay counselors at 96 FASTER supported health facilities on the use of the validated HIV risk screening tool, the importance of testing all children of parents living with HIV, and appropriate family monitoring tools. The health workers were drawn from public facilities and faith-based organizations (private not-for-profit facilities). Through the Young and Adolescent Peers Supporters (YAPS) activity, FASTER supported the development of HIV testing training materials and trained 75 YAPS trainers and peers to provide testing and linkage into care. This intervention will reduce missed opportunities for index testing, particularly among siblings of adolescents. FASTER mentored health facility staff of faith-based organizations sub-grantees to conduct home-based or community-based HIV testing for children of parents living with HIV who are not able to go to health facilities for an HIV test. Demand creation messages for faith leaders were developed to enable faith leaders mobilize communities on the importance of HIV testing for children of parents living with HIV. FASTER hired 39 pediatric coaches assigned to the health facilities to mentor health workers in use of the quality improvement approach, to close gaps in case identification and other continuity of care and treatment services.  

Commitment 9:

April 2021

  • FASTER Nigeria supported the training of health care workers (HCWs) to conduct multi-disease testing on the GeneXpert platform, procure and distribute cartridges, commence integrated testing and documentation in the selected sites and follow up with clients for appropriate clinical management. FASTER continues to monitor the use of POC testing at the priority sites to determine the proportion of early infant diagnosis (EID) tests conducted FASTER Nigeria will introduce POC technology and support integration of testing services on the GeneXpert platform to inform Diagnostic Network Optimization (DNO) by supporting the government, PEPFAR and other key stakeholders (in FY 22) to redesign the sample referral network based on the availability of POC and Near-POC platforms to complement the existing conventional platforms. Integration on the GeneXpert platform commenced in March 2021. 

  • In Uganda, FASTER is supporting the MOH to convene partners supporting diagnostics to optimize utilization of laboratory platforms.  By the end of FY21, optimization scenarios will be shared with key partners for continual quality improvement. Through national dashboards and use of digital technologies, FASTER Zambia is supporting MOH and partners with platforms linked to real time lab equipment data--that are interlinked to the Electronic Health Records--to further enhance program response and adaptation.  

 

Commitment 10:

April 2021

  • FASTER Tanzania worked with Ministry of Health, Community Development, Gender, Elders and Children (MOHCDGEC), CDC Tanzania, and implementing partners to conduct supportive supervision and mentorship to 48 selected priority facilities to improve pediatric and adolescent case identification through index testing and optimize provider-initiated testing and counseling. FASTER supported the review, printing, and orientation of stakeholders on the age-appropriate HIV screening tool as well as registers and reporting tools. The changes effected will allow the screening of children aged 2-9 years and 10-14 years to identify pediatrics and adolescents living with HIV/AIDS. FASTER Tanzania supported point of care early infant diagnosis (POC EID) focused mentorship, data review sessions, and monitoring test kits and reagent stock status, procured and deployed 47 thermomixers for expansion of POC EID testing. There has been improvement of POC EID testing coverage from 5% (Jan 20) to 69% (Dec 20), which is also attributed to regimens for conventional platforms being restocked; – additionally, there was an increase in the proportion of POC EID testing in priority sites from 9% (Jan 20) to 37% (Dec 20). Routine monitoring of stock status facilitated the strengthening of conventional testing, rapid clearance, and distribution of testing reagents. In addition, FASTER has initiated discussions with MOH on the use of whole blood for EID testing. FASTER has supported the sharing of experiences on dried blood spot HIV tests that will result in the scale up of whole blood POC EID testing nationwide through use of existing GeneXpert devices with capacity to conduct additional test. 

  • FASTER Uganda is supporting the MOH to strengthen infant exposure screening at all entry points through dissemination of demand creation materials and to scale up POC EID resulting in an increase of POC/EID from 33 sites to 130 sites countrywide. 

  • FASTER Nigeria trained HCWs at priority sites on indexing strategies to complete family trees and sexual network testing. FASTER provided technical support for HCWs to offer provider-initiated testing to pediatric and adolescent clients. The project secured the buy-in of governments and other stakeholders on scale up of HIV testing services at all entry points for pediatric and adolescent clients in the priority sites. Service providers were supported to use the HIV risk assessment tool to determine the eligibility of children and adolescents for requisite HIV diagnostic test at entry points in the priority sites. In Zambia, FASTER is exploiting non-traditional entry points such as non-maternal child health services for EID to optimize case finding towards eliminating mother-to-child transmission. 

 

Commitment 11:

April 2021

  • In Uganda, CHAI through UNITAID funding is supporting MOH to strengthen advanced HIV diagnostic and treatment services. FASTER Nigeria will align with current country strategy to improve AHD monitoring in-country. FASTER will improve the surveillance of AHD for all children and adolescents through improving awareness using tailored IECs, MSVS and where necessary process audits following data analysis. FASTER will also ensure that AHD is discussed in State wide Pediatric and Adolescent TWGs. 

Commitment 12:

April 2021

  • In Uganda and Zambia, FASTER received final CDC Science Integrity Branch approvals for the “Caregiver-assisted oral fluid-based HIV testing in children: An estimation of acceptability, feasibility and effectiveness linked to index testing services in Uganda and Zambia.” Implementation of the oral fluid-based HIV testing in children 18 months – 14 years in Zambia begun in February 2021. As of the end of March, >400 HIV-positive adult parents/caregivers accepted oral test kits for >680 eligible biological children in their care with recruitment continuing into the second half of 2021.  

  • Implementation in Uganda awaits final approval from the Uganda National Council of Science and Technology (expected in April 21). Once approved, data collection is anticipated to commence late April 2021 and expected to be completed in September/October 2021. FASTER expects to share results from the study in Dec 2021/Jan 2022 to inform updates of national HIV testing and service guidelines and WHO policy on caregiver assisted and HIV self-testing (HIVST) in children. 

  • FASTER Nigeria, in collaboration with CDC implementing partners, supported the use of HIVST to find HIV cases among children and adolescents using provider-initiated testing strategies at the priority sites and other CDC supported facilities and at the community HIVST service delivery channels. HCWs at FASTER priority sites have been supported with capacity building sessions on HIVST service delivery and commodity management to provide HIVST to eligible children and adolescents. In a period of 6 - 9 months, 63,000 HIVST have been distributed identifying 2,900 pediatrics and adolescents living with HIV/AIDS and linking them into care.  

2018 HIV DIAGNOSTICS

28. Equip, mobilize, and support faith leaders, FBOs, people in places of worship, and the wider community to create demand for testing of infants and children.

29. Combat stigma and discrimination among faith leaders and within communities of faith.

30. Further collaborate and coordinate community mobilization, education and outreach to find otherwise hard-to-reach children, adolescents, youth and adults for age appropriate prevention education, testing and linkage to treatment and health and social support services and integrate into the national system.

31. Ensure FBO participation in local and national diagnostic product/supplies forecasting.

32. Support and participate in national efforts to improve the use and impact of pediatric diagnostics and develop national strategies to optimize the use of new technologies and interventions.

33. Work to implement new HIVST modalities (such as oral fluid testing) in communities and homes, where national polices and regulations allow for lay implementation with children.

41. Strengthen and expand case-finding through developing nurturing and enabling environments, integrating testing into orphans and vulnerable children (OVC) programs, adapting and localizing case management tools, and promoting social services.

Updates

October 2020

  • In Q2/FY20, CRS OVC programs in 5 countries (through 7 separate projects) provided (PEPFAR) to 740,873 OVC 0-17 years of which 96.9% knew their HIV status (or a test was not required). Out of 74,429 HIV-positive OVC receiving comprehensive services, 99.9% were on treatment.

  • In an effort of having almost all children below 15 years know their HIV status, the Epidemic Control 90-90-90 (EpiC 3-90) project developed the Know Your Child’s HIV Status (KYCHS) strategy which is a subset of index testing targeting only biological children of unknown HIV status from women in the child-bearing age who have been on treatment for more than 3 months.This strategy is now in 66/102 facilities and the project has deliberate plans of rolling out this strategy to 90% of supported facilities.

  • CRS’ OVC programs in Cameroon, Zimbabwe, Uganda, and Kenya have expanded case finding using index testing supported by a case management approach. Working with the index children and caregivers enrolled in collaboration with clinical partners, CRS and partner caseworkers or para-social workers (PSW) conduct home visits and HIV risk assessments for family members of the index client and refer them for HIV testing services (HTS).Caseworkers refer all clients meeting risk criteria for HTS, including index-based testing of all biological children of HIV+ caregivers and biological siblings of CLHIV for whom HIV status is unknown. The PSW and supervisors coordinate with focal persons at the clinic to ensure completion of HTS referral, providing physical escort when necessary. HIV+ children are linked to treatment and adherence support, supported by project social worker, PSW and Linkages Focal Person.

June 2020

CRS: Strengthen and expand case-finding through developing nurturing and enabling environments, integrating testing into orphans and vulnerable children (OVC) programs, adapting and localizing case management tools, and promoting social services.

  • CRS FASTER’s studies on the acceptability, feasibility and effectiveness of caregiver-assisted oral fluid-based HIV screening of children 18 mo – 14 years in Zambia and Uganda are preparing for research assistant training and site activation in August and September, respectively. 

  • In light of PEPFAR’s recommendation to consider HIV oral screening for children 2-11 years in other countries during the time of COVID, FASTER and CDC have been in discussing caregiver-assisted testing of children with a CDC-supported colleagues in another Southern Africa country and have shared specific SOPs and training materials developed for the FASTER Zambia and Uganda studies with them.

  • FASTER is working with EGPAF to provide programmatic assistance with the Ministry of Health in Zimbabwe for the introduction of Raltegravir granules for HIV-positive neonates in 14 select POC-EID birth testing sites. Donated Raltegravir granules from Merck have been pre-positioned at the sites and training of healthcare staff at the sites was completed in mid-June with appropriate COVID-19 precautions. Protocol revisions are being finalized. Final approval and site activation is expected in this next quarter.

 

CRS's FASTER project has begun in Nigeria, Uganda, Tanzania, Zambia, and Zimbabwe (start-up meetings took place and work plans approved in all 5 countries). They are wrapping up protocol development for the Oraquick studies in Zambia and Uganda.

April 2020

CRS FASTER is involved in two studies on the acceptability, feasibility and effectiveness of caregiver-assisted oral fluid-based HIV screening of children 18 mo - 14 years in Zambia and Uganda. But study protocols hindered by COVID-19 at the moment.

 

With PEPFAR recommendation to allow HIV oral screening for children 2-11 years, there will be increased demand for test kits. Many countries will likely have competing priorities for use of their oral-fluid-based HIVST stock if also going to use for screening children.  Many countries only do quantification of need once or twice a year. Implementing this PEPFAR recommendation will require nation MOHs to both 1) update their national guidelines to allow this age group to be tested by their parent/caregiver and 2) look at re-prioritization of available kits and quickly regroup to do quatification to have enough kits available

Other activitie:

  • Supporting the National AIDS Control program to develop rapid advice for HIV programming in the COVID-19 era;

  • Supporting overall HIV program coordination at national and sub-national levels to ensure government support for uninterrupted HIV services at health facilities;

  • Working with lead IPs at the FASTER states to roll out programming strategies to ensure drug availability, drug pick-up and adherence, and uninterrupted uptake of VL and EID testing;

  • Rolling out service delivery models that promote the safety of HCWs and patients and minimizes the transmission of COVID-19 during clinical visits;

  • Promoting use of ICT4D for patient monitoring, appointment reminders, surveillance and monitoring of patients who become co-infected with COVID-19.

Commitment 28:

CRS:

  • FASTER supported development of PMTCT messages to be used by faith leaders to promote EID uptake, and facilitated faith leader participation in demand creation message development.

  • FASTER also supported NAC coordination of FBO and key stakeholders to review NGO engagement strategy and improve FBO community epidemic response potential and to educate and mobilize faith leaders (including youth leaders) on pediatric ART.

  • CRS’ EpiC 3-90 Project in Zambia supported the implementations of the Faith and Community Initiative activities across Eastern, Lusaka, Southern and Western Provinces of Zambia. The project engaged and oriented 279 faith leaders in the dissemination of new messages of Hope within their faith communities, leading to achievement of 93% towards the target. During the COVID-19 pandemic, the faith communities had to innovate and use their faith community social media platforms to disseminate the messages of hope. Faith leaders were engaged to create demand for the uptake of HIV services, especially encouraging the testing of men, children, and adolescents. EpiC 3-90 and its partners leveraged on the existing relationships with faith leaders and faith communities to bolster case-finding and linkage to treatment, especially among men.

  • To increase case identification among the men and children using HIV self-testing and index testing whilst promoting linkage to ART services, improving retention and viral suppression, EpiC 3-90 and its partners engaged faith community leaders, liaison officers and life coaches. The faith community leaders (or champions) conducted demand creation through dissemination of the messages of hope whilst the liaison officers who also took on the role of life coaches provided the HIV self-tests and linkage to HIV related services in the Community Posts. In total, support has been given to 279 faith leaders (champions) and 279 liaison officers or life coaches. This translates into a 93% achievement towards the target.

  • EpiC 3-90 distributed 3,674 HIV Self-tests in faith communities—an achievement of 147% of the target. A total of 2,108 individuals were identified to be living with HIV and 100% were linked to ART care. The positivity yield was at 33% with an index positive contribution of 37% to all the cases identified. In total, 279 congregations deployed support for linkage and retention.

  • The Lesotho 4Children Faith Communities Initiative is developing a sermon guide, or Faith Pack, to be used by faith community leaders to educate the community and increase demand for HIV testing, prevention, treatment, and viral load suppression services. The guide delivers HIV information tailored to leverage faith communities’ role as spiritual leaders, and mobilize the faith community to support families and affected communities living with HIV, while also reducing stigma and discrimination.

 

CRS FOCUS South Africa HIV Treatment Surge project completed adaptation of CABSA's "Churches, Channels of Hope®" faith-based leader training curriculum and parnticipant workbook to provide postive messages on importance of HIV testing, treatment and retention on treatment, and to destigmatize HIV, and trained 11 Master Trainers. Will be training 2,000 faith-based and traditional leaders. 

Commitment 29:

CRS FASTER supported development of FBO-tailored stigma and discrimination fact sheets, documenting the extent of the problem and the role of the FBO community in addressing stigma, and trained FBO leaders in their use. FBO leaders reviewed and approved materials, which are being printed and disseminated.

 

CRS FOCUS South Africa HIV Treatment Surge project completed adaptation of CABSA's "Churches, Channels of Hope®" faith-based leader training curriculum and parnticipant workbook to provide postive messages on importance of HIV testing, treatment and retention on treatment, and to destigmatize HIV, and trained 11 Master Trainers; and 600 of 2000 faith-based and traditional leaders trained. 

Commitment 30:

CRS:

  • FASTER supported MOH led scale up of youth and adolescent peer support models for case identification, linkage, and treatment retention and adherence, including the development and use of e-support during the COVID-19 pandemic.

  • FASTER Uganda supported development and scale up of antenatal and postnatal care for adolescent girls, enabling MOH led scale up of Group-ANC as a differentiated service delivery model.

  • FOCUS/South Africa supported demand creation, index testing, and family testing reaching men and AGYW.During FY20, CRS supported FBOs referred 15,566 persons 0-19 years for testing (with 7.5% testing positive), and directly tested 3,896 persons 0-19 (1.5% positive). 97% of individuals identified as positive started ART within the same month. FOCUS/South Africa also provided 4,929 persons 0-19 years with support services to adhere to ART.

CRS FASTER Project in Uganda supported MOH to conduct post- training technical supervision and mentorship of Young People and Adolescent Peer Supporters (YAPS); 10 national level mentorship teams reached 9 pilot districts, covering 49 health facilities; provided TA to review the YAPS mentorship tool.

CRS FASTER Project in Tanzania Paediatric HTS tool is in the final stages of editing.  FASTER is in discussions with EGPAF to operationalise its use (possibly with a focus on the 50 priority sites.
CRS FASTER Project in Zambia "clinical mentors" using CDC ECHO platform at 12 priority sites resulting in noticable improvement in pediatric case identification and ART initiation in previously poor performing sites; developed, printed and distributed a pediatric ART dosing chart which has been adopted by MOH and is being distributed countrywide. 

Commitment 31:

CRS FASTER promoted and supported FBO representation and participation in key national decision-making meetings, including the national Pediatric TWGs where National strategy formulation to optimize the use of new technologies and interventions is developed.

 

Attended national HIV commodity forecasting meetings with the Procurement and Supply Management TWG.

Commitment 32:

CRS:

  • FASTER helped Ministries of Health in five countries establish and expand access to Point-of-Care testing for EID and VL testing, including supporting validations and registrations where necessary, as well as the development of job aids for health care workers on EID integration into existing health platforms such as EPI to improve identification of children and adolescents with HIV. FASTER countries have successfully registered POC/EID diagnostics, and FASTER is supporting the scale-up and optimization of these platforms to enhance the identification of HIV infected children and the monitoring of viral load suppression trends. Tanzania is focusing on prioritizing POC platforms for pregnant and lactating mothers in sites with both testing platforms (conventional/POC).

  • FASTER supported the validation and rollout of HIV risk screening tools for children and adolescents and the incorporation of risk screening into national guidelines. In Zambia and Uganda, risk screening has been rolled out country wide.

  • FASTER continued to support IPs through mentorship and Continuous Quality improvement Initiatives to improve use of HIV risk screening tools. Countries have increased the analysis and use of data in decision making and have demonstrated responsive stewardship of the proposed interventions to plug the gaps in pediatric HIV management.FASTER has also increased the proportion of clients

  • In FASTER program countries, the proportion of clients tested through index testing has increased.FASTER’s focus on reaching children with unknown HIV status has increased the proportion of HIV positive children identified via index testing, and improved testing yields. This has been achieved through focused support by Ministries of Health and IPs for this testing modality.

  • FASTER also supported countries to update the registration status of the OraQuick oral fluid-based HIV test kit to reflect the 2019 change notification and advise on use by parents/guardians on their children as young as 2 years.

  • FASTER supported the development and launch of an online Diagnostics Evidence Hub (https://aslm.org/diagnostic-hub/) hosted by African Society for Laboratory Medicine (ASLM) that serves as a repository for technical and performance data on WHO-prequalified diagnostics, including Point-of-Care devices and HIV self-tests.

* CRS FASTER Project in Nigeria, Uganda, Tanzania, and Zambia is providing TA, tools, and training to MOH to expand POC EID; working with MOH to update 2016 "National Guidelines for HIV Prevention, Care and Support in Nigeria"; hosted a two-day meeting of the National Task Team on ART ad-hoc sub-committee and developed strategy and advocacy paper for country-wide elimination of user fees for HIV services which negatively impact case finding, linkage to treatment, retention in care and achievement of viral load suppression for children and adolescents; 
* CRS FASTER Project in Uganda developed EID-EPI integration job aid; and completed 93 of 193 POC EID site assessments in Dec 2019.
* CRS FASTER Project in Tanzania supported the national EID TWG to discuss refresher training on DBS sample collection and ensure more effective POC EID; preparing to operationalize the the pediatric section of national HIV risk screening tool with initial focus on 50 priority sites.

 

Commitment 33:

CRS FASTER project with CDC and PEPFAR has submitted a protocol for IRB approval of a study on caregiver assisted HIV oral screening of children between ages 2-18 years, to estimate acceptability, feasibility and impact linked to index testing services in Uganda and Zambia. Expecting to begin implementation by April 2020. The study is conducted in partnership with Orasure, which donated 10,000 testing kits, HIV screening to be performed by trained providers and care-givers in children aged 18 months -14 years. Meanwhile CRS is starting to train research assistants in order to enroll the first caregivers to be able to screen their eligible children with OraQuick tests (as soon as they will receive approval, expected April/May 2020)

In Uganda and Zambia, FASTER received final IRB approvals to conduct studies on the use of OraQuick oral fluid-based HIV testing in children 18 months – 14 years. Study launch preparations start in October 2020.FASTER is also supporting programmatic implementation of HIVST among adolescents 15-17 years to inform policy and HIV testing guidance and scale up.

2020 TB DIAGNOSTICS

38. Support and participate in national efforts to improve and integrate the use and impact of pediatric diagnostics for TB and HIV and develop national strategies to optimize the use of new technologies and interventions. 

Updates

-

2020 HIV TREATMENT

43. Through PENTA and IAS CIPHER, work together to develop an enhanced monitoring and safety data platform for new and existing pediatric ARV drugs. 

52. Support DTG global roll-out plan in collaboration with GAP-f partners by placing orders to enable early procurement of the DTG 10mg dispersible tablet formulation to ensure early and widespread roll-out 

53. Provide additional support for country programs to transition, including wastage of legacy products (e.g., NNRTIs) and funds to procure optimal formulations including pediatric DTG, and as needed, LPV/r formulations 

 

71. Equip, mobilize, and support faith leaders, FBOs, people in places of worship, and the wider community to create awareness of the importance of HIV testing of infants and children of people living with HIV. Demand that national school curricula include scientifically appropriate information on HIV prevention, testing and treatment. 

 

72. Combat stigma and discrimination among faith leaders and within communities of faith around HIV prevention, testing and treatment. Create demand for client-centered and stigma-free care within health facilities as well as access to community-based treatment. 

 

73. Further collaborate and coordinate community mobilization, education and outreach to find otherwise hard-to-reach children, adolescents, youth and adults for age appropriate prevention education, testing, and linkage to and continuity of treatment, health, psycho-social and spiritual support services and integrate into the national system. 

Updates

Commitment 43:

April 2021

  • The FASTER Zambia and Tanzania projects contribute to the establishment and  the improvement of country specific regulatory approval processes. This aims to circumvent protracted approvals and provide timely access to laboratory and diagnostic commodities that are critical to the pediatric/adolescent HIV response. 

Commitment 52:

April 2021

  • FASTER Tanzania supported DTG 10 mg adoption in three different technical forums -- which have all endorsed the adoption and have included DTG 10 mg in pediatric ARV forecasting and procurement. FASTER Uganda, with the support of UNITAID, is facilitating early DTG access through a catalytic procurement of pediatric DTG expected to be available to children in Uganda by June 2021. FASTER Zambia is supporting the MoH to accelerated adoption of the DTG-based child formulation by integrating it in forecasting and quantification processes and concurrently supporting the development and rollout of transition materials. 

  • FASTER Nigeria has supported the uptake of the DTG 10mg dispersible tablets when available in-country by ensuring that at state-level, Pediatric and Adolescent TWGs are updated on roll-out plans, TA support to Logistic Management Coordination Units (LMCUs) to analyze data and make adequate quantification and distribution plans. At facility-level, FASTER supports trainings and will provide copies of the updated National Guidelines on HIV, Prevention Care and Treatment and dosing wheels that contain the updated preferred regimen including pediatric DTG 10mg. FASTER is also supporting the quantification process for optimal regimens to determine the country requirements for the commodities and review the national supply plan to ensure commodity security.  

Commitment 53:

April 2021

  • To ensure commodity security for optimal formulations including pediatric DTG, and as needed, LPV/r formulations, FASTER Nigeria supports bimonthly state, and quarterly technical working group meetings. FASTER Nigeria also continues to strengthen data quality by supporting the bimonthly LMIS data entry exercise to ensure adequate stocks are available for use in the pediatric and adolescent clients at the priority sites. In Tanzania, FASTER has supported the MOHCDGEC to achieve more than 85% of the children and adolescents on optimal ART regimens. Focused mentorship and recall of suboptimal regimens contributed to achieving this transition in six months despite the challenges faced during the COVID-19 pandemic. FASTER Uganda is supporting the MOH to develop the transition plan, health care worker training materials, and caregiver literacy resources for pediatric DTG planned for Q4 2021. FASTER Zambia through treatment optimization oversight monitoring, has supported the MOH to successfully transition children from suboptimal regimes to potent regimens with the LPV/r, DTG backbone. FASTER Nigeria, Zambia and Tanzania  have consistently supported the review of ART optimization by weight and age band to ascertain the level of transition to optimal regimen and flag issues with use of sub-optimal regimen with the respective Implementing Partners (IP), HCWs for corrective action. The project has also continuously updates and communicating availability of such sub-optimal regimens to the national program through the national PSM TWG. 

2018 HIV TREATMENT

52. Ensure FBO participation in local and national forecasting of optimal paediatric drug formulations.

53. Collaborate with GAP-f partners to develop, test, and disseminate training tools for treatment initiation with LPV/r and other optimal pediatric formulations.

54. Support and increase family treatment initiation and retention for children, adolescents, and families by:

  • Increasing identification and provision of same-day/same-appointment mother/infant pair treatment through FBO clinics;

  • Promoting male/father engagement in EMTCT programmes; and

  • Increasing stigma reduction interventions through mobilized faith leaders and faith communities

  • Providing social work interventions to assist fathers to support treatment and adherence of their partners and children living with HIV.

55. Foster and more actively participate in coordinated and collaborative advocacy to:

  • Increase funding for research & development, introduction and scale-up of priority pediatric drugs and formulations;

  • Accelerate regulatory processes for rapid adoption and uptake of optimal paediatric drugs and formulations; and

  • Ensure sustainable access to optimal testing and treatment for infants and children.

Updates

Commitment 54:

 

CRS:

  • CRS’ EpiC 3-90 project capacitated all partners and sites on key activities including same day initiation (SDI) of pregnant women testing HIV-positive.Community-based Volunteers (CBVs) were oriented and mentorship provided to increase the uptake of SDI for pregnant women.As a result, of 409 identified HIV-positive women, 401 were initiated on ART.

  • CRS’ EpiC 3-90 project sensitized and educated pregnant women and their partners on the benefits of knowing their HIV status and PMTCT interventions.4,026 pregnant women attended ANC services during the reporting period and 3,866 of them had a known HIV status (including those newly tested for HIV during ANC and those who already knew their HIV status prior to ANC) representing 96% ANC testing coverage. Of the 3,866 that knew their HIV status, 10.6% were positive.

  • CRS’ EpiC 3-90 project supported local congregations to decrease stigma and non-adherence related to faith healing, predominantly through the dissemination of messages of hope. The project expanded the Know Your Child’s HIV Status (KYCHS) strategy by rolling out the strategy to remaining facilities supporting testing of all biological children, completing index testing of all HIV-positive women who have been on treatment for more than 3 months, and mobilizing communities to help mothers on ART living in far-to-reach locations.Community groups were also enabled to identify pregnant women and adolescents and support linkages to health facilities, encourage HIV-negative PBFW and AGYW to retest every three months; follow up PBFW and AGYW enrolled in ART care; assist Mother Baby Pairs to return to health facilities for EID of all HEIs; and reach any unlinked children and adolescents and link them to ART care.

Commitment 55:

 

With FASTER support, CHAI has been able to engage with multiple GAP-f partners to establish the consortium as a formal WHO network; expand the scope of diseases that GAP-f will be focusing on beyond HIV, TB and Hep C; and identify and convene an advisory committee for GAP-f to assist in strategic decision-making and fundraising

2017 HIV TREATMENT

Action 10: Promote the revision of national procurement plans to align with WHO recommended regimens and the Optimal Formulary, and support the provision of reliable forecasts and the consolidation of orders.

Action 22: Support the early adoption of priority formulations and diagnostics and take steps to facilitate their wider roll-out, including by developing introductory guidance, materials, and other tools for health facilities.

Action 27. Mobilize their networks and work with communities to help build treatment literacy, generate demand, and expand access to ARVs among children.

Action 28. Raising awareness in global fora about the unmet diagnostic and treatment needs of children with HIV.

Action 29. Promote uptake by mobilizing their networks of hospitals and community structures to distribute paediatric medicines in hard to reach places and in situations of conflict and crisis.

Action 34. Increase efforts to share information on the roll-out of new paediatric formulations, including lessons learned.

Updates

Action 10:

CRS, through the FASTER project, supported Ministries of Health and national pharmaceutical supply chain units and authorities in five African countries to reduce registration timelines for WHO prequalified commodities, streamline approval and procurement procedures, and develop rollout and distribution plans.

Action 22:

CRS:

  • FASTER in five African countries supported MOH leadership of pediatric and adolescent HIV treatment optimization TWGs to attain targets, including the development of SOPs, job aids, and curricula for rapid scale up of treatment optimization for children and adolescents.

  • FASTER also supported MOH led support supervision visits to health facilities to scale-up treatment optimization and working with MOH PMTCT Departments to scale up use of POC EID machines.

  • FASTER supported MOH adoption, introduction and roll out of optimal pediatric formulations (such as LPV/r granules, raltegravir, and DTG 10mg as soon as it becomes available) through development of training materials, Training of Trainers, job aids, and patient literacy materials (also contributing to Action 34).

  • Although there were delays due to COVID-19, 14 facilities in Zimbabwe have received training on raltegravir (RAL) granules and several HIV-positive newborns identified at birth and started on RAL granule-based ART regimens. Evaluation on acceptability and feasibility of the use of RAL granules in newborns received local and CDC IRB approvals in Q3/FY20, with results anticipated in mid-2021.

 

Action 27:

CRS:

  • FASTER supported MOH development of HIV demand creation materials for use by faith and religious leaders to mobilize and sensitize their communities on pediatric and adolescent HIV services.

  • FASTER supported development of caregiver pediatric ART literacy materials and ART dispensing messages supporting optimal pediatric ART formulations.

  • FASTER supported HIV implementing partners with mentorship and Continuous Quality improvement Initiatives

  • CRS has developed a Child Optimized Financial Education (COFE) curriculum for families and an accompanying Pre-Service Training on HIV and Child Protection for community facilitators. The COFE curriculum helps families save and budget for critical needs for their children, including education, nutrition and health services. COFE emphasizes the importance of planning for emergencies to weather shocks and continuing to meet the needs of children, including prioritizing their HIV treatment for HIV+ children. The Pre-Service training for community facilitators provides a child-protection sensitive primer on HIV, HIV prevention, and care and treatment so that community facilitators can support caregivers of HIV+ children to prioritize their children’s adherence to treatment, and be linked with HIV and other health and child protection services. The COFE and pre-service training has been developed and piloted in Uganda under the SOCY project, and is in consideration for roll-out in other OVC programs in Cameroon and Zimbabwe, among others.

  • CRS’s MWENDO project in Kenya has developed a set of pictorial case management tools to support families in increasing their resilience to care for their HIV+ children. The set of tools includes coaching cards on key information about HIV, testing, treatment, ART adherence, living positively with HIV, and viral load suppression. The coaching cards facilitate case worker engagement with caregivers and children to share important information, dispel misconceptions and answer common questions in a user friendly and picture-supported manner.

  • CRS’ OVC programs in Uganda, Kenya, Cameroon, and Zimbabwe have adapted the delivery of case management through the COVID-19 crisis to ensure that children and families continue to receive supportive services, with an emphasis on adherence counseling for families with HIV+ children and support to address barriers to adherence. Adaptations have consisted of telephonic scripts for case workers to reach families during periods of lockdown, the use of an M-Health platform to deliver SMS messages to caregivers with COVID prevention messages and treatment adherence messages, the use of a WhatsApp platform to communicate with beneficiaries, and the use of radio platforms to reach beneficiaries.

  • CRS OVC programs in Cameroon, Uganda, and Kenya have worked with clinical partners to support the provision of ART to children living with HIV through the COVID-19 crisis, supporting the provision of multi-month dispensing (MMD). By educating case workers and linking them with clinics providing MMD, HIV+ caregivers and children have been maintained on treatment. In Kenya, community mentor mothers delivered ART to beneficiaries’ homes; in Cameroon caseworkers delivered ART to beneficiaries’ homes.

 

2020 TB TREATMENT

119. Advocate for and support Ministries of Health to rapidly transition to optimal paediatric formulations as outlined by the latest WHO guidelines, provide coordinated support for the development and implementation of transition plans, inform clinicians and patients of the value of transitioning to new formulations, and ensure communication of reliable information on the availability of new formulations in-country.

 

120. Support the scale up of access to priority formulations and diagnostics and take steps to facilitate their wider roll-out, including by performing operational research, developing introductory guidance and education, materials, and other tools for health facilities and local community health structures.

 

121. Promote the revision of national procurement plans to align with WHO recommended regimens and the EML-C, and support the provision of reliable forecasts and the consolidation of orders.

 

122. Mobilize their networks and work with communities to help build treatment literacy, generate demand, and expand access to TB diagnosis and treatment among children in close collaboration with other stakeholders.

 

123. Raise awareness in local, national, and global fora about the unmet diagnostic and treatment and prevention needs of children with or at risk for TB.

 

124. Foster and more actively participate in coordinated and collaborative advocacy to:

  • Increase funding for TB research & development, introduction and scale-up of priority paediatric drugs and formulations; 

  • Accelerate regulatory processes for rapid adoption and uptake of optimal paediatric TB drugs and formulations; and

  • Ensure sustainable access to optimal TB testing and treatment for infants and children.

 

125. Tackle the TB stigma and discrimination in communities, schools, and healthcare settings that prevent children and adolescents living with TB or at risk of TB from accessing testing and treatment, including promotion of awareness of the difference between infection and disease  and include messages of hope regarding treatment of both HIV and TB.

 

126. Promote uptake by mobilizing their networks of hospitals and community structures to distribute paediatric medicines in hard to reach places and in situations of conflict and crisis.

 

127. Support and increase TB treatment initiation and retention for children, adolescents, and families by:

  • Identifying all TB-exposed children and connecting them to treatment and preventive TB treatment through FBO clinics and within communities of faith; 

  • Reducing TB stigma and discrimination through mobilization and evidence-based education and training of faith leaders and faith communities

Updates

-