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.

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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.

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.

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. 

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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. 

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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.

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

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.

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.

 

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

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