PEPFAR DREAMS NextGen Guidance

Adolescent girls and young women (AGYW) face an increased vulnerability for HIV acquisition when compared to their peers. In 2022, girls and women accounted for 63% of new infections in sub-Saharan Africa with 4,000 adolescent girls and young women acquiring HIV every week (UNAIDS). Additionally, data show that AGYW are a priority population to target in order to reduce new infections to reach HIV epidemic control. Pillar 1 in PEPFAR’s 5-year strategy, “Health Equity for Priority Populations,” affirms PEPFAR’s commitment to addressing the largest global HIV prevention and treatment gaps that remain in adolescent girls and young women, children, and key populations. Focus area 1 under Pillar 1, “Advancing Gender-Equitable Programming,” emphasizes addressing gender inequality and preventing and responding to gender-based violence in PEPFAR’s HIV prevention and clinical cascade services. This is essential to achieving new infection reduction goals. Click here for the full PEPFAR DREAMS NextGen Guidance page

TB Preventive Treatment (TPT) Implementation Tools

TB Preventive Treatment (TPT) should be given to any person living with HIV in a country with high burdens of both diseases. It is logistically and financially practicable, and is considered a routine standard for HIV care and treatment. In many countries with high dual burdens, TPT is recommended and included in national guidelines. However, it has not been well-implemented or widely scaled up in most countries. There are many different reasons for this, including clinician concerns about adverse events or engendering drug resistance, or programmatic concerns about administrative leadership and procurement. Click here for the full TPT Implementation Tools page

Index Testing for Biological Children and Adolescents (19yo) of PLHIV: Clinical and OVC Partner Collaboration to Expand Testing Services

Without treatment, most children vertically infected with HIV will die by the time they are 5 years of age. Index testing is an effective HIV case identification strategy to facilitate diagnosis for vertically infected children, including children infected postnatally during breastfeeding. Scaling and maintaining pediatric index testing services (also known as family-based index testing) is critical to identify children and adolescents living with HIV (C/ALHIV) before they become ill and improve their access to antiretroviral therapy. This is especially true for countries with large pediatric treatment gaps to reduce HIV-related mortality and morbidity among C/ALHIV. Click here for the full Index Testing page

Community-Led Monitoring Tools

Placing communities and patients at the center of the HIV response is critical to controlling the HIV epidemic. In particular, collaborating with community members in a way that will identify barriers and enablers to accessing and utilizing HIV services is pivotal to PEPFAR’s client-centered focus. Approaches like Community-led monitoring allows communities to themselves design, implement and carry out routine, ongoing monitoring of the quality and accessibility of HIV treatment and prevention services. Through use of community-led monitoring approaches, PEPFAR programs and health institutions can pinpoint persistent problems, solutions or enablers, and barriers to service uptake at the facility- and community- level. This approach can help ensure PEPFAR is providing quality HIV services that beneficiaries want to utilize, improves the patient experience, and ultimately improves patient outcomes. Click here for the full Community-Led Monitoring Tools page

Human Resources for Health Staffing Allocation Tool

To achieve the UNAIDS 95-95-95 targets, health facilities and community-based HIV service delivery points need to provide efficient, effective, and high-quality services to ensure that people living with HIV (PLHIV) know their status, receive antiretroviral therapy (ART), and achieve and main viral suppression. A key resource to achieve this goal, among other system factors, is the health workforce. Most low- and middle-income countries, though, experience many challenges when it comes to producing an adequate health workforce. These include, misallocation of new health workers, shortages of available health workers, and limited productivity and performance of the existing health workforce. Each of the 3 toolkits below address one of the above stated challenges, and can be used individually or in conjunction with one another. Click here for the full Human Resources for Health Staffing Allocation Tool page

PEPFAR Guidance on Implementing Safe and Ethical Index Testing Services

PEPFAR recognizes the importance of providing all HIV Testing Services (HTS) in accordance with internationally recognized standards to ensure the provision of safe and ethical HTS to all clients. PEPFAR minimum standards for safe and ethical Index/Partner Notification HTS include adherence to the 5Cs (Consent, Confidentiality, Counseling, Correct, and Connection/linkage), inclusion of Intimate Partner Violence risk assessment, monitoring adverse events, and training and supervising providers on the rights of clients, informed consent, and ethics. PEPFAR is committed to ensuring that (1) all PEPFAR-supported sites meet the minimum standards for safe and ethical index testing services AND (2) routine monitoring and remediation practices are in place for accountability and action.  PEPFAR believes that working collaboratively with diverse stakeholders is essential to improve the quality and effectiveness of services we support. As such, PEPFAR will work collaboratively with civil society partners, government leaders, and PEPFAR Implementing partners to ensure all voices are heard, remediation actions are taken in a timely manner, and the safety and ethical treatment of clients remains of utmost importance. Click here for the full Safe and Ethical Index Testing Services page

Loss to Follow-Up Tool: Tracking and Tracing HIV Patients

Loss at each step of the HIV diagnostic and treatment cascade has been well documented. Many newly-identified people living with HIV (PLHIV) fail to link to or enroll in care and initiate treatment, and those on antiretroviral treatment (ART) often miss appointments and fail to return to care/treatment. Addressing poor linkage and retention is critical for achieving HIV/AIDS epidemic control. Successful tracking and tracing of PLHIV who have failed to initiate treatment or failed to return to care/treatment will allow targeted interventions to help return those patients back to treatment, document their treatment in another setting, or document their death or loss to follow up (LTFU). Click here for the full Loss to Follow-Up Tool page

HIV Case-Based Surveillance System with Biometric Code and Patient Linkage and Retention Tool

Before 2012, Haiti did not have a system for following HIV-positive patients along the continuum of care. The Ministry of Health (MoH) realized that the lack of an integrated surveillance system was contributing to difficulties in tracking and treating people living with HIV (PLHIV). Whether PLHIV chose to use a different health facility, discontinued care altogether, or died, there was no system in place to track these individuals. As a result, in order to advance Haiti’s efforts to end its HIV epidemic and meet the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets, the MoH developed one of the first longitudinal case-based surveillance systems in the Caribbean region. Click here for the full HIV Case-Based Surveillance System page

Programmatic Considerations to Strengthen OVC and Clinical Partners Collaboration for Improved Health Outcomes

Collaboration between OVC and Pediatric HIV Clinical programs improves health outcomes for C/ALHIV, families affected by HIV, and PEPFAR-supported partners. However, technical, and programmatic considerations with compiled resources and actionable steps for PEPFAR-funded OVC and clinical partners to collaboratively build an integrated approach were not readily available. Click here for the full OVC and Clinical Partners Collaboration page

The Botswana Combination Prevention Project (BCPP) Data Linkage Tool

Data management systems that support individual-level patient tracking are often neither affordable nor easy to implement. However, being able to track patients at the individual level can facilitate timely and accurate HIV service delivery to those in need. For example, real-time follow of antiretroviral treatment (ART) patients who have not picked up their medications reduces the amount of time an ART patient is without medication. Click here for the full Botswana Combination Prevention Project (BCPP) page

Index and Partner Notification Testing Toolkit

Index testing and partner notification is a core intervention used to efficiently and effectively identify HIV-positive individuals. However, tools that helped ensure index testing programs were implemented with appropriate quality, scale, and fidelity were not readily available. Click here for the full Index and Partner Notification Testing Toolkit page

Expedited Biobehavioral Surveys and Data Availability

Data is necessary for targeted service delivery. Key population (KP) programs need relevant and timely data about KPs—sex workers, men who have sex with men, transgender individuals, people who inject drugs, and people in prison and other closed settings—engaged and not engaged in services in order to target their services. Biobehavioral surveys (BBS) provide population-based information about KP risk behaviors, HIV prevalence and, importantly, the 90-90-90 cascade to inform service provision and policy. The time BBSs take to plan, implement, and make available the results for remediated actions, is a major limitation to their utility. Click here for the full Expedited Biobehavioral Surveys and Data Availability page

Human Resources for Health Inventory Tool to Assess Donor-Supported HIV Workers

PEPFAR, The Global Fund, and other donors have invested millions of dollars to supplement the budgets of governments for human resources for health (HRH) and health worker staffing. Yet, there is a need for greater data to inform who the donor-supported workers are, where they are located, related costs, and status of alignment with existing host-country government structures and policies.  Donors and host governments need better tools to understand the scope and nature of staffing investments in order to optimize health worker utilization to advance epidemic control and to inform sustainability planning once epidemic control is achieved. Click here for the full Human Resources for Health Inventory Tool page

Improved Monitoring of the Key Population Cascade – The Need for Use of Customized Indicators

Specialized non-governmental organizations (NGOs) frequently provide testing and prevention services for key populations (KPs). However, HIV care and treatment are typically only accessible via government facilities. NGOs, then, act as the mechanism to link KPs to HIV testing and treatment services. Existing monitoring and evaluation (M&E) frameworks do not enable NGOs to measure and report these linkage services. As a result, it is difficult to track progress toward epidemic control among key populations. Click here for the full Improved Monitoring of the Key Population Cascade page

 

U.S. Department of State

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