​Commitment 28:

March 2022

• In collaboration with MoH, FASTER Uganda developed demand creation and patient literacy materials focused on children and adolescents. These included messages for PMTCT/EID for use by faith leaders in their communities. 35 Master trainers with representation of the 7 Religious denominations in Uganda were represented in the training. They are now cascading messages through their networks. 

• 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. 

• FASTER Nigeria developed the GRAIL III Strategy Training curriculum on HIV Prevention, Treatment and Care and Pastoral Guide for Facilitators and Religious Leaders and trained 87 religious’ leaders on incorporating HIV messaging on HIV testing to facilitate demand creation in  the pediatric and adolescent population.  

• FASTER Nigeria strengthened the capacity of FBOs to provide HIV testing services which improved case finding among pediatrics and adolescents. 

• FASTER Nigeria organized an inter-faith network of religious leaders to drive demand creation for pediatric and adolescent HIV testing and linkage to treatment and retention using existing DSD models and adopting novel strategies to improve bi-directional linkages between facility and community-based providers to monitor testing, treatment linkage and viral load uptake. 

• FASTER Nigeria supported the mapping of FBOs, the development of FBO service directories and activity plans, and inaugurated FBO network quarterly meetings across all FASTER states. 

• FASTER Nigeria supported the inclusion of FBOs into various state HIV response coordination platforms, like pART TWG, OVC TSC and other coordination meetings as statutory members. 

• FASTER Nigeria supported NACA, UNAIDS, PEPFAR, and FBO Nigeria Faith-Based Response initiative and contributed to the development of the operational plan of the initiative on increases case finding, linkage to treatment and retention. 

 

Previous

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. 

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Commitment 29:

March 2022

• The Lesotho 4Children Faith Communities Initiative developed and rolled out a sermon guide, Compassion to Care: HIV Essentials for the Faith Community, 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. An accompaniment, Compassion to Care: A Guide to Action, will also be rolled out to help faith communities make and implement action plans to address community needs related to HIV, including addressing stigma, increasing access to treatment and adherence, and family strengthening such as positive parenting and economic strengthening.

• FASTER Uganda developed materials for use by faith leaders in addressing stigma associated with HIV. These materials were developed with the input of representatives from faith communities. These materials are currently being rolled out through FBO structures.  

• FASTER Tanzania supported development and distribution of FBO-tailored stigma and discrimination fact sheet. 

• FASTER Nigeria supported the development of the GRAIL III Strategy Training curriculum on HIV Prevention, Treatment and Care and Pastoral Guide for Facilitators and Religious Leaders and trained 87 religious’ leaders to incorporate HIV messaging on stigma reduction in their various parishes. 

 

Previous

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. 

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Commitment 30:

March 2022

• FASTER Nigeria formalized community and FBO facility partnerships, improving ownership of locally owned strategies to achieve the 95-95-95 UNAIDS targets. The platform was used to evaluate existing DSD model, adopt new strategies and improve bi-directional linkages for facility and community-based providers to strengthen testing, treatment, and viral load uptake. 

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Previous

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.

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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. 

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Commitment 31:

March 2022

• FASTER Nigeria facilitated the inclusion of FBO representatives in state HIV response coordination platforms, e.g. pART TWG, OVC TSC and other coordination meetings as statutory members. This was achieved through organization of an FBO coordinating body for each state from where an FBO representative was identified for inclusion as a statutory member of the pART TWGs where discussions and decisions on product and supplies forecast.  

 

Previous

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.

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Commitment 32:

March 2022

• FASTER Uganda expanded the use of POC/EID from 33 pilot health facilities in FY20 to 132 facilities by September 2021, by placing 100 m-PIMA machines. Health workers at these facilities were trained on the use of the devices. FASTER also supported connectivity of these sites to the national LMIS, and improved coverage of tests done on POC platform from 2% in 2020 to 22% by 2021 (national target is 20% on POC platform). 

• FASTER Uganda developed job aid for EID/EPI integration to increase demand for POC/EID. Health care workers at FASTER supported sites were trained on the use of this tool.  

• FASTER Nigeria supported the re-establishment and quarterly meetings of the National HIV Lab Task Team (NHLTT) and developed the draft harmonized procedures to streamline processes for in-country validation and approval processes of In-Vitro Diagnostics (IVDs). This is to fast track the development of national strategies on the optimal use of new technologies and interventions and facilitate the rapid adoption and use of pediatric diagnostics. 

• FASTER Nigeria integrated POC EID testing on GeneXpert devices at 7 sites. Procured catalytic commodities following assessments. Supported monitoring, data management and personnel training 

• FASTER Nigeria rolled out Remote Sample Logging (RSL) at 21 priority sites and scaled to 430 additional sites across the country to reduce lab TAT. FASTER Nigeria has introduced the USSD technology which continues to be used for sample tracking and result delivery 

 

Previous

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.

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* 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:

March 2022

• FASTER Uganda completed their “Caregiver-assisted Oral Fluid-based HIV Screening of Children 18 Months – 14 Years” study in early October 2021, finding high acceptability, feasibility and effectiveness. Results were presented to the MoH HTS policy review committee in December 2021, resulting in the incorporation of caregiver-assisted HIVST of children into the national HTS policy. 

• FASTER Uganda introduced programmatic implementation of HIVST among adolescents 15-17 years. Adolescents appreciated this testing model peer distribution of HIVST kits, counseling and linkage to care support. This modality has also been included in the national HTS policy. 

• FASTER Zambia completed their “Caregiver-assisted Oral Fluid-based HIV Screening of Children 18 Months – 14 Years” study in late October 2021, finding high acceptability, feasibility and effectiveness. Results were presented to MOH and changes to national HTS policy are being discussed.   

• FASTER Nigeria supported the reactivation of the national task team on HIV Self Testing by NASCP (FMOH) to drive the scale-up and coordination of HIVST in the country. The project also provided technical assistance on the development of SOPs and guidelines, job aids, and HIVST trainers’ and trainee manuals 

• FASTER Nigeria advocated for the inclusion of HIVST kits in the national health commodity logistic management and built the capacity of HIVST service providers on HIV self-testing, tracking, linkage to care and reporting. 

• FASTER Nigeria provided continuous capacity building of service providers using onsite mentoring and virtual platforms. 

• The Project procured 100,000 HIVST kits and distributed to clients across 282 service delivery points (including health facilities, community pharmacies, TBA homes, CBOs, and FBOs) in the supported states. 

• FASTER Nigeria supported service providers to track clients through phone calls and home visits, escort clients for confirmatory HIV testing and uptake of linkages to treatment 

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October 2021

• In Nigeria, 98367 HIVST kits were distributed to clients out of which 99.9% of kits reported a result with an average of 4.4% reporting reactive results out of which 92.7%(n=4020) were confirmed HIV positive and linked into care. The yield for facility-based distribution of HIVST kits is 4.8% (n=29077) while community-based channel yielded 4.0% (n=71461). The yield across the 7+1 states ranged between 2.1% (Lagos state) and 9.0% (Delta state). Drawing from the lessons learnt from this demonstration, FASTER Nigeria is providing technical support to the Government of Nigeria for the implementation of HIVST services.

• In Tanzania, Uganda and Zambia – FASTER has supported targeted programmatic implementation of HIVST for adolescents.  

• Regarding the CDC funded study on the feasibility and acceptability of the HIVST in developing settings, Zambia has been enrolling adult parents/caregivers since the beginning of Feb 21 and Uganda has been enrolling since the third week in April 21. 

• Preliminary updates

  1. FASTER Uganda completed the OraQuick Caregiver-assisted oral fluid-based HIV study data collection on 30 September, having achieved full sample size of 4,739 children 18 months – 14 years at 32 study sites. Data cleaning and preliminary data analysis are ongoing. 

  2. FASTER Zambia has completed more than two-thirds of the OraQuick caregiver-assisted oral-fluid-based HIV study data collection with over 2,300 biological children 18 months – 14 years at 15 study sites. Data cleaning and preliminary data analysis and report writing are ongoing.

  3. FASTER Zimbabwe with EGPAF have completed both the quantitative and qualitative study components of the “Assessing the feasibility, acceptability and effects of HIV birth testing in maternity settings in Zimbabwe.” This study included the introduction of neonatal raltegravir granules for HIV-positive infants 0-28 days of life. Data analysis and report writing for the quantitative component are being completed by end of September. The data analysis and manuscript writing are ongoing and will be completed by January 2022. 

• Finally, we expect to complete enrollment in Zambia by the end of November, and in Uganda data collection has been completed.  

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October 2020

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• 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.

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June 2020

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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.

 

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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.

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April 2020

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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

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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.

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)

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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.