Post Office Tender - Equip Health



18323982291644EQUIP ZambiaQ3 Program Performance Report(01 April 2017 to 30 June 2017)____Submission Date: 07 September 2017Grant Number: AID-OAA-A-15-00070Activity Start Date: October 01, 2016USAID Mission POC: John KuehnleSubmitted By: Dr. Crispin Moyo00EQUIP ZambiaQ3 Program Performance Report(01 April 2017 to 30 June 2017)____Submission Date: 07 September 2017Grant Number: AID-OAA-A-15-00070Activity Start Date: October 01, 2016USAID Mission POC: John KuehnleSubmitted By: Dr. Crispin MoyoAlthough Zambia progress on spend is well behind target, much has been achieved in readiness of Test and Treat rollout:GIS mapping of facilities and road infrastructure is a huge enabler of optimal planning both for CCMDD and VL scale upActivation on the MMSD studyMOP up activities have been initiatedHIV self-testing project to be activated in September 2017A paper submitted on the protocol for MMSD in Zambia and MalawiThe treatment cascadeThe 2017 trends illustrate, a significant increase in HIV tests conducted within all quarters (Figure 1). Against the annual target for FY17, a 274% performance was achieved. The HIV positive yields have increased by quarter, and reflects a 136% achievement rate. To continuously improve these numbers, EQUIP Zambia has activated several targeted interventions that will increase access for testing for those at significant risk for HIV (these are detailed in the sections to follow). A steady increase in ART initiations have been observed, though still low (51% performance). This could be associated with Pre-ART patients that still need to be linked to treatment. A Mop-up exercise is still being prepared and will be activated in quarter 4. This will allow for a rapid transition, ultimately increasing the number for those initiated on ART. We anticipate this will be demonstrated in quarter 4 reports.The cumulative current on treatment remain higher than the annual target, but the treatment net new dropped in quarter 3 (confounded by the low numbers for those initiated on ART for the same quarters). No data from country sources is available for 2016 (q3 and 4). However, data is available on Panorama for the same periods is provided below:EQUIP-specific interventions along the cascadeFocus Area: Rapid Test and Treat Roll Out Support The following data reflects the total HTS done, yield and linkage to treatment by periods specified below, for the 6 provinces in which EQUIP is providing technical assistance in Zambia.HIV Counselling and Testing and Linkage to Care, by province, [Quarter 3 and 4 FY16 and Quarter 1, 2, 3 FY17]As for the data presented for quarters 3 and 4 (2016), data was sourced from Panorama, while actual data sources from Zambia were used for FY2017 Q1 - 3.The absolute numbers for HTS_POS increased between quarter 3 FY 2016 to quarter 3 FY2017 in the Copperbelt and marginally in Muchinga province. No particular trends were observed in the rest of the provinces for HTS_POS. The yield remains low in all provinces and targeted interventions for increasing are being introduced by EQUIP and explained in detail under the intervention section and includes HIV Self testing project, PICT, targeting high risk populations etc. Across all provinces, the linkage percentages reflected by TX_NEW (%) were all above 60%, for the time periods presented, with Northern Province, Muchinga, and North-west province having the highest in quarter 3 FY17. Activities to linkages to care are explained in detail under the intervention section, and includes MOP activities, strengthening test and treat, and linkage Apps, etc.Note: data for Q3 and Q4 2016 sourced from PanoramaCombined data illustrates that the rates of HIV testing remain high, however the yield remains low. Linkage to care indicates that out of 10 diagnosed to be positive, 7 are currently being linked to care. Evidence from the EQUIP Implementation Capacity Assessments (ICA) indicate an overall average yield was high (11%) in TB population, index partner, STI and inpatients. This indicates that if we target these populations, this could the total yield for Zambia.Focus Area: Differentiated Models of ART Delivery with focus on Multi-Month Scripting and dispensing at both Facility and Community levelEQUIP is assessing differentiated models of care in Zambia with retention and viral load suppression as primary HIV outcomes. These projects are explained in brief below:Multi-month dispensing (second and third 90)EQUIP Zambia has set ground for taking part in a multi-country Interval study to examine the role of multi-month supply of ART on retention and virologic suppression within 15 high volume sites in Kabwe, Kitwe and Ndola districts. The study activated in the 14th of august 2017, and to date a total of 80 were screened; 8 enrolled (target=2100) (5 in the 3 arms and 3 in the standard of Care arm); Primary reason for ineligibility was not having viral loads in the last 6 months.Centralised Chronic Medicines Dispensing and Distribution ProjectThe CCMDD initiative targets to enrol over 22,500 patients stable on ART out an estimated 47,721 patients (as at FY17 Q1) currently on ART (TX_CURR) in Ndola. The main purpose is to assess HIV related outcomes including retention and VL suppression after offering multi month dispensing of ART and other chronic medications. We hypothesize that this will facilitate decongesting facilities in Ndola district. This initiative will be activated in September 2017. The following milestones with regards to the CCMDD project were achieved: Quarter 4 FY16A site tour of the differentiated strategies and technologies of delivering ART by Right to Care in South Africa was conducted for the delegation of the key stakeholders from Zambia A concept note was subsequently developed and disseminated to all key stakeholders in Zambia on the implementation of the CCMDD programme. The concept note was accepted by both the Ministry and the USAID Mission.Quarter 2 FY17 An implementation plan and the budget estimates were prepared and approved as part of the country work planA feasibility assessment was conducted in Ndola and 10 high volume treatment sites which accounts for over 70% of patients currently on ART were selected The Medical Stores Limited (MSL) hub was identified as the potential CDU for the demonstration projectQuarter 3 FY17An assessment of 21 potential community-based alternative Pick-up Points (PuPs) was conductedA survey of patient preferences from a sample of 100 patients was conductedThe GIS mapping 21 PuPs was concludedA Service Level Agreement with potential PuP was drafted and finalisedThe process of contracting PuPs as service providers in the CCMDD programme was initiated and 13 PuPs were successfully contracted following compliance to set the criteriaThe process of contracting will be ongoing as more PuPs comply with the standardEQUIP engaged Right ePharmacy (REP) as the potential service provider of the CCMDD IT systemAn assessment of the IT infrastructure requirements was conducted in the identified 10 treatment sites, 20 potential PuPs, and the CDU sites in the MSL hub The system user requirements were finalised with REP and a proposal on the development of the system was acceptedThe first module of the systems which provides the functionality of patient screening and enrolment onto the CCMDD programme was completed and undergoing testingFocus Area: Strategies and Technologies for more efficient increases of HIV Testing Yield, Initiation on ART, Retention on ART and Viral Suppression for both Children and Adults Through FHI 360, EQUIP Zambia is offering technical assistance to facilities to improve testing yields through: Recruitment of local HIV counsellors in high volume facilities Index trailing to households (Partners of EMTCT and partners of positives on ARTScale up and monitoring of index testing, partner notification and targeted PITCMobile testing including ad hoc or temporary testing locations, such as a community centres, school, or mobile unit.Index trailing for HIV positive clients on treatment, POC testing, inpatient testing, exposed testing of babies, TB clients and EMTCT ClientsLynx-HCT applicationAs part of the current Lynx-HCT application enhancement, EQUIP engaged Qode? to include a linkage to care module to the technology framework. We believe that the only realistic link between testing (community, facility or self-testing for HIV) and treatment is to create access point for users of testing technology to an online off-line booking system. Therefore, this will be coded into the Lynx framework and then offered to public sector at no charge. Our data capturing software will have the ability to refer a patient into the listed facility booking system through the application interphase. The completed scoping document is being detailed into a user story which will be presented to stakeholders for review, before the programming and coding will commence. In parallel with the development of these documents the Qode-Lynx core technology has been strengthened to accommodate this and other interphase modules into the framework. Additionally, we intend in quarter 4 FY17, to activate HIV self-testing projects which will assess the uptake of HIV testing and yield using HIV ST strategy and linkage to treatment among adolescents and young adults aged 16 to 24 ears. Self-testing applicationEQUIP has engaged Qode? to develop a self-testing application which will help deliver on a research protocol developed with the Zambian Equip team.? This will be a new development into the Lynx-HCT framework.? The goal will be to use different Lynx applications to capture client data linked to the research protocol and have automate report available on live data within the framework.? This application will be ready in Q4FY17, when the project activates.Activities to strengthen linkages to care include MOP up activities that have the primary objective of cleaning up the PRE-ART registers. The MOP is also enabled by a high tech tool. Additionally, EQUIP Zambia through MOP and TA activities will strengthen the Test and Treat approach. As for data related for viral suppression, currently there is no data to reflect on this indicator. However, EQUIP Zambia has several innovative initiatives that are either on-going and/or about to be start to improve availability of data. These interventions include GIS mapping, E-labs, MOP up and VL scaling up activities. VL scaling up will be facilitated by a laboratory database being developed. We describe these interventions in detail under the relevant section (section 4).EQUIP is currently activating projects and studies, that will explore and assess innovative models on retention and VL suppression through multi month dispensing of drugs (the MMDS and CCMD projects).Paediatric activitiesTo date the following are the pediatric activities that are ongoingvalidation of the implementation capacity assessment toolPresented on challenges to VL suppression in paediatrics and adolescents at the Annual National HIV conference in December 2016.Supported in the development of the national HIV positive paediatric referral tool.Supported the development of a toll free helplines with paediatric experts in South AfricaSupported of the following tools for ZambiaPartial and full Disclosure tool (with training)Adolescent support group tool (with training)Resistance explanation toolMentorship logbook.Innovative approaches to support the Rapid Scale up of Viral Load MonitoringEQUIP lead a country wide GIS mapping exercise, with other partners including CDC, USAID and MOH-Zambia. This inter-agency border-less planning was facilitated and lead by EQUIP and USAID missions in Zambia. Whilst EQUIP is a USAID support mechanism; this mapping went beyond the areas EQUIP provides technical assistance, demonstrating EQUIPs approach of supporting the entire country.During quarter 3, 2017, EQUIP successfully completed the comprehensive assessments of 655 laboratories. The labs, which fall under the Ministry of Health, Zambia Defense Forces and private ownership, were initially identified under the GIS assessments. As part of the Viral Load Monitoring Scale Up, EQUIP provided technical assistance towards the mapping of 2433 healthcare facilities, across the whole country. The GIS mapping and laboratory assessments contributed towards the cost modelling for sample transportation and supported the VLSU strategy by guiding the optimum placement of VL testing platforms. The results from GIS analyses were presented in several meetings, held between EQUIP, CDC Zambia, USAID Zambia and implementing partners. These results provided key planning information, which generated a lot of interest, discussions and cooperation between partners. Other HIV organizations in Zambia including Churches Association of Zambia (CHAZ) and EGPAF, have used the GIS and laboratory assessment data collected under EQUIP, to identify locations where they can optimally place their newly acquired VL PCR Analyzers. By end of Q3, 91% of all public facilities in Zambia had been mapped by the GIS teams. In addition, high volume ART facilities and existing viral load platforms across the country had been identified. Initial GIS based analyses were then conducted to address the following: linking site level clinical information to location, for monitoring and evaluation purposes,vehicle routing and route optimization, in line with viral load scale up,analysing optimal location for placement of viral load machines using GIS algorithms.In Q4, a GIS based approach that uses facility level pre - ART registers to geo-map patients, will be implemented to; guide demand creation and facilitate patient tracing. To link key HIV information to location, clinical information from selected high-volume ART sites (in the provinces) and facility level data from field mapping, were integrated in ArcGIS, to create key spatial representations that show by location, the spread of 4 key HIV indicators, namely: (i) total number of HIV tests done (HTS); (ii) number of HIV positive tests (HTS (+ve); (iii) number of new patients of ART (Tx new); and (iv) number of patients currently on ART (Tx current). Linking key HIV information to sites will be important for programme implementation monitoring and evaluation.Optimal placement of VL machines: GIS based locational analyses was used to guide the placement of 4 new viral load testing machines bought in Zambia. Using ArcGIS, a GIS location allocation model was conducted to determine the optimal sites for placement of 4 new viral load machines, relative to high volume facilities. As shown on the map, the GIS algorithm selected VL labs in Chipata (Eastern), Ndola (Copper belt), Kabwe (Central) and Livingstone (Southern). Interestingly, the two VL labs in Lusaka were not selected. This appears to suggest that capacity of labs in Lusaka is sufficient and that the new machines would be better placed in other locations, with higher VL test demands and limited capacity.GIS used to determine vehicle routing: Furthermore, GIS analyses was used to determine the best vehicle routes, across the country, in support of sample transportation. A Vehicle Routing Problem Analyses was done using the road network (routable layer) and other assumptions (such as working hours and time spent at each facility); to determine optimal routes for vehicles from each of the VL labs. The map below presents an example of a vehicle routing analyses, performed for Southern Province currently. The map shows: the chosen daily routes (in brown) and weekly routes (shown in blue). All high-volume sites are shown in green, and 2 hubs have been selected at Choma and Mwandi. The VL lab is in Livingstone, and 2 unreachable high volume sites shown in red can be seen. These 2 unreachable sites could potentially be considered for point of care devices. Thus, through use of GIS, a lot of forward planning for routes has been facilitated across all provinces in Zambia.In Q4 FY17, a GIS based concept that involves the locational geo-mapping of patients using facility level pre-ART registers, will be implemented. Under this approach, pre-ART registers at selected facilities will be reviewed to extract patient addresses, which will then be geo mapped to the location of patient’s origin (suburb, village, street). Bubble maps showing patient origins will then be created. These bubble maps will then be used for guiding demand creation, patient tracking and directing out of facility activities. Those locations with high patient numbers (bigger bubbles) will be prioritized for demand creation, compared to locations with smaller bubbles. This will accelerate the tracing and linkages of ART patients. Laboratory data repositoryEQUIP has engaged Qode? to work with the NHLS and other partner to find a solution to the multiple data sources used in Zambia for laboratory data and or information systems. A collaborative meeting between stakeholders was held and a proposal was submitted to use the QodeInsight solution to interphase with the different LIS and data capturing systems, and to create a data repository with all laboratory data including viral loads and other HIV related variables i.e. CD4 from multiple systems. Algorithms and interphases and or scripts will be developed to place the collected data on data tube or tables. Visualization tools will be used to view the structured data within the data repository. Project proposals were written for the project after the stakeholders meeting and project plans are in place. eLABS demonstrationAn end to end holistic approach of managing VL using an application will be developed. The system is devised to cover the gaps found during the laboratory assessment. eLABS is expected to strengthen the VL value chain from patient registration, transportation, cold chain monitoring and result feedback to facilities and communication with patients.Mop-up applicationEQUIP engaged Qode? to develop a tool which can be used to “mop up” the current patients viral load into a clinical system which can help with the transition between current service providers and the Equip. the solution/tool is currently being used by the Equip teams.Key Success Q3 Fy17GIS mapping of facilities and road infrastructure is a huge enabler of optimal planning both for CCMDD and VL scale up as explained in Section 4Activation on the MMSD study in Q3FY17MOP up preparations concludedCCMDD preparations concluded and Section 3A paper submitted on the protocol for Zambia and Malawi (MMSD)Challenges Data gaps and completeness at facility levelsThis challenge remains a concern, and EQUIP has engaged Qode? to assist in developing a data repository that will aid all countries including Zambia in improving data resolutions, timely queries and improved integration of data. To date, the Qode? team have developed with the RTC and the Equip M&E, research and other relevant teams a project plan for this data repository/warehouse.?This included looking at the long, medium and short term deliverables.? The long term deliverable will include but is not limited to have a M&E data repository with limited data capturing to be done.? The transition will be from data capturing, cleaning to data being collected at the point of intervention through online tools.? These coded tools will integrate, compute and compare the various health outcomes/variables from both the public sector and other operational data sources.? Qode? has shared all assessments on the current data collection tools and EQUIP has given feedback on all excel tools currently being used.? These excel files will be “flattened” then standardized and loaded into the data repository. Viral load dataAs detailed in section 4, various activities are ongoing to improve data and scaling up of viral loads. These activities include GIS mapping, addition of viral load machines, and placing them at the right locations, developing of a laboratory database, and linkage Apps, and the MOP up activities.Low yieldsHIV self-testing projects to begin in Q4FY17, targeted among adolescents and young adults aged 16 to 24 years in 15 selected intervention clusters as compared to control clusters in two districts on the Copperbelt and Central provinces of Zambia. Additionally, EQUIP Zambia is offering technical assistance to facilities to improve testing yields through a targeted approach for those at higher risk for HIV acquisition (these activities have been detailed in Section 3)Planned activities for the next performance period (1 July 2017 – 30 September 2017)HIV Self testing study (first and second 90)An open label two-arm parallel, stratified, cluster-randomized study with the primary objective of accessing the uptake of HIV testing and positivity yield using HIV ST strategy and linkage to treatment among adolescents and young adults aged 16 to 24 years in 15 selected intervention clusters as compared to control clusters in two districts on the Copperbelt and Central provinces of Zambia. We selected the cluster-randomized design to reduce between-group treatment contamination. This study will be activated in q4 2017, and significant preparedness were done in q3 2017MOP and tracing activities and test and treat roll out (closing the pre-ART register) (cut across all 90s)To improve on the improve effectiveness of healthcare workers in providing HTS, EQUIP Zambia supported the Ministry of Health in printing of 10,000 additional copies of the 2016 Consolidated HIV Prevention and Treatment guidelines for Test and Start during the reporting period. The guidelines will be rolled out to facilities during site visits coupled with onsite mentoring to healthcare providers. The MOP rapid activities were planned in detail in q3, and will be activated in q4. This will allow, and in increase in the numbers initiated on ARTCCMDDTo be activated (screening and enrolling) in quarter 4 FY17 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download