Capacity Building

EQUIP works with local partners to strengthen country capacity for HIV services. Providing technical assistance to expand local capacity serves the goal of fostering a sustainable model for development in EQUIP-supported countries.

Capacity is a multidimensional concept. Capacity is the attribute of the individuals to fulfil their role and be able to adapt their response to changing conditions and contexts.

EQUIP and local implementation partners provide methodologies and tools designed to assist countries and local stakeholders in their quests for performance excellence.

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Community-Based ART

Delivering antiretroviral therapy (ART) to key populations requires innovative models and strategies to ensure effective and equitable delivery.

EQUIP and local implementation partners propose and implement context-specific, community based strategies, with a focus on retention and adherence, to deliver antiretroviral therapy (ART) to EQUIP-supported countries.

These strategies assist in improving access to ART delivery while minimizing barriers to retention, improving both the level of access to treatment and the quality of health outcomes for people living with HIV. ing services.

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Cost Modelling

Cost modelling data and reports for the differentiated models of testing, linkage and treatment scenarios in EQUIP-supported countries are developed according to requests from country stakeholders. Findings from modelling studies help health policy makers inform planning of services.

Performing cost analyses is essential in order to determine that the price the Government will pay for the supply, service or program is fair and reasonable. Analysing costs will strengthen the impact of work done, save money, and reduce the need for U.S. assistance over time.

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Demonstration Projects

Delivering antiretroviral therapy (ART) to key populations requires innovative models and strategies to ensure effective and equitable delivery.

Demonstration projects test and measure the effects of program changes in real-world situations.

EQUIP and local implementation partners propose and implement context-specific, community based strategies, with a focus on retention and adherence, to deliver antiretroviral therapy (ART) to EQUIP-supported countries.

These strategies assist in improving access to ART delivery while minimising barriers to retention.

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Direct Service Delivery

EQUIP provides scale-up of direct service delivery (DSD) support to sites and accelerates health systems strengthening initiatives, including those focused on health financing, Human Resources for Health (HRH), information systems, laboratory services, quality of service delivery, and supply chain.

Among the DSD services include: ongoing procurement of critical commodities such as test-kits, condoms, lubricants, or funding for salaries of personnel providing any of the prevention package components (i.e. peer navigators, outreach workers, program managers).

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Health Economics

Cost analyses and cost effectiveness models provide by EQUIP and local implementation partners deliver vital insights for decision-makers to better understand the cost implications of different treatment scale-up scenarios. Countries rely on accurate information on which to base resource allocation decisions that will affect health outcomes.

Health Economics apply economic approaches to inform policy decisions on the efficient allocation of scarce resources and provide technical advice to policy-makers on the use of economic policy levers to modify health behaviours.

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HIV and Hepatitis C Co-Infection (HIV/HCV)

Among the 36.7 million persons living with HIV in 2015, an estimated 2.3 million had been infected with Hepatitis C Virus. Liver diseases are a major cause of morbidity and mortality among those living with HIV and coinfected with viral hepatitis. They should be diagnosed and provided with appropriate and effective treatment for both HIV and hepatitis as a priority.

EQUIP implements and evaluates a simplified HIV/HCV testing, treatment and care model integrated with HIV testing and treatment initiation for co-infected individuals.

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Key Populations

Key populations are identified as commercial sex workers (CSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender persons and prisoners. These communities face much higher rates of HIV and AIDS than the general population, butt also have the least access to prevention, care, and treatment services because their behaviors are often stigmatized or even criminalized. Key populations are often extremely difficult to reach for critical testing, care and treatment services.

They also face significant barriers, prevent key populations from accessing the healthcare services they need. EQUIP’s Technical Working Groups (TWGs) address these elements and provide research-based recommendations for EQUIP-supported countries.

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Multi-Month Scripting and Dispensing

EQUIP is working with local partners to conduct demonstration projects for Multi-Month Scripting and Dispensing (MMSD) at both facility and community level.Demonstration projects provide stakeholders with important insights from operational research that can help countries establish or expand MMSD models appropriate to different community contexts.

The rationale for implementation of MMSD is to improve adherence to treatment, reduce costs of treatment (at patient and facility level), decongest health facilities to allow more intake, and reduce waiting times.

The practice of scripting and dispensing multiple quantities of a medicine at once, for periods exceeding one month, is only provided to a patient who is clinically identified as stable on treatment against defined criteria by an authorized prescriber or treating physician.

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Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) demonstration projects provided by EQUIP and local implementation partners aim to assess acceptability, feasibility and capability, and are conducted according to country work plans.

Findings from PrEP demonstrating projects are used to inform national PrEP guidelines and support PrEP roll-out in EQUIP-supported countries.

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Protocols and Procedures

Clear operational guidelines, quality standards and protocols are required for effective service delivery in EQUIP-supported countries. EQUIP and local implementation partners review and propose new protocols and monitoring procedures used for the training of healthcare workers, as well as information management systems needed for monitoring client registration, intake and referral mechanisms. Quality improvement processes are also provided for auditing adherence to policies, protocols and procedures, to establish and improve staff competency, counsellor skills, counselling protocols, the adequacy of laboratory testing and the perspective of clients on the accessibility and acceptability of testing and counselling services.
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Rapid Assessment Clinical Facilities

EQUIP provides a rapid assessment of clinical facilities at country and community level to better understand the barriers to providing and/or expanding high quality HIV care and treatment services.

Referred to as SWAT teams by staff on the ground, the EQUIP rapid-response treatment and prevention teams draw on support from local stakeholders.

SWAT Team work is a combination of technical expertise, resilience and commitment to ending the HIV epidemic by 2030 – assessing training and personnel capacity to deliver on a range of HIV services.
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Reaching Men

The sexual health needs of men who have sex with men (MSM), particularly men who identify as straight but engage in same-sex sexual practices, are notoriously neglected, making them a most-at-risk group, or key population in the HIV epidemic.

Barriers to MSM seeking health care include endemic homoprejudice and related stigma, anal phobia and discrimination – also within the public health system. EQUIP and consortium partner, Anova Health Institute’s Health4Men initiative is one of the first projects on the African continent to draw considerable attention to and address the sexual health needs of MSM in the context of HIV.

EQUIP utilize every available platform and context-specific strategies to reach men and ensure access to HIV prevention, treatment and care.
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Self-Testing

HIV self-testing is a new approach that has significant potential to address barriers to testing, while improving access to HIV testing beyond the limitations of existing country and community level infrastructure.

EQUIP and local implementation partners conduct self-testing demonstration projects in EQUIP-supported countries to strengthen uptake of HIV self-testing among key populations and contribute towards the 90-90-90 testing and treatment targets.
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Technical Assistance

When EQUIP visits a country, we assess what the problems are and then come up with innovative solutions to advise the ministry of health on how to improve their HIV management health systems.
The Technical Assistance team consists of staff who have clinical experience and technical specialty in either HIV care and treatment, supply chain, pharmaceutical, laboratory and commodity. Many have managed programs and worked in different public or private health systems. Ongoing support for HIV prevention includes mentoring and supportive supervision; training; organizational strengthening; program design like development of training curricula, standard operating procedures (SOPs) and follow-up to ensure quality of care; regular assistance with monitoring and evaluation functions and data quality assessments; or supply chain management.

Test & Start Roll Out

In October 2015, the World Health Organization issued on what it calls the treat-all approach—recommending antiretroviral therapy (ART), for everyone living with HIV at any CD4 cell count.

Commonly known as Test & Start or Test and Treat, this approach begins patients on ART immediately after an HIV-positive diagnosis to improve health outcomes.

Study evidence shows that the earlier patients initiate ART, the better they do. EQUIP and local implementation partners offer roll out support and implementation on the Test & Start strategy to EQUIP-supported countries.
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Viral Load Scale-Up

Since 2013, the World Health Organization (WHO) has recommended viral load testing as the preferred approach to monitor patient response to antiretroviral therapy (ART) and confirm treatment failure.

Viral load testing measures the amount of HIV virus in a person’s blood, and is the optimal method in which to identify antiretroviral therapy (ART) failure. Diagnosing treatment failure as soon as possible is important, so that HIV-positive people can switch to an effective second-line regimen that suppresses the virus and keeps them healthy.

EQUIP-supported countries have adopted this recommendation and are in the process of scaling up viral load testing capacity. Innovative technologies are also developed and provided by EQUIP to offer further potential to expand viral load monitoring.
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