Where we work
We work in countries where we’re invited to support the strategies towards reaching of the 90-90-90 targets

Highlights from our work in the EQUIP-supported countries include:

 

In Botswana we plan to focus our effort on cost analyses including community based programs.

Applying differentiated models for ART delivery with a focus on multi-month scripting and dispensing at facility and community level

  • Decanting patients from tertiary to primary health care
  • Implementing task-shifting of patient care to relieve shortages of doctors through a process NIMART (nurse initiated and managed ART)
  • Setting up of Community Action Groups (CAGs) and Adherence Clubs
  • Costing of implementation plans of activities at all levels of care

 

Implementing strategies and technologies for children and adults that increase the number of individuals tested positive for HIV and started on treatment, retained in care and virally suppressed

  • Propose a referral policy from tertiary to primary health care and between facilities to improve HIV testing and counseling
  • Integration of primary health care services
  • Alternative testing approaches in hospitals
  • Supervised testing at all levels of care
  • Track and trace pre-ART patients for initiation onto ART

 

Innovative approaches to support the rapid scale-up of viral load monitoring

  • Conduct a value chain analysis of viral load processes to identify and address bottlenecks

Support the roll-out of rapid Test & Start

  • Capacity assessment for implementation of Test & Start
  • Support the phased implementation of differentiated models for Test & Start
  • Support strategies that result in high rate of positive tests
  • Support innovative linkage strategies for newly diagnosed and pre-ART patients
  • Support for regimen switching services for nursing staff in primary health care

 

Support differentiated models of ART delivery with a focus on multi-month scripting and dispensing at facility and community level

  • Support multi-month scripting and dispensing at facilities through:
    • Community-based distribution of ART
    • Demonstration projects to determine the 6, 12, 18 and 24-month outcome of patients receiving multi-month dispensing

 

Viral Load Scale-Up

  • Conduct a laboratory baseline assessment for viral load scale-up
  • Provide support for training on viral load processing
  • Support and capacity building for patient education on viral load testing

 

Modelling costs for viral load testing versus the burden of disease

Cost modelling in support of our Test & Start strategy

Implementing strategies and technologies for children and adults that increase the number of individuals tested positive for HIV and started on treatment, retained in care and virally suppressed

  • Rapid expansion of efficiencies for positive diagnosis at testing points likely to yield high number of HIV positive tests
  • Ensure the efficiency of testing in New Start Centers

 

Demonstration project for self-testing

 

  • Self-testing as a screening tool that targets partners who decline index trailing
  • Expanded linkage to treatment
  • Cost analyses

 

Treatment approaches implemented that efficiently respond to the needs of key populations

  • Establish the level of existing clinical and community based services available for key populations
  • Support the expansion of key populations competent service coverage
  • Strengthen key populations competent reporting system at facilities
  • Develop key populations HIV testing and treatment demand creation strategy and tools

Develop differentiated models of ART delivery with a focus on multi-month scripting and dispensing at facility and community level

  • Multi-month scripting and dispensing at facilities
  • Multi-month scripting and dispensing through CARGS (Community ART Groups)
  • Demonstration projects for multi-month scripting and dispensing for stable patients
  • Cost analyses

 

Implementing strategies and technologies for children and adults that increase the number of individuals tested positive for HIV and started on treatment, retained in care and virally suppressed

  • Expanded high yield testing approaches
  • Demonstration projects for HIV self-testing

 

Treatment approaches implemented that efficiently respond to the needs of key populations

  • Through a rapid assessment, establish level of existing clinical and community-based services available for key populations
  • Identify competency gaps and expand key populations competent services coverage
  • Develop key populations HIV testing and treatment demand creation strategy and tools

 

Innovative approaches to support the rapid scale-up of viral load monitoring

  • Conduct a value chain analysis of viral load processes to identify and address bottlenecks
  • Implementation of viral load testing at site level
  • Viral load monitoring sensitization social marketing strategy and material

Support the roll-out of Test & Start

  • Expanded linkage to treatment
  • A facility-level database to capture existing pre-ART patients to be developed
  • Secondment of staff to address existing facility-level human resources that support testing, data management and tracking and tracing of pre-ART patients

 

Develop differentiated models of ART delivery with a focus on multi-month scripting and dispensing at facility and community level

  • Multi-month scripting and dispensing at facilities
  • Cost analyses

 

Treatment approaches implemented that efficiently respond to the needs of key populations

  • Demonstration projects for PrEP at identified facilities
  • Initiatives aimed at reaching men

Support the roll-out of Test & Start

  • Research to support development of models of Test & Start that address patients at risk of non-initiation, poor adherence, poor retention, or loss to follow-up

 

Develop differentiated models of ART delivery with a focus on multi-month scripting and dispensing at facility and community level

  • Part of a multi-country (Zambia and Malawi) multi-month dispensing study
  • Study the implications of fast-track refills

 

Implementing strategies and technologies for children and adults that increase the number of individuals tested positive for HIV and started on treatment, retained in care and virally suppressed

  • Scale-up of high yield testing approaches, including the validation of a pediatric HIV test pre-screening tool
  • Support innovative linkage initiatives e.g. active case findings of pre-ART patients
  • Self-testing study protocol developed and submitted to in-country IRB for approval

 

Demonstration projects

  • Test & Start implementation site level capacity assessments that inform other program optimization strategies

 

Innovative approaches to support the rapid scale-up of viral load monitoring

  • Technical assistance to improve total turnaround times for viral load monitoring
  • Set-up an electronic result reporting system
  • Establishment of genotyping and availability of third line HIV treatment protocols

Support the roll-out of Test & Start

  • Technical assistance through MISAU Clinical TWG
  • Potential technical assistance through FHI360 for implementation of new PSS guideline

 

Demonstration projects

  • Technical assistance through MISAU Evaluation TWG
  • Evaluation of Test & Start roll-out

 

Develop differentiated models of ART delivery with a focus on multi-month scripting and dispensing at facility and community level

Multi-month scripting and dispensing

  • Technical assistance to support shift from 1 to 3 month scripting for stable patients

 

Treatment approaches implemented that efficiently respond to the needs of key populations

  • Conduct comprehensive rapid assessment of HIV services for key populations
  • Develop PrEP services
  • Support diverse training initiatives to enhance competent health-service provision to MSM and Female Sex Workers
  • Develop CBO capacity to undertake diverse community-engagement initiatives
  • Strengthen and support M&E systems for key populations

 

Innovative approaches to support the rapid scale-up of viral load monitoring

  • Molecular laboratory staff training
  • Supply chain buffer to prevent Abbott reagent stock outs as viral load testing numbers increase
  • Develop implementation plan for national viral load monitoring program to ensure existing viral load monitoring and scale-up and Test & Start plans are aligned

Support for key populations

  • Including female sex workers, people who inject drugs
  • Provision of Health Information Systems Strengthening and support for civil society organizations

Support for key populations

  • Treatment approaches that efficiently respond to the needs of key populations
  • Conducting PrEP demonstration projects

Service delivery

  • Support to roll out Test & Start
  • Multi-month scripting and dispensing at facility and community level
  • Rapid scale-up of viral load monitoring
  • Cost analyses
  • Demonstration projects for self-testing

Support the roll-out of Test & Start

  • Strategies and technologies for more efficient increases of HIV testing yield, and ART retention
  • Treatment approaches implemented that efficiently respond to the needs of key populations
  • Technical assistance to support the competency gaps and expand key populations competent service coverage
  • Strengthen the reporting system at key populations competent facilities
  • Development of a key populations HIV testing and treatment demand creation strategy and tools
  • Development and implementation of a community ART model for key populations
  • Conduct cost modelling that supports differentiated models of testing

 

Innovative approaches to support the rapid scale-up of viral load monitoring linkage and treatment as well as distribution scenarios for community ART initiation for key populations

  • Conduct viral load value chain (pre/intra and post laboratory) assessment to identify and  address gaps and bottlenecks
  • Support the implementation of viral load testing at site level
  • Develop viral load monitoring and sensitization social marketing strategy and materials

Support the roll-out of Test & Start

  • Determine the resource allocation required to implement the Test & Start strategy
  • Estimate the costs of treatment applying differentiated modes of ART delivery

 

Cost modelling and cost outcomes

  • Update the Investment Case estimates and report with the new Test & Start scenario

Demonstration projects

  • Scale-up of rapid HCV/HIV testing among key populations in PWID
  • Simplify pre-treatment diagnostics and treatment monitoring of HCV
  • Concurrent HIV testing of all individuals testing for HCV
  • Immediate link of HIV positive patients to treatment
  • Determine the cost-effectiveness and investment case of applying best clinical practice in HCV/HIV treatment

Test & Start Roll Out Support

  • Conduct readiness assessments for Test & Start
  • Provide technical support to strengthen the policy and regulatory framework to enable Test & Start strategies
  • Participate and support in the activities of the TWG on T&T and influence policy.
  • Support capacity building for frontline health workers on implementation of new treatment guidelines

 

Demonstration projects for self- testing

  • Develop draft protocol for self- testing
  • Identify sites for implementation of self-testing
  • Application for IRB approval

 

Cost modelling and analysis for use of differentiated models of ART delivery

  • Assessment of the e-pharmacy automation
  • Cost analysis for use of health shops as alternative pick-up points

 

Develop differentiated models of ART delivery with a focus on multi-month scripting and dispensing at facility and community level

  • Demonstration project for multi-month scripting and dispensing
    • facility-based randomized study of standard of 3 versus 6 month dispensing

 

Implementing strategies and technologies for children and adults that increase the number of individuals tested positive for HIV and started on treatment, retained in care and virally suppressed

  • Enable more effective linkage activities from diagnosis to treatment, adherence and retention

 

Treatment approaches implemented that efficiently respond to the needs of key populations

Determine the impact of using test and linkage for key populations

  • Assessment to establish level of existing clinical and community-based services available for key populations
  • Provide In-country stakeholders with long-term technical support to develop key population competency

 

PrEP

  • Support the development of comprehensive guidelines on the use of PrEP

 

Innovative approaches to support the rapid scale-up of viral load monitoring

  • Strengthening of Viral load testing, monitoring and reporting
    • GIS mapping of laboratories to clinics nationally
    • Laboratory site level assessments and identifying the needs for pre and post analytic support
    • Technical assistance for viral load monitoring and supply chain management
    • Mentoring of staff on viral load testing, good lab practice, capacity enhancement, quality assurance and reporting.
  • Policy support and staff secondment
    • Update guidelines for adolescent testing and counseling, disclosure, initiation and retention
    • Update procurement and supply chain policies

Support the roll-out of Test & Start

  • Multi-month scripting and dispensing at both facility and community level
  • Innovative approaches to support the rapid scale-up of viral load monitoring

 

Demonstration projects

  • Self-testing
  • Multi-month scripting and dispensing for stable patients

 

Cost analyses

  • Determine the costs of implementing Test & Start initiatives at selected sites
  • Determine the cost outcomes of implementing multi-month dispensing in CARGs

 

Policy support/staff secondment

  • Provide technical assistance and essential staff to partners, Ministry of Health and USAID country mission on request to improve treatment coverage and patient outcomes in all USAID supported districts