1. HIV Programmatic Training Cape Town, March 2013 Summary Rreview Roger Teck 27 th January, 2014

2. Main changes: Content More space for program contexts with other operational priorities requiring integration of HIV/TB – Reference in several sessions – Presentation on PMTCT integration – Review session on minimum and extended package for HIV/TB – Session on distinct contexts: unstable context; emergency intervention; migrants – One group work case study: Paoua/CAR Session on key populations: prison & IDUs; CSW & clients; MSM. Tools: updated OCB CD-rom (Guidelines and tools: WHO, MSF, …)

3. Main changes: Agenda and Dynamics Agenda: +1 day Days finished by 18.00 PM (except for 2 debate evenings) Introduction session before start (+ expectations) Interactive/participatory exercise(s) in most sessions Half day field visit & feedback in each week (linked to subjects of that week) Group work on case studies; one feedback session at end of each week Evaluation formalized: written per session; interim after first week; written at the end; final oral evaluation referring to expectations.

4. Evaluation and recommendations Overall very positive: balanced content; not overloaded. Much more participation Accommodation LESS participants: OC quota not used Unbalanced participation in facilitation/presentation by OCs Some difficulties for some participants – French speakers ? – 2 non-medical Still late preparation for some sessions & case studies  Recommendations:  Organization of DR TB care and treatment; …  Organization of daily summaries ?  Pre and post test Quiz ?  …

5. 16 Participants: Not enough, OC quota not used OCsOCA 2 – OCB 5 – OCP 3 – OCG 4 - OCBA 2 ExperienceYes: 7 No: 9 Training background 9 MD – 2 CO – 3 nurses 1 socio – 1 psychologist Responsibility1 HOM – 8 MedCo/dep 2 FieldCo – 2 MTL – 3 Focal Points HIV/TB

6. Program contexts of Participants MIX: Vertical & projects integrating HIV/TB 8 Vertical projects (high prevalence and low prevalence settings) -Eshowe - KwaZulu Natal/SA, -Shiselweni/Swaziland -Gutu/Zimbabwe -Maputo/Mozambique -Chiradzulu/Malawi -Guinea Conakry -Myanmar -Sana/Yemen. 6 projects integrating HIV/TB -Ogaden/Ethiopia -Katanga/DRC -Paoua & …. / CAR -Mali -Agok / South Sudan -Dadaab/North-east Kenya

7. Facilitators/Presenters: SAMU/OCB dependent; less external presenters but less training-specific travelling AWGTB WG External3 SAMU/OCB911 OCB SA & Lesotho4 OCG & OCG/SAMU21 OCA1 Epicentre1 MSF South Africa2 AAU/OCB1 Total2321

8. Context/Response – Role - Needs Assessment Context – Response – Role of MSF  New WHO recommendations  MSF strategic framework; priorities & ongoing discussion  Integration in non-HIV/TB  gaps/unmet needs & coverage ?  accelerated earlier treatment ?  Prevention ?  Follow-up on implementation of new WHO recommendations ?  HIV advocacy priorities ? Needs assessment & priority setting  Draft checklist  Use of Spectrum modeling for estimates and projections  Dashboard for priority setting: vision/operations/OR/advocacy

9. Cascade – Concept – M&E – HIV Testing & Linkage to Care New WHO recommendations Case studies: KZN and Shiselweni – Pre-ART – ART treatment: July 2013 WHO recommendations, VL monitoring – Patient support: enhanced adherence counselling – Organisation of services: simplification - taskshifting, patient flow, infection control, patients with complications. – Community based models: CAG & Khayelitsha Tr. clubs

10. Integration of HIV with TB services – Integration: rationale; barriers; options – HIV and TB detection and prevention (5 I’s) – Management of HIV/TB and MDR TB co-infection

11. PMTCT – Children and Adolescents PMTCT – Options: with emphasis on option B/B+ – Cascade – Management of exposed infants – Integration of PMTCT in Reproductive health programs HIV/TB services for children and adolescents – Key elements of paediatric HIV/TB care and treatment – Patient support; children (disclosure) & adolescents – Adolescent clinic services.

12. Prevention “new” biomedical strategies, incl. TasP medical male circumcision (perspectives for non- surgical methods)

13. Laboratory - Supply Laboratory -tools for integration/decentralisation -use of information and communication technology -Update with regard to VL: Lab based and POC, sample pooling, FP DBS Supply Chain – Emphasis on role of MSF with regard to national supply: whistle blower – contingency stock ? – Case studies: Eastern Cape intervention; Shiselweni contingency stock

14. M& E, Supervision & Mentoring M & E Principles and requirements Available tools: three-tier paper/electronic, FUCHIA,.. Cascade: unlinked & linked Supervision & Clinical Mentoring Tools

15. M& E, Supervision & Mentoring M & E Principles and requirements Available tools: three-tier paper/electronic, FUCHIA,.. Cascade: unlinked & linked Supervision & Clinical Mentoring Tools

16. Operational Research HIV environment analysis/advocacy Operational Research Current priorities – contextual exercise HIV Environment analysis: national and international Civil society activism HIV Advocacy: national and international Current reflection on priorities

17. Handover/Exit – Dashboard Tool – Case studies: Thyolo (partial handover, in process) Zambia (full handover, completed, and with follow-up) – to be reviewed

18. Field visit First week (Thursday) Health centre (Ubuntu): – HIV/TB services; organisation/integration – Second-line ART (with OR on outcome of routine VL/enhanced adherence counselling) Treatment clubs: concept, organisation, tools Feedback session at noon

19. Field visit Second week (Tuesday) Health centre: integration of PMTCT with MCH services Youth Clinic: concept and services Youth treatment club Feedback session in the afternoon

20. Debates Access to HIV testing when access to HIV care cannot be guaranteed Focus on ACCESS (gaps of unmet needs: humanitarian approach) Versus Focus on COVERAGE (impact: public health approach)

21. Group work on case studies High HIV/TB – rural: Gutu/Zimbabwe 2011 High HIV/TB - urban: Maputo/Mozambique 2006 Unstable context: Paoua/CAR 2010 Low HIV - concentrated in key populations: Ukraine 2011