1. Sindy Matse Key Populations National Coordinator SNAP Swaziland
Swaziland’s Experience of a Joint Global Fund/HIV Cascade Assessment to Improve the National Key Population Program Swaziland's Experience of a Joint Global Fund/PEPFAR HIV Cascade Assessment to Improve the National Key Population Program
Sindy Matse
Key Populations National Coordinator
SNAP Swaziland
Laura Muzart
LINKAGES Country Representative
FHI 360

2. Joint HIV Cascade Assessment Objectives
Better understand and describe service flow at service delivery sites within the projects or within a certain geographical area (i.e., community-based, public sector, and hybrid models)
Identify “leaks” in the system where KPs are lost to follow up or unable to access critical products or services in the WHO KP comprehensive package
Identify successes for dissemination, scale-up and replication
Recommend solutions and innovations for barriers, optimization of service delivery, and joint TA
For the last bullet point: “Overview of South Africa PrEP and Test and Treat guidelines” – adapt according to audience, i.e. country, private or public sector, etc.

3. Swaziland Joint HIV Cascade Assessment November 16-21, 2016
Team Members
Ministry of Health
PEPFAR/USAID
PEPFAR/CDC
Global Fund
WHO
KP Implementing Partners
Timeframe
Period of alignment between Global Fund/PEPFAR KP program partners
Period of transition between MOH/PEPFAR-funded programs
At the start up of Global Fund’s KP program
Approach
Qualitative and Quantitative Tools:
Facilities
KP Representatives
KP NGOs/CBOs
KP Peer Cadre (Peer Navigators, Community Liaisons and Community Health Educators)
Data Flow Charts
Swaziland has a generalized HIV epidemic and new infections continue to occur despite major strides in the national response.
HIV prevalence among Men having sex with Men (MSM) is 17.7% and high among sex workers at 70.3%. HIV prevalence is evenly distributed across the four regions in the country. HTS uptake among pregnant women has slightly decreased from 97% in 2014 to 90% in Positivity rate at ANC is 37% with 93% of these women on ART. Sero conversion amongst infants 6-8 weeks is still high at 3% despite significant reduction over the years. There is no national data on sero-discordancy in Swaziland. However, programme data indicate an average of 15.5% (MoH Routine data).
Swaziland Global AIDS Report, 2014
Ministry of Health 2015 HIV Prevention Annual Report

4. The Leaky Pipe of the HIV Prevention, Care, and Treatment Cascade

5. Reach Key Findings: Informal mapping of KP hot spots
Duplication of roles and responsibilities of community-based health care staff
Poor coordination and collaboration between community-based health care staff
Limited staff to support KPs and high client-to-provider ratios

6. Reach Recommendation Update
Conduct rapid hot spot mapping and size estimation per venue
Completed June Updated clinical mobile service schedule, condom and lubricant distribution, and outreach approach
Microplanning around hot spots
-Trained managers
-Used data to prioritize hot spots for programming; community cadres training July 24-26, 2017
Develop clear scope of work (SOW) for community cadre
-Combined cadres, aligned scopes and stipends
-Standardized tools
-Defined geographic coverage
Establish safe spaces for FSWs and MSM
Ongoing with outreach workers
Implement innovative outreach strategies to increase reach to hard-to-reach areas and among KPs who have not tested.
-Trained both groups of outreach workers on mobilization techniques
-Conducting an Enhanced Outreach Services Campaign through July 2017
Update national package of services for KPs
-Developed and rolled out Peer Education Manual,
-Aligned clinical services provided to KPs

7. HIV Testing Services Key Findings
KPs are heavily reliant on the mobile clinic which has no fixed schedule and infrequent visits
Static clinics provide HTS, but are not considered KP friendly
Recommendation
Update
Conduct targeted community-based testing
-Lay Counsellors trained in HTS June 2017
-Roll out of HIV ST (1 region, scale up planned August 2017)

8. HIV Care and Treatment Key Findings
KPs are heavily reliant on the mobile clinic, which does not provide ART and has no fixed schedule and infrequent visits
Static clinics provide ART, but are not considered KP friendly
Nascent Peer Navigation program (# of Peer Navigators, confidentiality, availability to provide services)
Recommendation
Update
Conduct targeted community-based dispensing outside of fixed and mobile clinics
-Provision of ART in mobile clinic (planned September 2017)
-Begin CAG estimate in 1 catchment area (planned July 2017)
Increase counselling skills of PNs to handle complex issues (e.g., stigma and discrimination, relationships, disclosure)
-Trained all KP COWS on the Peer Education Manual including Peer Navigation
-Trained supervisors on supportive supervision techniques

9. Viral Load Key Findings Backlog of viral load analysis
KPs reported not knowing what a VL test was or why it was important
Recommendation
Update
Viral load scale-up plan to ensure all eligible clients, including KP individuals, have access to viral load monitoring
-National scale up of VL testing
-Incorporation of Viral Load testing in the Peer Education Manual (in which KP COWs are trained)
Ensure that viral load testing is incorporated into the operational plan for test-and-start
Improve demand creation for viral load monitoring from KPs

10. Monitoring and Evaluation
Key Findings
Lack of denominators for hot spots
Use of distinct data collection forms for different programs
Recommendation
Update
Prioritize hot spot mapping and KP size estimation
Completed mapping and size estimation
Harmonize data collection forms
-Aligned data collection forms for the community cadre
-Conducted a joint training on tools
-Developed a set of key M&E indicators with associated definitions and disaggregation guidance

11. Program Alignment and Coordination
Alignment of M&E tools and reporting mechanism
Geographical alignment for both programs to ensure coverage and minimize overlap
Joint trainings on Peer Education, microplanning and Peer Navigation
Joint hot spot mapping exercise by both CANGO (GF PR) and LINKAGES Outreach Workers
Monthly coordination meetings between PEPFAR and Global Fund implementing partners and the MoH
Joint review of program training materials & development of job aids

12. THANK YOU!