The CQUIN Learning Network

Transcription

1 The CQUIN Learning Network Innovations to reach the first 90 for children and adolescents: Lessons from Swaziland Dr. Lydia Mpango AIDSFree, Swaziland October 24-27, 2017 Johannesburg, South Africa

2 Introduction MoH-Swaziland is committed to achieving the ambitious goals in and UNAIDS goals for children and adolescents Swaziland s ensf is in-line with this commitment Strengthening efficiency of pediatric HIV case finding, early linkage to treatment, quality HIV clinical services, and increase HIV viral load monitoring are key strategies 84%(13542/16102) HIV Estimate Report Sources: HMIS APMR ART Data, 2017 Q2. 2

3 No. Swaziland HTS trends in children and adolescents (< 15yrs) Trends in HTS and positivity rates in Children and adolescents < 15yrs years femlaes <15 Tested femlaes <15 HIV+ males <15 Tested males <15 HIV+ Sources: HMIS APMR ART Data 3

4 Swaziland HIV incidence measurement survey 2 Swaziland 0-14 yrs. HIV prevalence 2.8% The disparity in HIV prevalence by sex is most pronounced among young adults: HIV prevalence among 20- to 24-year-olds is 5X higher among females (20.9%) than males (4.2 %). HIV PREVALENCE, BY AGE AND SEX 4

5 "Progress towards " 5

6 Aware of HIV Status Treated Virally Surpressed Aware of HIV Status Treated Virally Surpressed Aware of HIV Status Treated Virally Surpressed Aware of HIV Status Treated Virally Surpressed Progress towards in adolescents and young adults 15-24yrs (%) Swaziland Zimbabwe Malawi Zambia 6

7 II. Policy and guidelines A policy shift to aggressively test children and adolescents ( ) National Comprehensive HIV Package of Care for Adults and Adolescents in Swaziland January 2010 HTC recommended for HIV exposed children only Swaziland Consolidated HIV Management Guidelines 2014 All children should be tested at 9 months and months (after cessation of breastfeeding) (regardless of status of the parents) Test anytime if child is sick or HIV is suspected Age of consent is 12 years Age of consent 16 years Outcome: More tests will be performed under the new guidelines. In the case of minors (< 12years), the healthcare worker and/or guardian may give consent in the best interest of the client.

8 II. Policy and guidelines Decentralization of HTS to every point of contact in health facility ensure universal offer of HTS to ALL clients with unknown status (CIHTC,PIHTC) Decentralization of HTS to community settings to ensure universal offer of HTS to ALL clients with unknown status ( CIHTC,PIHTC) Pediatric HIV testing should be conducted in all HTC settings such as Child Welfare Departments, pediatric outpatient departments (OPDs) or pediatric wards as well as in adult testing points. HIV self-testing (HIVST), either supervised or unsupervised, with an age of consent is 16 years and older. (Implementation pilots) 8

9 Strengthening HIV infected children identification: RFM index case based home testing with ICAP-Baylor 700 April to June % positivity rate 83% Index cases mapped Contacts mapped IC contacts tested IC contacts tested positive IC contacts linked to care (started ARVs) 9

10 Pediatric intensified case finding Supported by ELMA philanthropies- EGPAF/AIDSFree National level: Development of Pediatric IEC materials Regional level (Shiselweni & Hhohho) Work with the RHMT to identify, map, select and sensitize civil society organisations (CBOs) in Hhohho and Shiselweni regions ( working around the 25 ELMA sites) on how to increase demand for paediatric HTS Training on intensified case finding for children and adolescents with HIV & Early ART initiation Community level: 2/6 Community days so far Service package inclusive of HTS, ART initiation & referrals - School debates 52 Teachers sensitized on the initiative 2 school debate has been successfully conducted (Winners awarded prizes) Topics : Should HIV and AIDS be treated as a standalone subject in primary school?, Cultural 10 beliefs that discourage children to go for HIV testing

11 Pediatric intensified case finding : Year 1 & 2 results Number of children Number of children Number of children Quarterly Trends of HTS/Positives, in 25 ELMA Sites Implementing ICF: Oct Jun ,000 6,000 5,000 4,000 Start of Project 3,584 3,422 8 HTS Counsellors at high volume sites 3,946 3,691 4,700 5,321 6,202 3,000 2,000 1,948 1, Jul-Sep 15 Oct-Dec 15 Jan-Mar 16 Apr-Jun 16 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17 # Tested for HIV # HIV+ # Initiated on ART HTS/Positives, in 25 ELMA Sites Implementing Index Testing: Apr- Jun % 1 1% % < 1 Year 1-9 Years Years Age group # Testing # HIV+ Yield 4% 3% 2% 1% 0% HIV Testing & ART Initiations for Children (0-14 years) in 25 ELMA Sites: Oct 2015-June , (1%) 122 (1%) (172%) (263%) # Tested # HIV+ # Initiated on ART HIV testing increased from year 1 to year 2 by 11%

12 Reaching Adolescents: DREAMS on Wheels PSI working with PACT to mobilise AGYW (15 24yrs) in schools for HTS Operate 4 mobile units 1 each region Mobile unit parks in the nearby shops and community structures next to schools Package of services: HIV risk reduction counseling and increasing risk perception HIV testing and counseling CD4 count screening and treatment for other STIs sexual and gender based violence (SGBV) screening and referrals PEP (if within 72 hours of sexual assault) FP counseling & methods (dual protection) pregnancy testing condom distribution and education on use of male and female condoms, TB screening with active referral Screening for NCDs Active referrals for follow up care using the national referral system (PMTCT and/or antenatal care (ANC) programs as appropriate, TB services, GBV, ART)

13 Results FY17 n= Adolescents 10-19yrs receiving HTS Age Group Female Male Negative Positive Negative Positive Total 0-4yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs Total

14 PoC EID (supported by UNITAID-EGPAF) 14

15 PoC EID: Results 15

16 Birth testing Implementation pilots in 4 regions of Swaziland 3 maternities using POC Supported by UNITAID-EGPAF 2 maternities using conventional testing supported by ICAP. Implementation started August

17 IV. Swaziland Innovations to reach the first 90 for children and adolescents: Lessons learned Index testing: Home visits done in the afternoon, Saturdays and also holidays. Some parents did not live with their children: hard to get them tested. Some clients were hard to get as they were always at work and if they were off duty they were going home in other regions. Some male index cases had children from different mothers making it difficult to map and reach with the service. Intensified Paediatric testing: Proper entry process enhances the buy in and support of the project Need for mentoring and supportive supervision of HCWs and community cadres Facilities need to plan outreaches at least once in a quarter to reach for the hard to reach areas There is need to engage the children concerning testing not to focus on the parents learning from the school debates Consent age has been reduced to 12 and this has played a key role in allowing children to test on their own. However, it still demands HCWs to do proper assessment before disclosing the results 17

18 V. Next steps 1. Strengthen Quality HTS provision in both community and facilities: Conducting QA assessments in all community sites and testing points Providing feedback and mentoring support 2. Implementing evidence based approaches for testing all the groups Routine reporting on index testing approach Implement HIV Self testing in adolescents > 16 years 3. Implement HTS targeted testing strategies ( Focusing on priority groups by risk- adolescents, young women, men) 4. Scale up of POC EID (+ birth testing) 5. Strengthening forecasting and HTS rapid testing stock ordering at all levels. 6. Mapping of the underserved communities and providing HTS 7. Conduct research/assessments to inform evidence based Paediatric HTS approaches 18

19 Appreciation: MoH SNAP SRHU PEPFAR Implementing partners Communities and Facilities in Swaziland