In Support Of South Africa’s National HIV Program

PEPFAR Oversight and Accountability Results Team (POART) COP16 (FY17 Q4)

Annual Program Results Review27 Focus Districts

PEPFAR South Africa

December 2017

2

COP16 - FY17 Q4 POART – 27 Focus Districts Outline/Table of Contents

Program Area Slides

Overview – Results 3-5

VMMC 6-11

DREAMS 12-14

OVC 15-20

Priority Populations Prevention 21-25

Key Populations 26-31

1st 90 32-46

2nd 90 47-63

3rd 90 64-69

Above Site Investments 70-76

SIMS 77-81

3

COP16 (FY17 APR) Overview: 27 Focus Districts

*PP_PREV target excludes SRHR and condom promotion / provision*OVC_SERV results reported for 52 districtsAPR-Annual Program Results

Good performance against target: HTS, Viral load suppression, and Prevention portfolio

FY2017 Q1 FY2017 Q2 FY2017 Q3 FY2017 Q4 FY2017 APR FY2017 TARGET % Achievement

HTS_TST 2,456,092 2,567,085 2,870,112 2,778,479 10,671,768 5,767,766 185%

HTS_TST_POS 221,892 234,127 241,300 223,025 920,344 839,648 110%

HTS Yield 9.0% 9.1% 8.4% 8.0% 8.6% 14.6%

TX-NEW 183,957 191,305 155,646 163,816 694,724 965,131 72%

Linkage 83% 82% 65% 73% 75% 115%

TX_CURR 2,950,894 3,040,021 3,157,137 3,157,965 3,157,965 3,935,927 80%

TX_NET_NEW 235,131 89,127 117,116 828 442,202 1,220,164 36%

TX_RET 70% 70% 90% 78%

TX_PVLS 85% 85% 91% 93%

VMMC_CIRC 44,626 47,280 158,791 189,950 440,647 393,465 112%

PrEP_NEW 304 381 698 768 2,151 1,279 168%

KP_PREV 116,930 71,115 188,045 109,385 172%

PP_PREV 343,849 752,441 1,096,290 579,323 189%

OVC_SERV 442,200 762,304 799,820 664,521 120%

NB: Low net increase in Tx_Curr Q3 to Q4 was dueto data reporting corrections, which have

been addressed. Net increase in reported Tx_Curr was 207,071 for facilities supported in the 27 focus districts.

4

COP16 (FY17 APR) Overview: 27 Focus Districts

*PP_PREV target excludes SRHR and condom promotion / provision*OVC_SERV results reported for 52 districtsAPR-Annual Program Results

Did not achieve target: TX_NEW, TX_CURR, Retention

FY2017 Q1 FY2017 Q2 FY2017 Q3 FY2017 Q4 FY2017 APR FY2017 TARGET % Achievement

HTS_TST 2,456,092 2,567,085 2,870,112 2,778,479 10,671,768 5,767,766 185%

HTS_TST_POS 221,892 234,127 241,300 223,025 920,344 839,648 110%

HTS Yield 9.0% 9.1% 8.4% 8.0% 8.6% 14.6%

TX-NEW 183,957 191,305 155,646 163,816 694,724 965,131 72%

Linkage 83% 82% 65% 73% 75% 115%

TX_CURR 2,950,894 3,040,021 3,157,137 3,157,965 3,157,965 3,935,927 80%

TX_NET_NEW 235,131 89,127 117,116 828 442,202 1,220,164 36%

TX_RET 70% 70% 90% 78%

TX_PVLS 85% 85% 91% 93%

VMMC_CIRC 44,626 47,280 158,791 189,950 440,647 393,465 112%

PrEP_NEW 304 381 698 768 2,151 1,279 168%

KP_PREV 116,930 71,115 188,045 109,385 172%

PP_PREV 343,849 752,441 1,096,290 579,323 189%

OVC_SERV 442,200 762,304 799,820 664,521 120%

5

Substantial Improvements Between COP15 and COP16 (FY16 and FY17)

8,968,393

861,291

546,79763% 2,715,763

285,260

11

10,671,768 920,344 694,724 76% 3,157,965 440,647 2,151

FY2016APR FY2017APR

19% increase

7% increase

27% increase

20% increase

16% increase

54% increase

Largeincrease

6

VMMC

7

Overall COP16 (FY17) Performance

1,273,212 males circumcised through the PEPFAR program in the past three years

428 486

Oct-Dec 2016

Jan-Mar 2017

Apr-Jun 2017

July-Sep 2017

460 668

-

50 000

100 000

150 000

200 000

250 000

300 000

350 000

400 000

450 000

500 000

FY17 Targets FY17 Results

0

50000

100000

150000

200000

250000

Jul-Sep 14 Oct-Dec 14Jan-Mar 15 Apr-Jun 15 Jul-Sep 15 Oct-Dec 15Jan-Mar 16 Apr-Jun 16 Jul-Sep16 Oct-Dec 16Jan-Mar 17 Apr-Jun 17 Jul-Sep 17

VMMC Perfomance Linear (VMMC Perfomance)

8

53%50%

96%

39%

35%

25%

79%

48%

70%

50%

59%

47%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-

10 000

20 000

30 000

40 000

50 000

60 000

FY17 Oct 16 - Sep 17 Results FY17 Results (%)

FY17 Performance Across Districts

DREAMS

Performance above 100%

9

VMMC Age trend FY16 – FY17

49% 47% 49%55%

43%

32%38%

50%

23%18% 16%

17%

16%

26%

26%

20%

11%

10% 11%

9%

12% 12%

15%10%

17%23% 23%

18%

27% 28%

20% 19%

1% 1% 1% 1% 2% 1% 1% 1%131 389 47 400 55 890 121 067 48 878 49 763 163 301 198 410

0%

20%

40%

60%

80%

100%

FY16 Q1 FY16 Q2 FY16 Q3 FY16 Q4 FY17 Q1 FY17 Q2 FY17 Q3 FY17 Q4

Total

>=50

25-49

20-24

15-19

10-14

10

VMMC Program Quality (SIMS)

• Overall performance: 82% Green

• New VMMC registers were introduced last month

• AE training & introduction of improved AE reporting forms

VMMC SETS Total CEEs RED YELLOW GREEN

05_01 [069] VMMC Registers (paper) 31 23% 3% 74%

05_02 [070] VMMC Registers (electronic) 1 0% 0% 100%

05_03 [071] Adverse Event Prevention and Management

33 21% 0% 79%

05_04 [072] Voluntarism and Informed Consent 30 7% 0% 93%

05_05 [073] VMMC Clinical Follow-Up 30 7% 10% 83%

11

DREAMS

12

DREAMS Districts (CoJ, Ekurhuleni, eThekwini, uMgungunlovu, uMkandekude)

Distribution of ANC clients by age between COP15 and 16 (FY16 - FY17)

R² = 0.7527

0100020003000400050006000700080009000

FY2

01

6Q

1

FY2

01

6Q

2

FY2

01

6Q

3

FY2

01

6Q

4

FY2

01

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FY2

01

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2

FY2

01

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3

FY2

01

7Q

4

ANC Clients Ages 15-19

ANC Clients (Ages15-19)

Linear (ANC Clients(Ages 15-19))

R² = 0.7534

0

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25000

30000

FY2

01

6Q

1

FY2

01

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FY2

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FY2

01

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FY2

01

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FY2

01

7Q

4

ANC Clients Ages 20-24

ANC Clients (Ages20-24)

Linear (ANC Clients(Ages 20-24))

R² = 0.3431

0

10000

20000

30000

40000

50000

60000

FY2

01

6Q

1

FY2

01

6Q

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FY2

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FY2

01

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FY2

01

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FY2

01

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FY2

01

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4

ANC Clients Ages 25+

ANC Clients (Ages25+)

Linear (ANC Clients(Ages 25+))

25% drop between FY 16 & FY 17

33% drop between FY16 & FY 17

8 % drop between FY 16 & FY 17

13

Distribution of Newly Identified Positives by age between FY 16 & FY 17

Reduction in Identified positives in ANC in DREAMS districts between FY 16 and FY 17:

• 15-19 years: 25%

• 20-24 years: 6.8%

• 25+ years: 7.4%

0

2000

4000

6000

8000

10000

12000

FY2

01

6Q

1

FY2

01

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FY2

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FY2

01

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FY2

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4

DREAMS Districts Newly Identified Positive by Age

Newly Identified Positive (Ages25+)

Newly Identified Positive (Ages20-24)

Newly Identified Positive (Ages15-19)

DREAMS Districts (CoJ, Ekurhuleni, eThekwini, uMgungunlovu, uMkandekude)

14

742 266

349 600282 330

12 2851 501

1 344 771

366 907

257 330

10 7691 233

181%

105%

91%88%

82%

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

200%

0

200000

400000

600000

800000

1000000

1200000

1400000

1600000

HTS_Community PP_Prev OVC_Serv Gend_GBV PrEP New

DREAMS Districts Performance, FY17

Target Result %Achieved

DREAMS Districts (CoJ, Ekurhuleni, eThekwini, uMgungunlovu, uMkandekude)

15

Orphans and Vulnerable Children (OVC)

16

OVC Served – Summary Achievement

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

140.00%

160.00%

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

FY17 Q4 OVC_SERV Results & % Achievement

OVC_SERV Results DSD +TA % Achieved

% Achieved

Gray = Saturation Districts

*Results over 175% not reported in chart. This includes: Buffalo

City Metro, Mopani District, UguDistrict, Harry Gwala District, King

Cetshwayo District, Alfred Nzo District, Dr. KK District, and

Waterburg District.

No

. of

ben

efic

iari

es

reac

hed

• OVC Program achieved 115% of FY2017 target

• 23 of the 27 Focus Districts achieved 80% or above target.

17

OVC HIV_Status Program Performance and Linkage to ART

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40%

60%

80%

100%

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OVC_HIV STAT_POS and Linkage to ART FY17 APR

Total OVC_HIVSTAT_POS Total OVC_HIVSTAT_ART

Target Proxy Linkage to ART

No

. of

ben

efic

iari

es

170 914

9 079

320 775

66 716

0

100 000

200 000

300 000

400 000

500 000

600 000

APR 2017 Result

No

of

Be

ne

fici

arie

s

OVC_HIVSTAT Results

OVC_HIVSTAT Test Not Indicated

OVC_HIVSTAT Other Reasons

OVC_HIVSTAT Positive

OVC_HIVSTAT Negative

12%

57%

2%

30%

18

Site Improvement Monitoring System (SIMS) Scores: OVC

• OVC identified as area for improvement in South Africa.

• OVC sites identified for increased SIMS assessments.

• Weakest CEEs in both FY 16 & FY 17 include: Preventing HIV in Girls and Linkages to HIV testing

Note: The assessments take place at different sites in each quarter. Assumption is if IPs are strengthening certain aspects of their support, they are doing so in all their PEPFAR supported sites

Compiled SIMS CEEs include: Case Management Services, Preventing HIV in Girls, Linkages to HIV Testing, Child Protection Services, Education Services, Girls Secondary Education Transition, Economic Strengthening and Social Protection Services, Early Childhood Development Services, Community Pediatric Nutrition Screening & Referral to

Clinical Services, Family Planning/HIV Integration Service Delivery in Community Settings

29 assessments

28 assessments

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FY 16 FY 17

Community Tool Set 3 All Core Essential Elements

(CEEs)

Exceeds Expectation

Meets Expectation

Needs Improvement

Urgent Remediation

19

Focus to Reaching Girls Aged 15-17

• Focusing to reach more girls 15-17 (priority population) with evidence-based, layered programming.

• Number of adolescent girls ages 15-17 has increased by 138% from COP 2014 to COP 2016.

• Aiming to increase this by 56% to reach almost 140,000 girls ages 15-17 in COP 2017.

3753447058

89347

139655

0

20000

40000

60000

80000

100000

120000

140000

160000

OVC_SERV (DSD + TA): Beneficiaries 15-17 Female

No

. of

be

ne

fici

arie

s

OVC_SERV Females 15-17

APR 2015 APR 2016 APR 2017 APR 2018 (Target)

1827 1331 82333662542 3474 3638

6132

15330

105078313 6938

0

5000

10000

15000

20000

gp City ofJohannesburg Metro

gp Ekurhuleni Metro kz eThekwini Metro kz uMgungundlovuDistrict

No

. of

be

ne

fica

irie

s

OVC_SERV Females 15-17: Saturation Districts

Total OVC_SERV Females ages 15-17 APR 2015 Total OVC_SERV Females ages 15-17 APR 2016

Total OVC_SERV Females ages 15-17 APR 2017

• Focus on the Saturation Districts: The number of adolescent girls ages 15-17 increased by almost 460% from APR 2015 to APR 2017.

20

Case Example: Linkages & Layering

Edith Moleko*, 17 years old• lives with grandmother & two siblings in Johannesburg• parents passed away when she was 13 • Two years later, raped by an immediate family member• reported to grandmother, Gogo Lizzy*; labelled a liar• substance abuse & unprotected sex with multiple partners• contracted HIV, became pregnant, struggled in school• Interventions:

o Risk Assessment & enrolment into HIVSA DREAMS program;

o Vhutshilo HIV Prevention Education;

o ART adherence support (including PTMCT);

o Access to SRHR;

o Psychosocial support: family-centred disclosure, communication skills;

o Educational support;

o Safe space (Choma DREAMS café - internet access);

o Financial capabilities: savings skills and entrepreneurship support; &

o Older, female mentor (DREAMS facilitator).

Edith Moleko and her grandmother, GogoLizzy at Ikageng Itireleng AIDS Ministryoutside a DREAMS Choma café .

“She was transformed from being an abused child into being an independent and dedicated young mother. She is determined to

live a positive life and succeed in achieving her goals.”

21

Priority Populations Prevention

22

Priority Population Prevention (PP_Prev) in Non-DREAMS Districts, COP16 (FY17)

209%

132%123%

115% 111% 107% 105%99% 98%

80%71%

59%

39%

0%

50%

100%

150%

200%

250%

0

10000

20000

30000

40000

50000

60000

RESULT 10-14 RESULT 15-19 RESULT 20-24 RESULT 25-49 RESULT 50+ %Overall Achievement

Focus on High Burden Areas in High Priority Age Cohort

23

PP_Prev by Sex in Non-DREAMS Districts - FY17

209%

132%123%

115% 111%107% 105%

99% 98%

80%71%

59%

39%

0%

50%

100%

150%

200%

250%

0

10000

20000

30000

40000

50000

60000

Males RESULT Females RESULT %Achieved Overall

24

COP16 Number of people receiving postgender based violence (GBV) clinical care based on the minimum package

GEND_GBV REACH by District, APR 2017568%

208%

167% 159% 151%136%

119% 119% 116% 116% 115% 115% 105% 99% 90% 84% 83%

49% 44% 41%16%

2% 0%

100%

200%

300%

400%

500%

600%

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Target Result %Achieved

Top 5 Districts

<50% Achievement

25

Site Improvement Monitoring System (SIMS) Prevention Scores

2

4

1

10

4

21

6

62

1

2

1

23

6

16

3

98

2

1

3

16

32

39

45

92

325

14

20

34

0% 25% 50% 75% 100%

C_01_26 [226] Condom Availability at the Service Delivery Point [AP-HTC]

C_01_11 [211] Risk Reduction Counseling [AP]

C_01_12 [212] Facilitation of Small Group Sessions for HIV Prevention [AP]

C_01_13 [213] Small Group Sessions for HIV Prevention [AP]

C_01_03 [203] Accessible Services [AP]

F_01_03 [003] Risk Reduction Counseling and Condom Availability

C_05_02 [255] Preventing HIV in Girls

C_05_06 [226] Condom Availability

C_03_02 [255] Preventing HIV in Girls

01

C0

1B

01

A5

3

FY 17, Q4 Scores for Prevention Related CEEs

26

Key Populations

27

Key Population Prevention (KP_PREV) Results and Estimated Reach, FY17

179%

229%

144%

741%

354%

196%

64%66%

19%

99%46%

50%

0%

100%

200%

300%

400%

500%

600%

700%

800%

0

50000

100000

150000

200000

250000

300000

Inmates FSW MSM/TGW Male PWID Female PWID Grand Total

Results

Results (%)

Est. Population Reached (%)

• Collectively doubled targets at 196% (253,711/129,424)

• Focus on strengthening MSMresponse through SNS, social media

• PSE revisions

28

Comparison of Clinical Cascade by Group, FY17

29

PrEP with FSWs: June 2016 – August 2017

Note: Data as of 5 September 2017 (NDoH)

Estimated SW population size1: 153,000 [132,000 -182,000]; ~95% femaleOperational PrEP sites: 14 in 7 of the 9 provinces

HIV Tests 36,239HIV-Negatives

31,590 (87%)Initiated 2,311 (7%)

PrEP for Female Sex Workers

PrEP for MSM

HIV Tests 2,219HIV-Negatives

2,098 (95%)

Initiated

325 (15%)

Estimated MSM population size1: 850,000 -1.2 million Operational PrEP sites: 3 in 2 provinces

30

Increased Collaboration with Global Fund Grantees

Challenges Identified Solutions Implemented

Overlap with site and partner funds Regular meetings, sharing plans and targets on grassroots levels

Duplication of targets in the same geographic areas

Movement out of some sites by PEPFAR where overlap does not justify yield

31

South African Government Shares Responsibility for MSM Clinic

• Stigma and marginalization area significant barriers to accessing and utilizing public health services

• Ivan Toms Health4Men Clinic in Cape Town has provided sensitized and clinically competent services for MSM

• Ivan Toms Center will be co-located with Western Cape Provincial Government from Dec 2017

• Support and sustainable key populations services

32

1st 90

33

COP16 HIV Testing (HTS_POS) Yield by District

Comparing HTS_POS Target to Result (#s)

9%10%

12%11%

8%9%9%8%

10%

9%9%

5%

4%

9%

4%

8%

11%

4%

8%8%

7%

11%

8%

6%5%

9%

6%

0%

2%

4%

6%

8%

10%

12%

14%

0

20000

40000

60000

80000

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120000

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160000

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Fy2017Apr Fy2017 Targets Yield

Overall improving case finding24/27 districts have a yield between 5 and 12%

Apr – Annual Program Report

34

COP16 HIV Testing Yield by Partner – Facility-based District Support Partners (DSPs)

12%

10% 10% 10% 9% 9% 9%8%

8%

3%

0%

2%

4%

6%

8%

10%

12%

14%

0

50000

100000

150000

200000

250000

300000

350000

Sum of HTS_TST_POS Sum of Yield (%)

Facility yield remains higher when compared to community yield as most cases are identified in facilities

35

Who are we identifying?

AGYW HTS Yield trend in DREAMS Districts

<01 – 14 year olds Yield in DREAMS District

Yield by sex and age

Under 15 Case Finding in Facility: Child Health Services, Family Planning, IndexingCommunity: OVC, CBOs

36

6%

7%9%

8% 8%

13%

19%

9%

2% 2%

17%

0%

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10%

15%

20%

25%

0

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200000

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ex

Community Facility

HTS_TST_POS Yield

HTS Modalities and associated yields

Community index yield improved from 7% in Q3 to 9% in Q4Actual numbers of index networks tested low: currently training of service providers, standardized SOPs and strengthened M&E underway

37

COP16 Index testing quarterly trend

Remedial ActionsFacility: Training of providers, SOPs and correct reporting by implementing partnersCommunity: Reducing costs-classifying the contact list according to the neighborhoods for tracing

33 152

12 205

16 515

14 999

8%

11%

6%

12%

0%

2%

4%

6%

8%

10%

12%

14%

0

5 000

10 000

15 000

20 000

25 000

30 000

35 000

Fy2017Q1 Fy2017Q2 Fy2017Q3 Fy2017Q4

HTS Index testing Yield

38

COp16 HTS Index Testing –Identified HIV Positives: Peads and Males

Community HTS Index Peads age distribution

Successes in identifying children of PLHIV and men aged 25-49 through index testing.

0% 0% 0% 0%

30%

50%

62%

86%

70%

50%

38%

14%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sum ofFy2017Q1

Sum ofFy2017Q2

Sum ofFy2017Q3

Sum ofFy2017Q4

HTS_TST_POS

10-14

01-09

<01

3% 0%

2%

1%

16%6%

7%

8%

73%

84%

75%86%

6%9%

5% 5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sum ofFy2017Q1

Sum ofFy2017Q2

Sum ofFy2017Q3

Sum ofFy2017Q4

HTS_TST_POS

Male

50+

25-49

20-24

15-19

10-14

Community HTS Index Male age distribution

39

COP15 and COP16: Site Improvement Monitoring System (SIMS) Index Testing Scores

Comment: Index testing has improved in the Gen Pop and PMTCT_ANC from FY16 to FY 17

229 assessments

203 assessments

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FY 16 FY 17

Facility ToolCEE: F_02.13 Routine HIV Testing of children

of Adult Patients (C&T Gen Pop)

194 assessments

147 assessments

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FY 16 FY 17

Facility ToolCEE: F_02.13 Routine HIV Testing of

children of Adult Patients (PMTCT-ANC)

1st 90:

Linkage to Treatment

41

Linkage interventions

Facility linkage:• UTT

• Linkage Officers

• Health education

• TIER. Net expansion (HTS & Pre-ART module)

• Same day and same site initiation

• Flexi hour (adolescents and men)

• Unique Identifier

Community linkage:• Linkage ‘handshake’

between facility and community

• Linkage tracers

• HTS_POS_ART indicator

• Health education

• Scaling up recording of ID numbers at community testing sites

Sowetan times: 13 July 2015

42

Linkage Across the 27 Districts

908 881

728 848693 600 693 600

76%

95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

100 000

200 000

300 000

400 000

500 000

600 000

700 000

800 000

900 000

1 000 000

Coarse Linkage Facility Linkage

HTS_TST_POS

TX_NEW

Linkage

COP16 (FY 17) Facility linkage is 95%

43

COP16 Age/Sex Linkage in Saturation Districts

Linkage Challenges in AGYW and Men

Diagnosis: Highest number linked - females 25-49

Remediation:Flexi hour services for linking adolescents

44

COP16 District Linkage

All saturation districts have a linkage rate of above 90%

45

COP15 and COP16 SIMS Linkage Services Scores

234 assessments

204 assessments

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FY 16 FY 17

Facility toolCEE: F_07.03 HTC Referrals to HIV Care

and Treatment

Improved SIMS results for linkage of patients from HTS to ART

46

Direct Linkage Indicator

Community HTS_TST

Referral of HTS_POS clients to facility

Work with Facility Staff and Implementing partners

Confirmed HIV positive patients in TIER.Net HTS module

Confirmed HIV positive patients linkage to ART in TIER.Net HTS

module

Beginning in COP17 (FY18), PEPFAR CDC and USAID will require additional data to directlymeasure ART initiation among persons newly tested positive

47

2nd 90

48

COP15 and COP16 (FY16 &FY17): TX_NEW results by quarter

FY16 total: 546,797

FY17 total: 693,600 (72% of target) Increase of

146,803 vs. FY16

(+27%)

∆ Q1: +39,683

∆ Q2: +59,208

∆ Q3: +22,283

∆ Q4: +25,629

49

COP16 (FY17) TX_NEW Cumulative Results by Partner & District (27 focus districts)

Intrapartner variability across districts-actions: • Improve performance consistency across

districts /partners by addressing district-level situational barriers

• Shift targets to other partners where feasible• Set up district and Provincial level engagement• Direct Service Delivery staff secondment

50

COP16 TX_NEW Achievement by Partner (27 focus districts)

>150%

Remediation/Ongoing interventions:• Active partner management and

weekly tracking of results to inform course correction

• Transition of targets to higher performing partners

• SIMS visits and intensified site-level data quality assessments

• PEPFAR/SA mandating DSPs to:• Fully implement SDI • Ensure active linkage and

tracking to down-referral sites

51

COP16 (FY17): TX_NEW by Age/Sex (4 saturation districts)

Cumulative FY17 performance

For purposes of epidemic control, implement and scale innovative strategies targeting:• Adolescents friendly services (AYFS expansion support); • Targeted DSD and linkage with DREAMS demand creation and mobilization • Male friendly services (including extended hours, male counsellors, entry points,

workplace ART initiation)

52

Update: Same Day ART Initiation (SDI)

• District Support Partners representing 18 districts (and 1021 facilities) responded to survey to ascertain status of 3 core interventions in the field: SDI, Tx and Retention Acceleration Plan, and community-based ART initiation

• Same Day ART Initiation

– 12 districts (634 facilities) report 100% of supported facilities implementing SDI

25 assessments

110 assessments

47 assessments

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FY 17 Q2 FY 17 Q3 FY 17 Q4

SIMS Set 12, CEE 12_01: Test and Start

26 assessments 40

assessments112

assessments

0%

20%

40%

60%

80%

100%

FY 17 Q2 FY 17 Q3 FY 17 Q4

SIMS Set 12, CEE 12_02: Appointment Spacing and Multi-

Month Drug Dispensing (Differentiated Care)

53

NDoH Treatment & Retention Acceleration Plan

NDoH Engagement and Policy Update Timeline

54

Tx and Retention Acceleration Plan Implementation -

# of districts fully implementing TRAP 13

# of districts responding to data calls 11

# of districts whose DSP is participating in weekly data calls 16

# of districts whose DSP is involved in remediation plans 12

• Survey responses from DSPs representing 18 districts• Acceleration plan is being brought to scale

Source: Rapid DSP assessment survey findings (November 2017)

55

eThekwini COP17 Strategy Update –Dec 2017

Core Intervention Progress to date Comments

1.Enhanced M&E (Evaluation by clusters and weekly performance tracking)

• 12 clusters with referral hubs identified, communicated to facilities

• All identified clusters: Nerve centre meetings started.

2. Tier.net Expansion • On track • Completion of module implementation by end March 2018

3. Unique Patient Identifier Current coverage 30% Mitigation plans in place to increase ( 90% coverage 90% by September 2018

4. Maximizing Entry Points • All hospitals now have clinic navigators and professional nurses actively tracking all hospital admissions and all hospital entry points to ART initiation

• Advance clinical care for Unstable clients and complicated patients

5. Moving Stable Patients out of facilities • 88 483 clients decanted 46% of stable patients) • Tier.net export actively traces stable clients for CCMDD enrolment

6. GP Models • District Management Team signed off on GP pilot project and ARV Drug Supply and HTS testing kits provided by DOH health facility

• Submitted General Practitioner Contracting Model to USAID

7.Mass Media for TX_NEW • Provincial media campaign underway and signage and messaging at all health facilities

• Local media involvement via community engagement ongoing.

8. Ideal Clinic Expansion and reconfiguring of service delivery platforms

• Achieved 22% coverage . Overall, average scoring eThekwini is 76% green areas

• Mitigation strategy in place to increase coverage.

9. Community Facility Linkage • Facilitated meetings with community partners –formalised linkage processes

• Campaigns targeting men to increase awareness on Men’s Health with linkage officers and mobile ART teams

2nd 90:

Treatment

Retention

57

Current on Treatment (TX_CURR) Progress Toward COP16 Targets - 27 Focus Districts

• TX_CURR increased by 19% in the 27 focus districts over FY16 (COP15) achievement.

• FY17 (COP16) coverage reached 70% of the saturation goal in the 27 focus districts.

58

TX_CURR Progress Toward COP16 Targets - 4 Saturation Districts

59

TX_CURR COP16 Achievement vs. TX_CURR % Gap to 2nd 90 by Age and Sex - 4 Saturation Districts

TX_CURR, FY17APR TX_CURR gap to 81% PLHIV coverageLabels show saturation levels (81% of total PLHIV, 2016 estimate)

60

COP16 TX_RET Performance by District - 27 focus districts

Saturation district

61

COP16 TX_RET Performance by Facility - 27 Focus Districts

93% facilities <90%

79% facilities <80%

48% facilities <70%

62

Retention Remediation Activities

▪ Improve Patient Access

▪ Expanded clinic hours and Saturday hours

▪ Expand use of mobile clinics for both initiation and ongoing care

▪ Improve Patient Experience

▪ Encourage appointment time scheduling to reduce waiting time

▪ Direct service delivery support by DSPs to reduce burden on under-staffed facilities

▪ Motivate staff through recognition

▪ Mentors to foster respectful, non-discriminatory care

▪ Implement adolescent & youth friendly services

▪ Expand incorporation of peer navigators/expert patients into facility-based services.

▪ Use of interpersonal health communication products

▪ Maximize effectiveness of Linkage & Retention Coordinators

63

Interpersonal Health Communication Products

64

3rd 90

65

Retention on ART, VL Done, and VL Suppression COPs 14, 15, 16 (Fys 15-17): 27 Focus Districts

76%

61%

79%77%

63%

87%

70%

80%85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

12-month retention VL completed VL <1,000 cp/mL

FY15 FY16 FY17 FY15 FY16 FY17 FY15 FY16 FY17

66

FY 2016 (COP15) TX Cascade thru Retention at 12 Months, VLD and VL Suppression

0

100 000

200 000

300 000

400 000

500 000

600 000

700 000

800 000

900 000

1 000 000

South Africa

One Year Outcomes of Persons Initiated on ART in FY16

FY16 HTS_PoS FY16 TX_NEW FY17 TX_RET_N FY17 PVLS_D FY17 PVLS_N

80% of those

retained 85% of those tested

70% of TX_NEW FY16

861,291 positive tests in

FY16 63% of Positive Tests =

Tx_New

67

COP16 Annual Viral Load Done & Suppressed Trend—Saturation Districts

68

NHLS: Monthly Viral Suppression Monitoring

69

VL Suppression by Age, Sex (Source: NHLS)

• 3,218,394 VL tests done in the previous 12 months among 27 focus districts • 83.1% of the tests had a

suppressed VL (< 1000 copies/mL),• 16.9% had VL results above 1,000

copies/mL, and • 9.8% were above 10,000 copies/mL

• Proportion of VLS ↑ with age from a low of 64% in children < 10 years to 85% in patients 25 years and older.

• ↑ VLS among females 15+ vs males 15+ (84.4% vs 79.4%)

• VLS age 1-9: 66.4%; 10-14F: 65.0%, 10-14M: 62.9%

70

Above-Site Investments

71

2017 Sustainability Index Dashboard (SID) Summary

Sustainability Analysis for Epidemic Control:

Epidemic Type:

Income Level: Upper middle income

PEPFAR Categorization: Long-term Strategy (Co-finance)

PEPFAR COP 17 Planning Level: $483 million (+ $51 million central VMMC funds)

2015 (SID 2.0) 2017 (SID 3.0) 2019 2021Governance, Leadership, and Accountability

1. Planning and Coordination 9.67 9.17

2. Policies and Governance 8.45 8.87

3. Civil Society Engagement 7.33 9.04

4. Private Sector Engagement 6.50 9.17

5. Public Access to Information 10.00 8.00

National Health System and Service Delivery

6. Service Delivery 7.69 6.71

7. Human Resources for Health 6.97 6.16

8. Commodity Security and Supply Chain 4.67 6.92

9. Quality Management 8.38 8.00

10. Laboratory 6.67 9.58Strategic Investments, Efficiency, and

Sustainable Financing

11. Domestic Resource Mobilization 8.61 8.53

12. Technical and Allocative Efficiencies 8.61 9.28

Strategic Information

13. Epidemiological and Health Data 6.77 6.90

14. Financial/Expenditure Data 9.58 8.33

15. Performance Data 8.73 8.83

SUST

AIN

ABIL

ITY

DO

MAI

NS

and

ELEM

ENTS

South Africa

Generalized

0

500

1 000

1 500

2 000

2 500

3 000

2016 2017 2018

(projected)

USD

Mil

lion

s

Financing the HIV Response

Partner Gov't PEPFAR Global FundOther Donors Private Sector

0

1000

2000

3000

4000

5000

6000

7000

8000

1990 1994 1998 2002 2006 2010 2014

Curr

ent

U.S

. dol

lars

GNI Per Capita (Atlas Method)

0

2000

4000

6000

8000

0.0

5.0

10.0

15.0

20.0

1990 1994 1998 2002 2006 2010

Dea

ths/

PLH

IV (t

hous

ands

)

Adul

t Pre

v./I

ncid

. Rat

e (%

)

Epidemiological Data

Adult Prevalence Adult Incidence

PLHIV AIDS-related Deaths

0.0

2.0

4.0

0.0

20.0

40.0

60.0

1990 1994 1998 2002 2006 2010 2014

Fert

ility

/Pop

. Gro

wth

Rat

e

Tota

l Pop

. (m

illio

ns)

Population and Fertility

Population Pop. Growth Rate Fertility Rate

0

2

4

6

8

PLHIV Diagnosed On ART VirallySuppressed

* m

illio

ns

National DoH Clinical Cascade (3/17)

<15 >15

10.0% 5.0% 0.0% 5.0% 10.0%

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-79

80+

Population %

Age

Population Pyramid (2017)

Female %

Male %

CONTEXTUAL DATA

CON

TEXT

UAL

DATA

72

SID and Table 6 Activities

Supply Chain: key interventions improved score from 4.67 to 6.92

Lab: significant gains from 6.67 to 9.58

Service Delivery: despite significant efforts, decreased from 7.69 to 6.71

HRH: PEPFAR increased direct service delivery also reflects the decrease from 6.97 to 6.16

73

SID 2.0 & 3.0 Comparison (2015 and 2017)

0

1

2

3

4

5

6

7

8

9

Dark Green Light Green Yellow

SID 2.0 & 3.0 Comparison

SID 2.0 SID 3.0

• SID 3.0 completed November 2017

• Overall, SID scores have improved from 2015 to 2017

• Lab and private sector engagement go from Yellow to Dark Green in

• Only decreasing scores: service delivery (a reflection of need for increased service delivery support in the program and other health system delivery challenges)

74

Shift in Laboratory Support

• Laboratory and Clinic Lab interface Continuous Quality Improvement capacity building

• Strengthening of communication, training and support, and collaboration

• Strengthening of NDoH ownership and oversight of laboratory support

75

Strategic Shifts

• Focus program to scale what works

• Coalesce behind key activities to achieve priorities & ensure all activities fall under identified priority areas

• Identify and eliminate duplication

• Exchange activities between partners to keep similar activities together

• Identify activities not strategically aligned with 90-90-90 or sustainability

– Redirect activity (change work plan)

–Discontinue funding in COP18

76

Strategic Shifts

Key Population Programming Models

Laboratory Support

New and Efficient Service Delivery

77

Site Improvement Monitoring System (SIMS) Data

78

PEPFAR SA SIMS Sites Surveyed Cumulative Performance

CDC Q1 Q2 Q3 Q4 Total

FY15 14 11 0 22 47

FY16 37 9 30 63 139

FY17 57 39 71 46 213

Total 108 59 101 85 399

USAID Q1 Q2 Q3 Q4 Total

FY16 1 68 123 192

FY17 36 8 74 19 137

Total 36 9 142 123 329

* The USAID visits are underreported for FY17 as some of the visits conducted are not showing in the USAID GHSMA system. The USAID HQ team is currently investigating and rectifying this issue.

79

SIMS 2.0/3.0 Scores by Partners FY 16 & FY 17

Facility Tool

Note: The assessments take place at different sites each quarter. Assumption is if IPs are strengthening certain aspects of their support, they are doing so in all their PEPFAR supported sites

FY 17FY 16

80

SIMS 2.0/3.0 Scores by Partners COP15 & cop16

Community Tool

Note: The assessments take place at different sites in each quarter. Assumption is if IPs are strengthening certain aspects of their support, they are doing so in all their PEPFAR supported sites

FY 17 (COP16)FY 16 (COP15)

81

End – FY 17 Q4 (COP16 Summary Results Review - POART)

Siyabonga !

For additional details please contact:Charles Pill

SA PEPFAR Coordinator

pillc@state.gov