Advancing comprehensive community-based HIV services to achieve epidemic control in namibia under the U.S. President's emergency plan for aids relief (pepfar) - the society for family health (SFH) and…

Advancing comprehensive community-based HIV services to achieve epidemic control in namibia under the U.S. President's emergency plan for aids relief (pepfar) - the society for family health (SFH) and tonata together the team will align program activities with pepfar country operational plan (COP) for namibia 2020/21, and the government of the republic of namibia's national strategic framework for HIV and aids 2017/2022, in order to achieve the following program goal: reduce TB and HIV incidence, morbidity, and mortality and improve quality of life for plhiv. Namibia presents a generalized HIV epidemic, with 8.3% of the general population living with HIV (2020 spectrum model). 2017 namibia population-based HIV impact assessment indicates an achievement of 86-96-91 HIV care cascade. Of the 220 infants under 12 months of age that were infected in 2017, 74% were during the breastfeeding period (2018 mohss program data). Regions with high population density has the highest HIV incidence (2020 spectrum model). In 2018, there were 8,108 TB cases (61% male and 39% female), notified of which most of the cases were aged 25-34 years. In efforts to avoid duplication of and maximize resources, the team will collaboration with CDC and pepfar partners, and other stakeholders, thereby ensuring "structural sustainability" and synergy within and among stakeholders between communities and health facilities through BI-directional referrals, follow up and exchange of lessons learned. The program team includes: SFH, as the prime applicant, an established leader in community-based HIV service delivery in namibia with more than 24 years of experience, and tonata, as sub-partner, the largest network of plhiv in namibia with a membership of 18,000 individuals, tonata directly connects plhv with the health care system to ensure improved quality of care and sustained viral suppression. For the past 10 years, SFH's HIV/aids-related programming spans the 95-95-95 targets and includes among others: strategic social behavior change, HTS with a focus on highly effective case finding and hivst; tracing, and active linkage to care. Tonata, former implementing partner of USAID, was the first organization to develop and introduce a novel community art groups (cags), a community-based model of antiretroviral therapy (art) delivery in 8 districts. The program team will use the "fiver system of integrated community care" approach as prioritized in the namibia COP2020, an approach with a primary focus on identifying and addressing recent infections, ensuring that all HIV positive people are put on treatment, remain on treatment, and virally suppressed. Start-up activities will include capacity enhancement of program staff, establishing baselines and RE-engaging with the mohss at the national, regional and district levels to maintain buy-in. The program will implement a regional-based accountability model that will strengthen the scale, quality, and intensity of technical assistance to field officers. Each of the 8 regional-based teams will be comprised of one quality improvement officer with track record of experience in HIV/TB clinical services and least two teams of field officers with work experience in community-based HIV/TB and capacity to provide HTS, capture and report data. Based on historic achievements, existing gaps and anticipated outcomes, the team expect to achieve key results in year one of program implementation, such as 4,000 individuals identified and tested positive using index testing services and received their results; achieve 26% yield of community index testing; 1,127 existing cags sustained, 110 support groups established, and 280 cags established; 6,489 pregnant and breastfeeding mothers and their infants followed up with focused interventions to ensure VL suppression and avert new pediatric infections; zero new pediatric infections through focused interventions to HIV positive pregnant and breastfeeding women and their infants; and 98