Cooperative Agreement NU2GGH002495

LIGHTHOUSE CENTERS OF EXCELLENCE FOR COMPREHENSIVE INTEGRATED HIV CARE AND TREATMENT SERVICES IN MALAWI UNDER THE PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF (PEPFAR) - BACKGROUND MALAWI HAS AN ESTIMATED HIV PREVALENCE OF 7.7% IN ADULTS AND 15,000 NEW INFECTIONS PER YEAR. THE COUNTRY MADE GREAT STRIDES TOWARDS ACHIEVING THE UNAIDS 95-95-95 TARGETS THROUGH A MULTI-SECTORAL APPROACH. TO STAY ON THIS SUCCESSFUL PATH, MALAWI HIV PROGRAM MUST APPLY MORE EFFORTS IN TARGETED TESTING FOR HIGH-RISK GROUPS, LINKING THEM TO CARE, SCALE-UP DIFFERENTIATED SERVICE DELIVERY MODELS, ADEQUATE SCREENING, AND MANAGEMENT OF ADVANCED HIV DISEASE (AHD), OPTIMIZE VIRAL LOAD (VL) MANAGEMENT, AND MITIGATE THE EFFECT OF OTHER PUBLIC HEALTH THREATS ON HIV SERVICES. LIGHTHOUSE TRUST, AN INDIGENOUS MALAWIAN ORGANIZATION, IS STRATEGICALLY POSITIONED TO ADDRESS CHALLENGES IN HIV CARE THROUGH A HOLISTIC, DATA-DRIVEN, AND LOCALLY TAILORED APPROACH. OVER THE PAST DECADES, LH ESTABLISHED CENTERS OF EXCELLENCE IN HIV CARE IN MALAWI REFERRAL HOSPITALS AND NOW OPERATES FIVE COES ACROSS THE COUNTRY IN ALL MAJOR CITIES. IN ADDITION, LH PROVIDES DIRECT SERVICE DELIVERY AND TECHNICAL SUPPORT TO PROTOTYPE FACILITIES IN LILONGWE WHICH INCLUDES EIGHT GOVERNMENT FACILITIES AND TWO PRISONS. PURPOSE THE PURPOSE OF THIS PROJECT IS TO DELIVER HIGH-IMPACT HIV TESTING AND TREATMENT SERVICES TO SUSTAIN ACHIEVEMENTS, GROW THE COHORT OF PLHIV ON ART, AND REACH THE 95-95-95 TARGETS. TO ACHIEVE THIS, LH PLANS TO CONTINUE OPERATING COES AT ALL REFERRAL HOSPITALS, IN MALAWI. THE PROJECT WILL THUS SUPPORT TERTIARY-LEVEL HIV CARE, FOCUSING ON AHD, HIV-ASSOCIATED CANCERS AND NON-COMMUNICABLE DISEASES (NCDS). MALAWI HEALTH SYSTEMS FOR HIV CARE WILL BE STRENGTHENED THROUGH MENTORSHIP, DEVELOPING MODEL INTERVENTIONS AND DIRECT SERVICE DELIVERY FOR THE PROTOTYPE FACILITIES. THUS, THE MAIN STRATEGIES OF THIS PROJECT ARE TO: OPTIMIZE STATUS-NEUTRAL TESTING SERVICES WITH IDENTIFICATION OF UNDIAGNOSED PLHIV (1ST 95) AND REFERRAL OF THE UNINFECTED FOR BIOMEDICAL PREVENTIVE SERVICES. ENSURE LINKAGE TO QUALITY CARE (2ND 95) AND OPTIMAL TREATMENT, RETENTION, AND VIRAL LOAD MONITORING (3RD 95) OF PLHIV. PROVIDE PATIENT-CENTERED, HIGH-QUALITY ADVANCED HIV TREATMENT SERVICES INCLUDING DIFFERENTIATED SERVICE DELIVERY MODELS AND INTEGRATED CARE AT ALL COES. SUPPORT THE NATIONAL ART PROGRAM THROUGH IMPLEMENTATION OF MODEL INTERVENTIONS IN PROTOTYPE CLINICS AND HEALTH-SYSTEM STRENGTHENING ACTIVITIES BEYOND COE CARE. OUTCOMES THE LONG-TERM OUTCOME OF THIS PROJECT IS THE ATTAINMENT OF THE UNAIDS 95-95-95 GOALS IN THE PROPOSED PROJECT DISTRICTS FOR ALL AGES, GENDERS, AND POPULATION GROUPS AT RISK FOR HIV INFECTION. LIGHTHOUSE WILL UNSURE THAT THAT ALL HEALTH EQUITY GAPS ARE ADDRESSED, AND EVIDENCE-BASED HIV PREVENTION INTERVENTIONS ARE OFFERED TO ALL POPULATION GROUPS. LIGHTHOUSE (LH) HAS OUTLINED A SERIES OF PRIORITIES TO IMPROVE HIV CASE FINDING, TREATMENT AND PREVENTION. THESE PRIORITIES INCLUDE INCREASING THE UPTAKE AND CONTINUITY OF PREP AMONG HIGH-RISK INDIVIDUALS AND USING TARGETED TESTING STRATEGIES TO IDENTIFY MORE UNDIAGNOSED HIV-POSITIVE INDIVIDUALS, WITH A PARTICULAR EMPHASIS ON CHILDREN 0 TO 14 YEARS, MEN, AND THE YOUTH. FURTHERMORE, LH WILL INCREASE ART COHORT GROWTH, DECREASE ATTRITION AMONG NEW ART INITIATES, AND INCREASE VIRAL LOAD SUPPRESSION ACROSS ALL AGE AND SEX GROUPS THROUGH THE VARIOUS PATIENT AND PEOPLE-CENTERED APPROACHES TO HEALTH SERVICE DELIVERY. TO SUPPORT THESE EFFORTS, LH STRENGTHEN COLLABORATION THE WITH THE MINISTRY OF HEALTH, DEPARTMENT OF HIV AND AIDS AS WELL AS HOSPITAL LEADERSHIP OF THE TERTIARY HOSPITALS AND PROTOTYPE FACILITIES. LH WILL CONTINUE BUILDING CAPACITY THROUGH CLINICAL MENTORSHIP, USING THE ESTABLISHED CASE-BASED TRAINING PLATFORM (PROJECT ECHO) TO ENSURE QUALITY SERVICES ARE BEING ALWAYS OFFERED. LH WILL USE DATA-DRIVEN QUALITY IMPROVEMENT (QI) INTERVENTIONS TO REFINE THE IMPLEMENTATION OF THESE ACTIVITIES.