AMENDMENT 04 - N00244-17-S-FO01 (DHAPP Non-PEPFAR FUNDED).pdf

AMENDMENT 0004

FUNDING OPPORTUNITY ANNOUNCEMENT (FOA)

Number N00244-17-S-FO01

“FY17 – FY18 Department of Defense HIV/AIDS Prevention Program:

Military Specific HIV/AIDS Prevention, Care, and Treatment Program for Non-PEPFAR (President’s Emergency Plan for AIDS Relief)

Funded Countries”

The purpose of this Amendment 0004 is to incorporate the following:

DHAPP is accepting “Concept Papers” for Gabon and Mali as described below through 8 June 2018.

NOTE: Each narrative is a standalone effort and should not be combined with another narrative and all the program elements (tasks) in each specific narrative must be addressed in that concept paper submission.

E-mail address for submission of Concept Papers: usn.nhrc.dhapp@mail.mil

The full solicitation is available at: http://www.grants.gov/

Eligible Applicants are requested to submit Concept Papers following the guidelines and format provided in the N00244-17-S-FO01, Section IV.

All respondents must demonstrate the active support of the in-country military and the DoD representative in the corresponding U.S. Embassy in the planning and execution of their proposals. The selected Grantee is the Implementing Partner and will be referred to as IP in this document.

mailto:usn.nhrc.dhapp@mail.mil http://www.grants.gov/

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program for Non-PEPFAR Funded Countries)

Gabon: DoD-GDSF partnership program for sustainable HIV epidemic control

No Budget code Phase 1 Phase 2 Phase 3 Phase 4

1 HVOP $30,000 $30,000 $30,000 $30,000

2 HVCT $50,000 $50,000 $50,000 $50,000

3 HLAB $65,000 $85,000 $85,000 $85,000

4 HVSI $30,000 $30,000 $30,000 $30,000

5 HTXS $105,000 $85,000 $85,000 $85,000

TOTAL $280,000 $280,000 $280,000 $280,000

Proposals are requested to support Gabon to reduce the number of new HIV infections and other sexually transmitted diseases among members of the Gabon Defense and Security Forces (GDSF), their families, and the civilian communities served by the GDSF and help the military reach the UNAIDS 90-90-90 goals. The TBD partner will work directly with the GDSF in the military HIV Prevention, Care and Treatment program and increase the GDSF’s capacity to deliver comprehensive and quality HIV treatment and prevention in a sustainable and cost effective way. The Department of Defense HIV/AIDS Prevention Program (DHAPP) programming to support the GDSF will focus on the following technical areas: 1) HIV/AIDS Prevention; 2) HIV Testing Services (HTS); 3) HIV/AIDS Care and Treatment; 4) TB/HIV activities; 5) Clinical Laboratory Support; 6) HIV Clinical Monitoring Systems.

The TBD partner’s program should emphasize capacity building across all activities and technical areas. All proposals should detail how the partner will engage the GDSF leadership as well as GDSF personnel at all levels in this work; and, specifically how the partner will utilize the organizational structure of the military to strengthen the internal capacity of the GDSF to conduct these activities. Within the proposal the partner will need to demonstrate transition of programmatic capabilities and capacity to the military over the life of the grant.

The partner must work in complete coordination with the GDSF’s HIV prevention and health services, as well as the DHAPP/DoD Program Manager based at the US Embassy in Libreville, Gabon and the DHAPP Headquarters Team at San Diego, USA. The Grantee is the Implementing Partner and will be referred to as IP in this document. Dollar amounts, budget codes, and implementing strategy are subject to change in alignment with the annual DHP Operational Plan (DOP) process.

HIV/AIDS Prevention (HVOP: $30,000)

Technical Area Targets, Year 1

Indicator Label Military

Only Civilian Total

PP_PREV

Number of the priority populations (PP) reached with the standardized, evidence-based intervention(s) required that are designed to promote the adoption of HIV prevention behaviors and service uptake

4,210 0 4,210

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

The IP will strategically target sub-populations within the military as defined by Gabon OU team in the COP process with a written plan for identifying the specific sub-populations.

The intervention package for adults will include the following:

• Promotion of relevant prevention and clinical services, and demand creation to increase awareness, acceptability, and uptake of these services.

• Information, education, and skills development to: (1) reduce HIV risk and vulnerability, (2) correctly identify HIV prevention methods, (3) adopt and sustain positive behavior change, (4) promote gender equity and supportive norms and stigma reduction.

• Referral to or provision of HIV testing; facilitated linkage to care and prevention services;

and/or support services to promote use of, retention in, and adherence to care.

• Condom and lubricant (where feasible) promotion, skills building, and facilitated access to condoms and lubricant (where feasible) through direct provision or linkages to social marketing and/or other service outlets.

Data collection requires reliable tracking systems that are designed to count the number of one-on-one encounters or participation in group interventions and that reduce double-counting of individuals in a reporting period. Data should be collected at every encounter/point of service and aggregated in time for DHP reporting cycles. This indicator only counts those interventions at the individual and/or group level.

Tracking systems must be able to reduce double-counting of individuals in a reporting period.

If possible, a unique identifier should be assigned to program participants. Site facility level system should maintain accurate registers for each individual priority population, and sum these individual populations when reporting this indicator.

HIV/AIDS Testing Services (HVCT: $50,000)

Technical Area Targets, Year 1

No Indicator Label Military

Only Civilian Total

1 HTS_TST

Number of individuals who received HIV Testing Services (HTS) and received their test results

5,341 4,560 9,901

2 HTS_TST_POS

Number of individuals who received HIV Testing Services (HTS) and received their POSITIVE test results

6.3%

8%

The IP will work closely with the GDSF and DHAPP HQ to 1.) Target HIV testing to populations with high risk and high HIV seropositivity; 2.) Begin conversations to transition routine, low-risk HIV testing to the GDSF; and 3.) Regularly review (weekly) programmatic

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program data in order to constantly inform programming and refine strategy to identify more PLHIV.

Each individual’s HIV diagnosis must be confirmed using the nationally validated testing algorithm.

Ensure that any positives identified are linked to HIV care and treatment is essential to the success of the GDSF program. Therefore, the IP should work with the GDSF to create/maintain a system to follow-up and document successful linkages into care, even if the linkage is into the Ministry of Health (MOH) care system. The IP should work to achieve 95% linkage of HIV+ individuals identified for both GDSF members and civilians. The IP will ensure that Index testing, also referred as partner testing/partner notification services of an HIV-positive person are elicited and offered HIV testing services. The IP will monitor HIV testing yield; modifying strategies or locations that are not identifying and/or linking significant numbers of HIV positive persons to HIV care and treatment. The IP will ensure that all HTS is conducted via finger prick method.

The IP will work closely with the GDSF to ensure that all patients with presumptive TB or TB disease receive HIV testing and provide immediate access to ART for patients, with the goal of providing universal ART coverage among HIV-infected TB patients and universal TB screening for all HIV-infected individuals.

The IP will support all GDSF ART sites to ensure that 1) all pregnant women are aware of their HIV status during their first ANC; and 2) all infants born to HIV-positive women are receiving a first virologic HIV test by 12 months of age.

The IP will be responsible for:

Targeted testing to geographic locations and populations with high risk and high HIV seropositivity Utilize a risk screening tool to help identify high-risk individuals for testing Index-case testing/partner notification for spouses, other sexual partners of HIV+ individuals Training healthcare providers on partner notification

Index-case testing/partner notification for biological children under 15 years old of HIV+ females

100% testing of all TB-infected clients (both military and civilian) treated in military health services

Routine opt-out HIV testing for partners (including partner notification options for all sexual partners) of pregnant women to identify HIV serodiscordant couples

Training healthcare providers on HIV self-testing (HIVST) (how to direct assisted and unassisted testing and in what modalities/circumstances it is most effective)

Creating HIVST resource package to be distributed with each self-test that has education and linkage information for military facilities

Provider-Initiated testing and counseling within military health services for both military personnel and civilians who are at high risk with 95% of positives diagnosed through PITC linked to HIV care and treatment services

Quality Improvement / Quality Assurance for all GDSF HTS including continuous training and mentoring

Tracking PLHIV from HTS to clinical care and treatment services for same day initiation

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Transition Peace Keeping mission testing which contributes to low yield for military to the

GDSF

Supporting GDSF clinical services to screen all pregnant women attending military health services for HIV

Quality Assurance / Quality Improvement of GDSF PMTCT services Routine Early Infant Diagnosis of exposed infants based on existing WHO guidelines to include EID virological testing at 4-6 weeks of age and serologic testing at 9 months of age

Begin discussions to transfer PMTCT low yield testing to the GDSF

HIV/AIDS Care and Treatment (HTXS: $105,000)

No Indicator Label Military Civilian Total

1 TX_NEW

Number of adults and children newly enrolled on antiretroviral therapy

(ART)

353 375 728

2 TX_CURR

Number of adults and children currently receiving antiretroviral therapy (ART)

614 1,700 2,313

3 TX_RET

Percentage of adults and children known to be on treatment 12 months after initiation of antiretroviral therapy (Note: reporting 24 and 36 months is recommended, but optional)

553 510 1,063

4 TX_PVLS

Percentage of ART patients with a viral load result documented in the medical record and/or laboratory information systems (LIS) within the past 12 months with a suppressed viral load (<1000 copies/ml)

100% coverage

70% VLS

50% VLS

50% VLS

5 TX_TB

The proportion of ART patients screened for TB in the semiannual reporting period who are receiving TB treatment

46/614 38/510 84/1,124

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

6 TB_STAT

Percentage of new and relapse TB cases with documented HIV status

100%

100%

TB_STAT_P

OS

Percentage of new and relapse TB cases with documented POSITIVE HIV status

100%

100%

8 TB_PREV

The number of ART patients who completed a standard course of TB preventive therapy within the semiannual reporting period

430 357 787

9 TB_ART

The number of HIV-positive new and relapsed TB cases on ART during TB treatment

37 0 37

10 PMTCT_ART

Percentage of HIV-positive pregnant women who received ART to reduce the risk of mother-to-child-transmission (MTCT) during pregnancy

100%

100%

100%

PMTCT_STA

T

Percentage of pregnant women with known HIV status at antenatal care (includes those who already knew their HIV status prior to ANC)

90%

90%

90%

PMTCT_STA

T_POS

Percentage of pregnant women with a POSITIVE HIV status at antenatal care (includes those who already knew their HIV status prior to ANC)

18%

18%

18%

13 PMTCT_EID

Percentage of infants born to HIV-positive women who received a first virologic HIV test (sample collected) by 12 months of age

40%

40%

40%

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

The IP will work closely with the GDSF to scale-up the HIV Care and Treatment program and increase the GDSF’s capacity to deliver comprehensive and quality HIV care and treatment in a sustainable and cost effective way.

The IP will work closely with the GDSF to continue to provide quality and comprehensive HIV/AIDS care and treatment services at the Omar Bongo Ondimba Military Hospital, the Louembe Infirmary-Hospital, SMI Ntchoréré, SMI Gros-Bouquet, SMI Toulekima and SMI Garde Républicaine and the Peace Keeping Training Center [SMIs are antenatal care (ANC) sites]. The IP will practice Test and Start (starting ART immediately upon HIV diagnosis) for GDSF military personnel. The IP will work closely with GDSF to ensure that all TB/HIV military patients treated at the military hospital have access to TB preventive therapy to prevent progression to active TB disease among military PLHIV and their family members.

Work closely with GDSF to ensure the successful linkage between TB and HIV programs.

The IP will be responsible for:

Enrollment into HIV clinical care and treatment

Aggressive enrollment of HIV-infected military personnel nationwide, their family members and the local communities served by the GDSF in scale-up districts into clinical care and treatment

Passive enrollment of HIV-infected civilians and dependents into clinical care and treatment in non-scale-up districts

Ongoing clinical support for all ART patients Supporting the GDSF with multi-month scripting (minimum 3 months) Clinical monitoring of all HIV+ positive patients including CD4 at baseline, viral load at baseline, first 6 months and then every 12 months thereafter, tuberculosis screening, screening for other opportunistic infections including cryptococcosis, etc.

Positive Health, Dignity, and Prevention (PHDP) services including STI screening and treatment, prevention of unintended pregnancies among women living with HIV, Nutritional assessment Counseling Support (NACS) of HIV+ patients, cervical cancer screening, etc.

Universal TB screening using standard TB questionnaire at least every 6 months for 100% of HIV-infected individuals in care

Close coordination with GDSF to track down and follow enrolled patients that are deployed or going on training, to ensure they have their meds and continue to receive regular viral load (SMS VL results and education) and other required lab checks and ensure that they are included in data reporting back to GDSF during deployment (ie:

counted as part of TX_CURR cohort, VL result recorded, etc.)

Medication adherence and retention support including treatment literacy, active tracing and peer support for HIV+ patients, and other evidence-based retention interventions for adults, children, and pregnant women on ART.

Coordination of HIV clinical care and treatment services Organize a comprehensive training program targeting officers from the EASSML

"Ecole d’Application du Service de Santé Militaire de Libreville” (military medical school) in the view of enhancing their capacities for addressing HIV prevention, care and treatment activities once hired by Military Hospital and other military health facilities

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Planning, logistics, and monitoring of ART clinics to reach military ART targets Promoting ongoing communication and collaboration between GDSF clinical services and other district/provincial/national level care and treatment programs and/or government entities

Ensure the availability of essential HIV clinical commodities through support for forecasting, responsible use, stock management, and other activities critical to ensure a secure supply

Ensure HIV+ patients exhibiting immunologic failure on first-line ART receive adherence support and switched to appropriate second-line therapy (based on available population-level genotypic resistance data) when indicated and feasible

Transitioning first-line ART to Tenofovir Lamivudine Dolutegravir (TLD) in all GDSF facilities

Conducting and documenting index patient testing for all HIV-infected clients Index-case testing/partner notification for all sexual partners (not just spouses) and children under 15 of HIV-positive women Initiating all HIV-positive pregnant women on ART; with a focus on adherence and retention during pregnancy and post-partum Ensure post-partum neonatal ART prophylaxis per existing Option B+ guidelines Support PMTCT counseling and ancillary support to include breastfeeding Ensure retention through the breastfeeding period Routine opt-out HIV testing for partners (including partner notification options for all sexual partners) of pregnant women to identify HIV serodiscordant couples Begin discussions to transfer PMTCT low yield testing to the GDSF Ensure that military HIV-positive personnel on ART have received at least six months of isoniazid preventive therapy (IPT) or have completed another standard course of TB preventive therapy Ensure that active duty military patients who are taking a 6-month regimen of Isoniazid and Rifapentine will complete their therapy Ensure that all military HIV-infected TB patients are effectively linked to appropriate HIV treatment nationwide

Clinical Laboratory Support (HLAB: $65,000)

Clinical laboratories for HIV care and treatment are present at Omar Bongo Ondimba Military Hospital and the Infirmary-Hospital Louembe in Military Region # 1 and in the Infirmary- Hospital of Port-Gentil Region #8, Mouila Region # 6, and Franceville Region # 2. The IP will work with GDSF clinical and laboratory staff in support of all HIV laboratory services.

The IP will be responsible for:

Inventory control, forecasting, and procurement of laboratory reagents to ensure that laboratory services are uninterrupted Training of the laboratory staff on the use of the equipment Monitoring laboratory quality and adherence to quality systems guidelines through routine visits to each of the labs to assess achievements, review/evaluate activities, and provide recommendations with the development of improvement plans to resolve any identified problems

Linking GDSF laboratory services to other laboratory resources at the district, provincial, and national levels

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Building capacity in the GDSF for GDSF staff to take full ownership of lab functionality

Working with the military on an aggressive timeline towards full lab accreditation

HIV Clinical Monitoring Systems (Strategic Information) [HVSI: $30,000]

Successful tracking of patient level data is critical to the success of the GDSF clinical care and treatment program’s ability to monitor progress towards epidemic control. The military is a highly mobile population. Clinical HIV monitoring systems, including patient level data, will be required to ensure that GDSF clinical staff and program managers at national and subnational levels have access to the right information at the right time in any location the patient may be seen. The IP will work with the GDSF to support the collection of patient-level data, the clinical and programmatic use of data, and the reporting of site-level data to DHAPP HQ and the GDSF leadership. All medical record (EMR) work should be coordinated and aligned with PEPFAR/DHP, MOH/MOD, clinical staff requirements, WHO SANTIA HIV software, and national/international standards. The IP should state what system they intend to use for HIV clinical care and treatment; how the data collected within this system will be accessed by the GDSF clinical staff and leadership; and, how the IP will responsibly protect military data from dissemination outside of GDSF and DHAPP.

The IP will be responsible for:

Staffing support and mentoring of existing GDSF staff for data entry, information technology assistance, data managers, etc. to fill any gaps where the GDSF is unable to provide sufficient staff

Training and on-the-job mentorship of GDSF clinical staff on the use of any clinical monitoring system at site and national/program levels

Ensure confidentiality and security of data, in line with MOD, MOH, and national guidelines

Quality Assurance / Quality Improvement for all data collection, reporting, and use

Timely, accurate reporting of all indicators required by the GDSF and DHAPP disaggregated by military and civilian and all other MER 2.0 required disaggregation

Securing all patient-level and site-level data from dissemination outside of GDSF and DHAPP without prior approval from GDSF

Support for data entry, cleaning, reporting, analyzation, and use Implementation of clinical monitoring system, including maintenance of network infrastructure (if necessary) Developing HIV case-based surveillance

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

WORK PLANS

Grantee must submit annual, programmatic and financial, work plans to DHAPP Program Manager and DHAPP HQ (Budget breakdown per activity and for program management is required). Work plans include activities implementation timeline, including the M&E ones.

REPORTING

Quarterly Fiscal Reports: Grantee must submit quarterly programmatic and financial reports to DHAPP in order to monitor expenditures according to the program area(s) [HVAB; HVOP; etc.]. The report template will be provided by DHAPP. Submit 30 calendar days after each reporting period (3/31, 6/30, 9/30, and 12/31).

Interim Progress: Indicator Report: This report shall summarize progress in relation to the approved Work Plan as well as monitor grant deliverables. The Grantee shall submit quarterly indicator reports in accordance with the format provided by the Program Office within 45 calendar days following the end of the reporting period: 12/31, 3/31, 6/30 and 9/30. The Recipient shall provide reports in accordance with the template provided by

NHRC

Reports will follow DHAPP Headquarters and Country Team Templates

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Mali: Comprehensive HIV/AIDS Prevention, Testing, and Treatment Activities in the

Mali Armed Forces

Phase 1

9 Months Phase 2

12 Months Phase 3

12 Months

Phase 4

12 Months

HVOP $50,000 $50,000 $50,000 $50,000

HVCT $70,000 $90,000 $90,000 $90,000

HTXS $25,000 $50,000 $50,000 $50,000

HVSI $20,000 $35,000 $35,000 $35,000

TOTAL $165,000 $225,000 $225,000 $225,000

Proposals are requested to support Mali in their fight to reduce the number of new HIV infections and other sexually transmitted diseases among members of the Malian Armed Forces (MAF), their dependents, and the surrounding communities. Department of Defense HIV/AIDS Prevention Program

(DHAPP) support to the MAF will focus on the following technical areas: (1) HIV/AIDS Prevention interventions; (2) HIV/AIDS Counseling and Testing Services; (3) Adult HIV/AIDS Care and

Treatment; and (4) HIV/AIDS Clinical Monitoring Systems support.

The TBD partner’s program should emphasize capacity building across all activities and technical areas. All proposals should detail how the partner will engage the MAF leadership as well as the military personnel at all levels in this work; and specifically how the partner will utilize the organizational structure of the military to strengthen the internal capacity of the MAF to conduct these activities. The primary objectives of the first two years of the program will be to complete facility assessments, to collaborate on policy writing and strategy development, and to build capacity across testing/treatment sites to eventually build up to and enable a robust and comprehensive HIV/AIDS prevention program. The partner will be responsible for identifying barriers to high quality care and treatment, and for strategizing with MAF, the country team and DHAPP HQ to overcome those hindrances and ultimately strengthen the program on the ground. Over the life of the grant, the partner should be working to reinforce and support Mali to implement a fully sustainable and comprehensive

HIV/AIDS package working towards achieving the three HIV/AIDS epidemic control goals set forth by UNAID:

(1) 90% of people living with HIV know their status;

(2) Of whom 90% are on treatment; and

(3) Of whom 90% are virally suppressed

Within the proposal the partner will need to demonstrate program sustainability via the transition of programmatic capabilities and capacity to the military over the life of the grant.

The Grantee is the Implementing Partner and will be referred to as IP in this document. The IP will work under the direction of the DHAPP/DoD Program Manager based at the US Embassy in Bamako, and must work in complete coordination with the MAF HIV/AIDS and health services. The DHAPP

Headquarters Team will provide policy guidance, as well as administrative and technical support as required.

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

HIV/AIDS Prevention (HVOP: $50,000)

Technical Area Target, Phase 1

Indicator Label Military + Civilian

Target

PP_PREV Number of individuals from priority populations who completed a standardized HIV prevention intervention, including the specified minimum components, during the reporting period

5,500

The IP will work with the Malian military to select a few target or “hotspot” locations/sites in geographically prioritized regions based on available HIV prevalence data. Sites defined as hotspots include but are not limited to: presence of a military camp with a large number of soldiers, high

HIV/STI prevalence, observed high frequency of multiple sex partners, high priority locations for military, places with poor access to prevention services for new recruits, and sites with a combination of families and FSW. Proposed activities to reduce HIV risk at the selected locations will include 1)

STI screening and care; 2) alcohol harm reduction; and 3) condom promotion and distribution. In addition, activities will include mobile HIV testing/counseling and linkage/referral of 100% of PLHIV identified to military treatment centers.

Promotion of relevant prevention and clinical services and demand creation to increase awareness, acceptability, and uptake of these services.

Positive Health, Dignity, and Prevention (PHDP) services to all PLHIV, which includes

STI screening and treatment, prevention of unintended pregnancies, Nutritional assessment Counseling Support (NACS), alcohol screening, adherence support, condom provision, partner notification/disclosure, etc.

Information, education, and skills development to: reduce HIV risk and vulnerability;

correctly identify HIV prevention methods; adopt and sustain positive behavior change;

and promote gender equity and supportive norms and stigma reduction.

Referral to or provision of HIV testing; facilitated linkage to care and prevention services; and/or support services to promote use of, retention in, and adherence to care.

Procurement of male and female condoms, and lubricant

Condom and lubricant (where feasible) promotion, skills building, and facilitated access to condoms and lubricant (where feasible) through direct provision or linkages to social marketing and/or other service outlets.

Data collection requires reliable tracking systems that are designed to count the number of one-on-one encounters or participation in group interventions and that reduce double-counting of individuals in a reporting period. Data should be collected at every encounter/point of service and aggregated in time for DHP reporting cycles. This indicator only counts those interventions at the individual or group level.

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

HIV/AIDS Testing Services (HVCT: $70,000)

Technical Area Targets, Phase 1

Indicator Label Military Civilian

HTS_TST Number of individuals who received

HTS services for HIV and received their test results

1,070 8,700

HTS_POS Number of individuals who received

HTS services for HIV, received their test results, and the result is positive for HIV

59 306

The IP will work closely with the MAF to aggressively scale-up HIV Testing Services in an effort to achieve the 1 st 90 for military personnel: 90% of all MAF PLHIV know their status. Commonly, military PLHIV only access treatment at the military ART facility when they are symptomatic. In an effort to reach these men and women before they become symptomatic, HTS will focus primarily on outreach testing to larger, high HIV-burden military locations.

Outreach testing should be closely linked to the mobile ART clinic schedule, ideally with both services provided concurrently to maximize linkage. Provider-Initiated Testing and Counseling (PITC) will continue in the fixed sites for both the military and civilian cohorts with implementation of a screening tool to identify high risk (and eligible) individuals for HIV testing services. Index case testing will be a critical modality for the success of this program and for identifying high risk individuals; the index case testing model should be applied to every HIV-infected military person and their sexual partners once an individual tests positive. The IP will be responsible for testing all of the sexual partners of the index case, and following through the case’s sexual network, as well as testing all children under 15 years old of HIV+ mothers. Ensuring that any positives identified are linked to HIV care and treatment is essential to the success of the MAF program. The IP should work to drastically improve linkage of

PLHIV identified through PITC, index case testing and outreach testing to HIV clinical care and treatment, ensuring same-day initiation. The IP should also promote partner notification as a means of encouraging voluntary testing. There is currently no self-testing program developed in the country, however, it will be the IP’s responsibility to engage with the MOH, MOD, and other stakeholders to facilitate discussions about the acquisition self-test kits and roll out of self-testing programs. HIV self-testing is an effective screening tool that can be integrated into the index case testing model to encourage sexual partners and at risk individuals to seek their HIV status, and to ultimately enter into the testing/treatment cascades.

The IP will also monitor HIV testing yield, and will modify strategies and/or sites that are not identifying and/or linking significant numbers of HIV positive persons to HIV care and treatment.

Train 15 health care works on HTS services, with strong emphasis on index case testing, partner notification, and stigma & discrimination reduction training

Outreach HTS to military camps

Client-initiated HTS.

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Conduct and document partner notification and index patient testing for all HIV-infected clients o Index-case testing for sexual partners of HIV-infected military personnel, dependents and civilians o Index-case testing for all children under 15 years of age with HIV-infected mothers

Provider-Initiated Testing and Counseling within military health services for both military personnel and civilians using screening checklist and linkage.

Coordination of outreach HTS with ART clinic activities, and tracking PLHIV from

HTS to clinical care and treatment services.

Quality Improvement/Quality Assurance for all MAF HIV testing facilities including continuous training and mentoring, as well as supervisory visits at least quarterly

Procurement of test kits, reagents, and other testing paraphernalia

Ensuring the availability of essential HIV clinical commodities through support for forecasting, responsible use, stock management, and other activities critical to ensuring a secure supply

Prevention of Mother-to-Child Transmission

Indicator Label Target

PMTCT_STAT # of pregnant women with known status (includes women who were tested for HIV and received their results)

PMTCT_ART # of HIV+ pregnant women who received ART to reduce risk for mother-to-child-transmission during pregnancy

PMTCT_EID # of infants born to HIV-positive women who had a virologic

HIV test done within 12 months of birth

The IP will support all MAF ART sites to ensure that all pregnant women are aware of their HIV status; and that all HIV+ pregnant women are initiated and retained on ART to reduce risk for mother-to-child transmission during pregnancy.

Supporting MAF clinical services to screen all pregnant women attending military health services for HIV

Initiating all HIV+ pregnant women on ART; with a focus on adherence and retention during pregnancy and post-partum

Quality Assurance / Quality Improvement of MAF PMTCT services

Ensuring post-partum neonatal ART prophylaxis per existing Option B+ guidelines

Routine Early Infant Diagnosis of exposed infants based on existing WHO guidelines to include EID virological testing at 4-6 weeks of age and serologic testing at 9 months of age

Support PMTCT counseling and ancillary support to include breastfeeding

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Routine opt-out HIV testing for partners (including partner notification options for all sexual partners) of pregnant women to identify HIV serodiscordant couples

HIV/AIDS Care and Treatment (HTXS: $25,000)

Technical Area Targets, Phase 1

Indicator Label Military Civilian

TX_NEW Number of adults and children newly enrolled on antiretroviral therapy (ART) 44 240

TX_CURR Number of adults and children currently receiving ART 132 600

TX_RET % of adults and children known to be alive and on treatment 12 months after initiation of

ART

90% 90%

TX_PVLS % of adult and pediatric patients on ART with suppressed viral load results (<1,000 copies/ml) documented in the medical records and/or supporting laboratory results within the past 12 months

90%

The IP will work closely with the MAF to aggressively scale-up ART coverage in an effort to achieve

90-90-90 goals for military personnel. Targets for HIV/AIDS care and treatment will focus on generating significant progress towards the 2 nd and 3 rd

90s: initiation of 90% of identified HIV-infected military personnel on ART and 90% viral suppression amongst military personnel taking ART.

At present, all PLHIV identified are not directly enrolled on ART as the country has not moved to

TEST and START. The IP will work directly with the MAF to develop and implement a military policy for TEST and START. The IP will also work with the MAF to quickly roll out TEST and

START and put in place innovative and evidence-based models of care to improve retention of those who are initiated on ART treatment.

Aggressive enrollment of HIV-infected military personnel into clinical care and treatment

Passive enrollment of HIV-infected civilians and dependents into clinical care and treatment at the military site

Ongoing clinical support for all Pre-ART and ART patients

Retention support including treatment literacy, active tracing and peer support for HIV+ patients, and other evidence-based retention interventions for adults, children, and pregnant women on ART

Coordination of HIV clinical care and treatment services

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Linking MAF personnel, including clinical staff, to other local HIV clinical care and treatment resources provided by the MOH, or other relevant entities.

Promoting ongoing communication and collaboration between Mali Defense Force clinical services and other district/provincial/national level care and treatment programs and/or government entities

Ensuring viral load testing for those on ART whose care is in military treatment facilities as per the national guidelines and viral load and EID scaling plan: putting in place effective viral load sample transportation and results transmission network.

Train 15 healthcare workers on PHDP

Clinical monitoring of all HIV+ positive patients including CD4 every 6 months, hemoglobin, creatinine, tuberculosis screening, screening for other opportunistic infections including cryptococcosis, etc.

Cotrimoxazole prophylaxis for HIV positive patients, fluconazole prophylaxis for asymptomatic cryptococcal antigenemia with CD4<100 cells/uL, Isoniazid Preventive

Therapy, etc.

Universal TB screening using standard TB questionnaire at least every 6 months for

100% of HIV-infected individuals in care – Although no targets are set for the partner during Phase 1 of the grant in order to give time for the partner to get acclimated to the country and to build up capacity and human resources

Ensuring the availability of essential HIV clinical commodities through support for forecasting, responsible use, stock management, and other activities critical to ensuring a secure supply

The MAF currently tests viral load at the national level for PLHIV at least once a year, and testing sites do not have their own VL machines. The partner will facilitate meetings with the MAF, MOH, and other national partners to discuss viral load machine capacity, reagent/supply procurement, stockouts, and the need for access to additional equipment, and to strategize on how to build up VL testing capacity across the country.

Support and participate in viral load testing per current WHO and national guidelines, with reporting on:

o TX_PVLS: Percentage of ART patients with a viral load result documented in the medical record and/or laboratory information systems (LIS) within the past

12 months with a suppressed viral load (<1000 copies/mil)

Close coordination with the MAF to track down and follow enrolled patients that are deployed, to ensure they have a regular supply of medication and appropriate follow-up, including VL testing.

Ensuring a Differentiated Model of Care is provided to HIV patients in accordance with their clinical needs.

Conduct monitoring and evaluation quarterly supervision visits to identified military sites throughout the country

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

HIV Clinical Monitoring Systems (HVSI: $20,000)

Successful tracking of patient level data is critical to the success of the Mali Armed Forces clinical care and treatment program’s ability to monitor progress towards epidemic control. The military is a highly mobile population. Clinical HIV monitoring systems, including patient level data, will be required to ensure that MAF clinical staff and program managers at national and subnational levels have access to the right information at the right time in any location the patient may be seen. The IP will work with the MAF to support the electronic collection of patient-level data, the clinical and programmatic use of electronic data, and the reporting of site-level data to DHAPP HQ and the MAF leadership. The IP should state what system they intend to use for HIV clinical care and treatment;

how the data collected within this system will be accessed by the MAF Force clinical staff and leadership; and, how the IP will responsibly protect military data from dissemination outside of MAF and DHAPP.

Strengthen HIV treatment monitoring, evaluating and reporting systems

Staffing support and mentoring of existing MAF staff for data entry, information technology assistance, data managers, etc. to fill any gaps where the MAF is unable to provide sufficient staff

Maintain database and M&E processes and provide refresher training to 30 military leadership personnel to collect, enter, manage and use data;

Training and on-the-job mentorship of MAF clinical staff on the use of any clinical monitoring system at site and national/program levels

Complete an IT needs assessment across all sites during the first year of the program, so that the partner can ultimately procure the necessary hardware and software aligned with the national and international laboratory standards and guidelines, and IT resources needed to enable electronic capture, storage and communication of M&E data

Ensuring confidentiality and security of data, in line with MOD, MOH, and national guidelines

Quality Assurance/Quality Improvement for all data collection, reporting, and use.

Timely, accurate reporting of all indicators required by the MAF and DHAPP

Securing all patient-level and site-level data from dissemination outside of MAF and

DHAPP without prior approval from MAF

Support for data entry, cleaning, reporting, and use

Implementation of clinical monitoring system, including maintenance of network infrastructure (if necessary)

Advocate for changes to national registries to improve collection of strategic information that will guide ongoing prevention and treatment efforts;

Amendment #0004, N00244-17-S-FO01 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

WORK PLANS

Grantee must submit annual, programmatic and financial, work plans to DHAPP Program Manager and DHAPP HQ (Budget breakdown per activity and for program management is required). Work plans include activities implementation timeline, including the M&E ones.

REPORTING

Quarterly Fiscal Reports: Grantee must submit quarterly programmatic and financial reports to DHAPP in order to monitor expenditures according to the program area(s) [HVAB; HVOP; etc.]. The report template will be provided by DHAPP. Submit 30 calendar days after each reporting period (3/31, 6/30, 9/30, and 12/31).

Interim Progress: Indicator Report: This report shall summarize progress in relation to the approved Work Plan as well as monitor grant deliverables. The Grantee shall submit quarterly indicator reports in accordance with the format provided by the Program Office within 45 calendar days following the end of the reporting period: 12/31, 3/31, 6/30 and 9/30. The Recipient shall provide reports in accordance with the template provided by

NHRC

Reports will follow DHAPP Headquarters and Country Team Templates