COP 2017 Approval Meeting Out-brief ZIMBABWE · HTC HTC Pos TX_New TX_CURR Result Target All PEPFAR...

COP 2017 Approval Meeting Out-brief

ZIMBABWE

April 21,2017

A New Era of Accountability, Transparency, and Solidarity to Accelerate IMPACT

• Zimbabwe’s cash shortage crisis continues even with the release of bond notes

• Economic growth is waning, with exports and imports declining and 2016 GDP at 0.6%

• Potential impact on health work force if conditions worsen

2

Context: Economy

A New Era of Accountability, Transparency, and Solidarity to Accelerate IMPACT 3

Context: Environmental Factors


Launched national

consolidated guidelines - Dec.

1, 2016

Sensitisation of all 10 provinces

done mid-November followed by provincial

dissemination meeting

All 10 provinces have been

advised to start implementing

the treat all recommendation

All 36 districts fully

implementing Treat All

Some PEPFAR districts started as

late as February/March

2017

Most non-PEPFAR districts not yet

started (awaiting guidelines)

Guidelines printing underway;

distribution to the districts start May

2017

Expected full-scale implementation by

May 2017

Adoption of self testing by MOHCC (50% of self-testers are men, 28% are

youths)

MOHCC – KP/PreP integration in

public facilities

4

Context: Policy Overview


55.5%

81.51% 82.36% 79.3% 87.8% 87.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Aware of Status On Treatment Virally Suppressed

<30 Years PLHIV 30+ Years PLHIV

National 90-90-90 of 15-64 Year Olds

(Under 30 and 30+ years)

COP 2017: Impact of Population Data on Decision-Making ZIMIPHIA


0 20 40 60 80 100 120 140 160 180

Community-based Treatment & Support

PMTCT

Key Population Prevention

SI, Surveys & Surveillance

OVC

HTS

Laboratory

Priority Population Prevention

VMMC

HSS

Clinical Care , Treatment & Support

Millions

PEPFAR GF HDPG Private Sector Government of Zimabwe

Context: Annual Investment Profile by Program Area

First 90 COP 2016 Performance & COP 2017 Strategies


COP 2016 Progress: Q1 & Q2 Clinical Cascade Performance

8

48%

42% 25%

71%

FY16, Q4, 733,157

FY17, Q1

FY17, Q1 FY17, Q1

FY17, Q1

22%

19% 11%

67%

HTC Target, 2,544,654

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

HTC HTC Pos TX_New TX_CURRResult Target

All PEPFAR FY 2017 Q2 program results and achievements included within this presentation were based upon preliminary reporting and may differ from the final submission results. Final FY 2017 Q2 results, as well as past and future quarterly and annual PEPFAR program results, can be accessed on the PEPFAR Dashboard at

http://data.pepfar.net.

http://data.pepfar.net/


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0

100000

200000

300000

400000

500000

600000

Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2

PITC TA PITC DSD Index Targeted Outreach VCT

HTS_POS & Yield by Testing Modality (Q1 & Q2)

HTC Neg HTC Pos Yield

COP 2016 Progress: First 90 HTS_POS and Yield by Testing Modality





1759 2009 2013

1073 1130

2645

499

775

1009

512 509

948

0%

10%

20%

30%

40%

50%

60%

0

500

1000

1500

2000

2500

3000

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

HIV Tested

HIV Positive

Yield

COP 2016 Progress: First 90 Partner Example - Index Testing Yield Q1 & Q2





Status of COP16 HRH Implementation & Performance by Key Partners: HTC ITECH OPHID/FHI360

% HTS Providers deployed 105% 20%

COP16 HTC target 488043 153067

# tests done 161,440 36,559

% HTC achieved 33% 24%

COP16 target HTC Pos 43760 29,348

# pos identified 11,880 6,146

% pos achieved 27% 21%

Positivity Rate 7% 17%

# ART Providers deployed 31 141

% ART Providers deployed 52% 101%

COP16 Tx_New target 67827 64,953

# Tx_New Achieved 5,177 7,712

% Tx_New Achieved 8% 12%

Average Tests done per Provider 1,170 348

Average Positives id'd per Provider 86 59

Average Tx_New per Provider 167 55

Average Linkage by Partner 44% 125%

More Testers needed

More Testers needed

Index testing doubles overall yield

Patient navigators intervention working

All PEPFAR FY 2017 Q2 program results and achievements included within this

presentation were based upon preliminary reporting and may differ from the final

submission results. Final FY 2017 Q2 results, as well as past and future quarterly and annual PEPFAR program results, can be accessed on the PEPFAR Dashboard at




0

100,000

200,000

300,000

400,000

500,000

600,000

COP16 COP17 COP16 COP17 COP16 COP17 COP16 COP17 COP16 COP17

Facility DSD Index Testing Stand alone VCT and ARTinitiation centers

Self-Testing Targeted Outreach(previously known as Mobile)

9.9% 11.1%

13.2%

44.9% 13.1%

11.1% 11.1%

13.1%

11.1%

Yield

Positives

Negatives

COP 2017: First 90 - Targeted and Nationally Coherent Testing Strategy

Note: DSD Targets Only





Evidence from HIVST pilot in Zimbabwe

50% of self-testers are men and 28% youth that would otherwise not be reached with testing, addressing current gaps

21% -23% of self-testers have never tested before

52% of self-testers with reactive result at community level linked to health facilities within a week

99% of the self-testers with reactive results at NSC were confirmed positive

Plans for 2017 onwards

• Optimize and scale-up equitable and sustainable HIVST across sectors

• Secondary Distribution of HIVSTs to HIV positive index client to increase sexual partner testing

• HIVST integration with public sector PITC

• Secondary Distribution of HIVSTs by pregnant women enrolled in PMTCT program to increase partner testing

• Distribution to key populations (MSM and FSWs)

COP 2017: First 90 – Innovation through HIV Self-Testing


Modelling Andrew Phillips and Valentina Cambriano, 2016

Maintaining the current rate of testing, modelling suggests that we would not be predicted to achieve the 1st 90 by 2020

Only with the introduction of targeted community-based HIVST in young people, FSW and adult men, it will be possible to achieve the first 90 by 2019 !

COP 2017: Can we achieve the First 90 without HIVST?

Second 90 COP 2016 Performance & COP 2017 Strategies


28,106

40,447 38,467 42,842

40,196

48,984

19,280 21,413 20,800

28,837 28,687

35,968

0%

10%

20%

30%

40%

50%

60%

70%

80%

0

10,000

20,000

30,000

40,000

50,000

60,000

FY16 Q1Results

FY16 Q2Results

FY16 Q3Results

FY16 Q4Results

FY17 Q1Results

FY17 Q2Results

HTS_TST_POS TX_NEW TX_NEW/HTC_Pos

COP 2016 Progress: Second 90 – TX_NEW and Linkages




A New Era of Accountability, Transparency, and Solidarity to Accelerate IMPACT 0.0%

40.0%

80.0%

120.0%

160.0%

200.0%

240.0%

280.0%

0

100

200

300

400

500

600

700

800

HTS_TST_POS link

COP 2016 Progress: Second 90 – Site Volume and Linkages Q1 & Q2 All PEPFAR FY 2017 Q2 program results and achievements included within this

presentation were based upon preliminary reporting and may differ

from the final submission results. Final FY 2017 Q2 results, as well as past and

future quarterly and annual PEPFAR program results, can be accessed on the

PEPFAR Dashboard at http://data.pepfar.net.



Linkage Rate by District *example of analyses done*

18

0%

80%

160%

240%

0

1000

2000

3000

4000

5000

6000

7000

8000

Lin

kage

Rat

e

Nu

mb

er

of

Ind

ivid

ual

s Sum of HTS_TST_POS





Linkage Rate by Site: Zvimba District *example of analyses done*

19

0%

40%

80%

120%

0

20

40

60

80

100

120

Lin

kage

Rat

e

Nu

mb

er

of

Ind

ivid

ual

s

Facility

HTS_TST_POS TX_NEW Linkage




21 Sites account for 80% of IP Q2 TX_New Gap

0%

20%

40%

60%

80%

100%

120%1 4 7

10

13

16

19

22

25

28

31

34

37

40

43

46

49

52

55

58

61

64

67

70

73

76

79

82

85

88

91

94

97

10

0

10

3

10

6

10

9

11

2

11

5

11

8

12

1

12

4

12

7

Site Share of District Gap Cumulative TX_New Gap

COP 2016 Progress: Second 90 – TX_NEW Partner Performance Analysis

Response: Directed HRH Deployment to these 21 low performing sites in Q2





0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q1 Q2

<1 1-9 10-14 F 10-14 M 15-19 F 15-19 M 20-24 F 20-24 M 25-49 F 25-49 M 50+ F 50+ M

COP 2016 Linkage to treatment by age and sex; Oct 2016 - Mar 2017

HIV+ TX_New LinkageAll PEPFAR FY 2017 Q2 program results and achievements included within this presentation were based upon preliminary reporting and may differ from the final

submission results. Final FY 2017 Q2 results, as well as past and future quarterly and annual PEPFAR program results, can be accessed on the PEPFAR Dashboard at http://data.pepfar.net.



Improved linkage among young men

and women

HRH investments: community linkage facilitators, patient

navigators, ART initiators

Demand creation: treatment literacy

targeting young people

Differentiated care: community ART/Same Day Initiation CARGs, support

groups (e.g. young mothers), CATS

Partner management: site level biweekly

cascade data review & expansion to all sites

COP 2017: Overarching Strategies to Increase Performance


SIMS: Care and Treatment –General Population Example

23

51

34

34

53

5

50

4

44

37

48

10

48

2

29

20

7

10

9

1

0

3

0

2

6

7

6

9

1

12

6

0

16

12

1

0

0

0

3

7

3

16

0

1

8

10

1

0

1

1

0

4

0

9

8

0

26

0

14

5

17

02.01 Patient/Beneficiary Records [C&T GEN POP]

02.02 Patient Tracking-ART Patients [C&T GEN POP]

02.03 Patient Tracking-Pre-ART Patients [C&T GEN POP]

02.04 ART Register (paper) [C&T GEN POP]

02.05 ART Register (electronic) [C&T GEN POP]

02.06 pre-ART Register (paper) [C&T GEN POP]

02.07 pre-ART Register (electronic) [C&T GEN POP]

02.08 ART Eligibility [C&T GEN POP]

02.09 Cotrimoxazole [C&T GEN POP]

02.10 Adherence Support [C&T GEN POP]

02.11 ART Monitoring [C&T GEN POP]

02.16 TB Screening (Adult) [C&T GEN POP]

02.17 Isoniazid Preventive Therapy (IPT) [C&T GEN POP]

02.18 TB Diagnostic Evaluation Cascade [C&T GEN POP]

02.19 Facility Linkage to Community Services for Adult and Child PLHIV…

Surpasses Standards Meets Expectations Needs Improvement Needs Urgent Improvement


Viral Load Scale-Up Support

• Support No Site Level HIV-PT-up

Support Ongoing Scale-up

• Navigators in Facilities

Navigators in Facilities

Tools Developed

Bins and Liners Procured

Poor ART Monitoring

Poor Linkage HTS-ART

Poor

Community Referral Systems

Limited Waste

Segregation

Site Improvement Monitoring Systems (SIMS): Addressing the Gaps

Third 90 COP 2016 Performance & COP 2017 Strategies

COP 2017: Third 90 Differentiated care to reach and maintain viral suppression

Stable patients

• Multi-month prescribing • 3-month Rx nationwide

• Fast-track drug pickup visits

• CARGs

• Community outreach/support

Unstable patients

• Home visits, support groups: • CATS for adolescents • Community cadres for adults

• Mental health support • Referrals for ancillary services • Repeat VL, potential regimen

switch • Viremic pregnant/BF women:

• Extended infant prophylaxis • Intensified adherence support


Viral Load Cascade


Reaching the third 90: Scaling Up Viral Load Access and Coverage

19 24

11 18 15

37

49

12 10

32

15 10

30

16 16

52

13 18

14 16 11

18 15 9 10

22

11 17 18 16 14 17

12 11 7

13

24

28

15

20 25

36

33

8 6

19

7

4

12

5 4

12

3

4 3

3

2

3 2

1 1

2

1

1 1 0

0 0

0 0 0

0

0%

20%

40%

60%

80%

100%

120%

0

10

20

30

40

50

60

70

80

90

Bu

law

ayo

Bu

her

a

Ch

ipin

ge

Mak

on

i

Gu

tu

Mas

vin

go

Mu

tare

Mw

en

ezi

Kad

om

a

Mak

on

de

Mu

tasa

Ch

ire

dzi

Gw

eru

Zvim

ba

Tsh

olo

tsh

o

Har

are

Go

rom

on

zi

Gw

and

a

Ch

ivi

Kw

ekw

e

Nka

yi

Hu

run

gwe

Ch

egu

tu

Mb

eren

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Lup

ane

Maz

ow

e

Insi

za

Mar

on

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a

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ruve

Mo

un

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arw

in

Mu

rew

a

Zaka

Bei

tbri

dge

Bu

lilim

a

Mat

ob

o

Go

kwe

So

uth

% C

OV

ERA

GE

# O

F SE

ND

ING

SIT

ES

DISTRICTS

Target Actual % Coverage

PEPFAR District Coverage: 31 of 36 districts covered (86%); PEPFAR Clinics within Districts Coverage: 332 of 585 covered ( 57%)

COP16 Q2 - 144,406 out of 832,207 patients (17%) have received a viral load test All PEPFAR FY 2017 Q2 program results and achievements included within this presentation were based upon preliminary reporting and may differ from the final




0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

0

10

20

30

40

50

60

70

80

90

100

2015 2016 2017 2018 2019 2020

Gap to Target

PEPFAR

Global Fund

PEPFAR TX Curr

Reaching the third 90 – National Viral Load Coverage 2015-2020 Reagent Commitments (Actual and Projected)

VMMC COP 2016 Performance & COP 2017 Strategies


COP 16 Progress & COP17 VMMC Strategy

48,145 39,591

30,456 49,661

34,730

45,796

164,114 306,139

0

50000

100000

150000

200000

250000

300000

350000

COP 15 (FY16) COP 16 (FY17) COP17

Budget, Target And Results Trends (COP15 - COP17)

Q1 Q2 Q3 Q4 Gap to target

$29.7M

$32.3M

35%

$35.6M

338

1184

2129 2974 2992 2958

3910

3733 3806

5002

5179

6047

6957

0

1000

2000

3000

4000

5000

6000

7000

8000

2-J

an

9-J

an

16

-Jan

23

-Jan

30

-Jan

6-F

eb

13

-Feb

20

-Feb

27

-Feb

6-M

ar

13

-Mar

20

-Mar

27

-Mar

Weekly Trajectory towards Program Recovery

Weekly Results

FY17 Weekly Target (6335)

FY18 Weekly Target (7653)





COP 16 Progress: Age Pivot Shift due to Method Change

•51% of all VMMCs 15-29yr (Surgical + PrePex)

39%

29%

14%

8% 9%

1% FY16 Q1&2

•46% of all VMMCs in 15-29yr (No PrePex)

47%

27%

12%

7% 7% 0%

FY17 Q1&2

10-14y

15-19y

20-24y

25-29y

30-49y

50+





COP 16 Progress: DREAMS Districts Innovations & Performance

0

100

200

300

400

500

600

700

800

900

Nu

mb

er

of

MC

s

DREAMS District Recovery Trajectory, Jan-Mar `17

Jan Feb Mar

DREAMS District

Coverage - End of FY16

Target Saturation Date

Bulawayo 72% FY17

Gweru 62% FY18

Makoni 25% FY18

Mazowe 35% FY18

Mutare 25% FY19

Chipinge 22% FY19




Condom & PrEP Programming


Condom Trends in Zimbabwe: Utilization

0

10

20

30

40

50

60

70

80

90

100

Condom use at last higherrisk sex (with a non-marital,

non-cohabiting partner)[Men]

Condom use at last higherrisk sex (with a non-marital,

non-cohabiting partner)[Women]

Condom use at last paidsexual intercourse [Men]

Condom use during higher-risk sex (with multiple

partners) [Men]

Condom use during higher-risk sex (with multiple

partners) [Women]

1999

2005

2010

2015





COP 17 Condom Strategy • Apply total market lens for a sustainable condom strategy, ensuring lasting impact of USG investments &

reduced dependence of the condom market on donor funding

• Build on FY17 study to implement evidence based demand creation interventions targeting youth and adolescents, clients of SWs, and KPs to reduce the condom use gap, with a focus on sustained use of condoms

• Generic category promotion benefits free condoms, social marketed, and commercial sector brands

• 1.25 million monthly sales target to reach 15 million/year


FY17 Q2 PrEP_NEW

37

15%

64%

11% 15%

0%

10%

20%

30%

40%

50%

60%

70%

0

200

400

600

800

1000

1200

1400

1600

Bulawayo Mutare Chipinge Gweru Harare Masvingo Total

15-19 20-24 25+ Total AGYW Total PrEP_NEW DREAMS 2-yr Target % Achievement

*22% of DREAMS 2 year target





PrEP in COP17 • Extend from 4 DREAMS districts to 6,

adding 2 using public sector approach

• Provide PrEP at 5 KP sites • Demand creation AGYW; retention

Population Target

AGYW 16-24 1,457

FSW 710

Other females at risk 250

Gen pop men (discordant couples)

145

MSM 467

Total 3,029

Key Populations Performance & COP 2017 Strategies


FY17 Q2 FSW Results vs Targets

page 40

10,800

8,505

3,280

5,396 8,491

6,330

1,888 4,560

79%

74%

58%

85%

0

2,000

4,000

6,000

8,000

10,000

12,000

KP Prev HTC_TST Treatment New Treatment current

Target Result % Achievement*All PEPFAR FY 2017 Q2 program results and achievements included within this presentation were based upon preliminary reporting and may differ from the final




FY17 HIV Testing Volume & Yield Women Engaging in Transactional Sex (non-self identifying FSW)

376 169 916 527

Static Site Yield, 40%

Static Site Yield, 39%

Outreach Yield, 29%

Outreach Yield, 30%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0

100

200

300

400

500

600

700

800

900

1000

FY17 Q1 FY17 Q2

Static Site Volume Outreach Volume

Static Site Yield Outreach Yield

Characteristics of those reporting transactional sex & testing HIV+ (n=414) • 36% age 15-24, 22% age 25-29, 42% age

30+ • Unemployed (52%) or self-employed (31%) • Divorced (38%), never married (25%),

separated (19%) • Completed secondary school (75%) • Tested in Harare (53%)





FY17 Q2 MSM Results vs Targets

page 42

1,662

1,312

316 341

824

122 74 126

50%

9% 23% 37%

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

KP Prev HTC_TST Treatment new Treatment current

Target Result % Achievement*





COP17 FSW Targets • Size estimation results in June 2017

• Factored in SAPHHiRe baseline & care cascade analyses

18,378

14,859

8,544

6,389 7,421

1,831 1,668

6,501 5,965

710

02,0004,0006,0008,000

10,00012,00014,00016,00018,00020,000

Est pop Reach (81%) HIV+ (58%) On ART(43%, DSD& publicsector))

HTC_TST(HIV- &

unknownstatus)

PEPFARHTC_POS

PEPFARTX_NEW

(91%)

PEPFARTX_CURR

HIV- PEPFARPrEP_NEW(12% HIV-)


COP17 MSM Targets

4,568

3,425

805

346

1,628

382 344 415

1,245

467

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Pop Est(0.2% male

pop)

Reach(75%)

HIV+(23.5%)

On ART(43%)

HTC_TST(HIV- &

unknownstatus)

PEPFARHTC_POS(23.5%)

PEPFARTX_NEW

(90%)

PEPFARTX_CURR

HIV- PrEP_NEW38%


COP17 KP Strategy: Public Sector Approach

• Build on previous investments & infrastructure

• Design model linking clinical services (public sector) with community support (KP groups)

• Use existing KP TX sites as centers of excellence

• Expand in phased approach beginning with Gov’t/Municipal facilities in current sites

• Expand to border/corridor areas in coordination with GF & other donor investments

Learn from neighboring

countries

Second MOHCC KP Coordinator

Plan & implement together with KP

groups Values exploration

HCW attachments to New Start &

Sisters

Peer navigation Integrate people

living with disabilities

Monitoring & QI with KP groups

DREAMS Performance & COP 2017 Strategies


Schools

Community

Health services (FP, HTS, GBV)

Cash transfer program

• AG 15-19

• Out of school AG 15-19

• YW 20-24

• Young women selling sex

• Service provided, referred into ‘program services’ according to need

• Economically vulnerable AGYW 10-24

DREAMS Zimbabwe Entry Points


DREAMS in COP17: Overview

Working together to provide a holistic package

of services for adolescent girls & young women

to be Determined, Resilient, Empowered,

AIDS-Free, Mentored & Safe

DREAMS Zimbabwe

GOAL

HIV testing & counseling

HIV treatment

HIV treatment & adherence

support for adolescents

USAID

TEA ST AS GD EE NTI C

N Y

U

IN T

T NE ER MN PA OT LI EO VN EA DL

USAIDFROM THE AMERICAN PEOPLE

Families Parenting clubs

Savings & lending clubs

Cash transfer

1. Bulawayo

2. Gweru

3. Mazowe

4. Makoni

5. Mutare

6. Chipinge

CommunitiesProvide a supportive

environment for young girls

to achieve their DREAMS

Reduce HIV infections in adolescent girls

& young women by

40%

Educational subsidies

Part-time continuing education

Internships & vocational training

DREAMS clubs

PACKAGE OF SERVICES PROVIDEDFOR ADOLESCENT GIRLS AND YOUNG WOMEN

to stay healthy

in a supportive

community

15-24 Yrs

Male Partners VMMC Voluntary Medical Male Circumcision

Condoms

HIV treatment

Pre-exposure prophylaxis

Gender-based

violence response

Family planning services

Support groups for

women who sell sex

Condoms

• Maintain core services in 6 DREAMS districts

• Saturation of in-school & out-of-school HIV/GBV

• Increase Family Planning targets by 25% & emphasis on teen pregnancy prevention

• Triple investments in educational subsidies to cover 10% of 15-19 year olds overall, targeted to economically vulnerable & at risk of drop out (5 fold increase in targets)

• Expand interventions to return girls to school & mentored work readiness, doubling targets

• Ensure coverage of norms change/community mobilization, and male engagement activities, in wards in existing districts not yet covered

• Continue CTs in 4 districts but plan for transition

• Expansion of PrEP

• Continued support for coordination, M&E including DHIS-2 database

DREAMS: Update on Layering

Unique AGYW 10-24 provided with a DREAMS service, inception through FY17 Q2** Estimating Layering

• ~110,000 unique AGYW 10-24

• 55,433 (59%) AGYW 15-24 received at least 3 services: curriculum based HIV-GBV prevention, social asset building, condom promotion/distribution

• 22,936 (21%) AGYW 10-24 in cash transfer households received at least 5 services: cash transfer, education subsidies or work readiness, social asset building; plus parenting & economic strengthening for their caregiver

49

0 20,000 40,000 60,000 80,000 100,000 120,000

Bulawayo

Chipinge

Gweru

Makoni

Mazowe

Mutare

Total

Bulawayo Chipinge Gweru Makoni Mazowe Mutare Total

Females 10-14 5,170 1,653 3,418 1,560 1,409 2,377 15,587

Females 15-19 16,889 9,175 12,211 7,793 5,576 13,095 64,739

Females 20-24 9,116 3,362 5,305 3,408 1,837 6,844 29,872




OVC COP 2016 Performance & COP 17 Strategies


COP 2016 OVC Progress COP17 OVC Strategy

0%

50%

100%

OVC_SERV TargetReached

428,280 (110%)

TOTAL OVC_SERV Target: 343,500 Boosted UE: $39

22 of 36 PEPFAR districts

Age Distribution

6%

20%

26% 22%

8%

18%





Improve HIV Risk Avoidance

among 9-14 year olds

HIV Support Groups (CATS)

Education Assistance

HIV Case Management

Social Asset Building

Household Resilience Building

SRH, HIV, and GBV

Education

COP2017: Improving HIV Risk Avoidance among 9- 14 year old OVC


GBV Prevention

Community Mobilization:

GBV education for norms change

SRH, HIV, and GBV Education

GBV Response

One Stop Model:

Integrated services at drop in centers

Case management & referral

Psychosocial, legal, & health services

Transportation vouchers & temporary shelter

Post-exposure prophylaxis (PEP)

COP 2017: Addressing GBV through OVC Programming

Validation of COP 2017 DCMM and External Engagement


EVENT TIMING/FREQUENCY COP 2017 Feedback Incorporated

PEPFAR Partners Quarterly meeting Quarterly • PLWHIV & Disabilities Adopted as a Priority

Population for targeted outreach

• Integration of models from the SEARCH study into the HIV Testing Strategy

• Integration of Key Pop Programming in Public Sector Facilities and targeted efforts to increase reach of MSM

• Capacity Building & Demand Creation resources for CSO to monitoring of site-level performance

COP17 Planning retreat Annually

ZNASP multi sectoral review occasional

MOHCC Strategic review and planning meeting

annual

GF funding request writing session After three years

Health Development partners’ meeting

Bi monthly

CSO/ PEPFAR MEETING quarterly

Private sector /PEPFAR meeting half yearly

COP 2017: Stakeholder Engagement and Feedback


Engagement – Open and

Transparent Process

Alignment of Key

Strategies

Commodity Support –

ARVs, RTKs and Lab

58

We are constantly evolving to better serve people affected by the diseases. -Global Fund

PEPFAR and Global Fund


Summary of COP 2017 Targets by Prioritization

59

COP17 Priority

COP17 Target (APR18) HTC_Test

COP17 Target (APR18) HTC_Pos

COP17 Target (APR18) Tx_New

COP17 Target (APR18) Tx_CURR

COP17 Target (APR18) OVC_Serv (excl. DREAMS)

COP17 Target (APR18) KP_Prev (MSM/FSW/DREAMS)

COP17 Target (APR18) PP_Prev

COP17 Target (APR18) VMMC

TOTAL 2,910,458 308,583 269,315 984,129 365,011 19,837 113,024 306,139

Saturation 2,910,458 308,583 269,315 984,129 365,011 19,837 113,024 306,139

Note: Key Pop and DREAMS cascades presented separately


Impact over time: Tx_New and Tx_CURR Details

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COP 17 Priority COP 16 # of SNUs

TX_New: APR 2016

Achievement

TX_CURR: APR16

Achievement

TX_New: FY 2017 Target /

FY 2017 Results to-date

TX_CURR: FY 2017 Target /

FY 2017 Results to-date

COP 17 # of SNUs

TX_New: COP 2017

Target (APR 2018)

TX_CURR: COP 2017

Target (APR 2018)

Net New: COP 2017

TOTAL 60 90,330 737,085 25% 71% 60 263,424 984,410 139,260

Saturation

17

32,038 261,949 40 263,424 984,410 139,260

Aggressive 19 49,389 388,959 0

Central Support

24 8,903 86,177 20




0

50000

100000

150000

200000

250000

300000

350000

0-14 F 0-14 M 15-24 F 15-24 M 25+ F 25+ M

COP17 Clinical Cascades by Gender and Age

HTC HTC Pos TX_New


PEPFAR supply chain

management investments

include

Seconded staff to MOHCC DPS and DLS logistics units National &

subnational support and

coordination for quantification and

supply planning

Routine quarterly pipeline

monitoring

Storage and distribution

support

Support for data collection and

reporting systems for distribution

systems

Support to optimize existing

pharmaceutical supply chain

systems

Central level ARV stock audits at

NatPharm (Harare and branches)

Supply Chain Management

Commodity & SCM support is the same across all SNUs

regardless of categorization.

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ARV Commitments vs. National and PEPFAR targets

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0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

2017 2018 2019 2020

Global Fund

USG

GOZ

National target

PEPFAR target (36-40 districts only)

*PEPFAR 2019 and 2020 targets estimated at 1,250,000 and 1,300,000.

Gap of 99,994 pts.

$11.8 million


Commodities

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COP 2017: Table 6 • System activities cover both site (~$14.5m) and above-site (~$4.5m) barriers

• Systems in Zimbabwe rely primarily on the Ministry of Health for implementation and most commodities are provided by the Global Fund.

• Table 6 has been approved

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Need for improved HTC alignment, yield

and ongoing ART patient monitoring

Coordination of national Key

Populations Strategy

Address Suboptimal ART initiation and

adherence

Improve national data for

programmatic decision making

Supply chain support and strengthening

Community support and accountability


PEPFAR Budget Code

2016 Budget by Budget Code

2017 Budget by Budget Code

PMTCT $1,309,769 $425,017 HVAB $776 $947,317 HVOP $896,458 $9,169,278 IDUP

$0 $0 HMBL HMIN CIRC $13,143,370 $13,051,794 HVCT $9,894,719 $13,286,835 HBHC $3,985,245 $9,796,377 PDCS $716,547 $1,400,220 HKID $7,589,019 $15,002,079 HTXS $26,718,602 $27,404,657 HTXD $21,971,822 $20,029,673 PDTX $3,295,443 $2,648,344 HVTB $1,638,563 $4,360,363 HLAB $220,081 $210,583 HVSI $1,419,003 $1,983,145 OHSS $815,782 $473,723 HVMS $7,384,801 $6,783,999 Total $101,000,000 $126,973,404 Note: Excludes VMMC Central

Prevention Including DREAMS

7% CIRC 10%

Testing Services 11%

Adult and Pediatric Care and Treatment Services including

PMTCT 36%

LAB 0%

HVAB 1%

HVSI 2%

OHSS 0%

M & Ops 5%

OVC Including DREAMS

12%

HTXD 16%

COP 2017 Categories COP 2016 vs. COP 2017: Budget Codes


Above -Site Site Level $4,435,199 $110,218,352

Technical Assistance for Service Delivery

Improvement (TA)

• Site-Level Clinical Supervision & Mentoring

• QI/QA • Forecasting/Quantification • National Lab Quality • MOHCC Secondments • PITC TA-SDI • Surveys

• COP 17 TA Allocation:

$18,748,227

Direct Service Delivery (DSD)

• HRH for PITC +, Index Testing, Patient Navigators, Mobile ART Initiators

• Commodities • Friendship Bench Pilot • DREAMS & VMMC • Condom Programming • OVC & Key Pop

• COP 17 DSD Allocation:

$81,863,641

Note: Excluding M&O & PM/SI

COP 2017: Allocations – Above Site vs. TA vs. DSD


Earmark

Earmark Requirement

Allocation

Total Notes

C&T Earmark Requirement in Planning Level Letter

$69,522,619

$69,753,190

$5,166,042

C&T Earmark is at or above requirement

OVC Earmark Requirement

$7,589,019

$15,002,079

$7,413,060 OVC Earmark is at or above requirement

GBV Earmark Requirement

$894,000

$1,821,275

$927,275 Earmark is at or above requirement

Water Earmark Requirement

$100,000

$125,000

$25,000 Earmark is at or above requirement

Agency New FY 2017 Funding (all accounts) Applied Pipeline Total Planning Level

USAID $92,037,399

$0

$126,973,404 HHS/CDC $34,179,005

HHS/HRSA $525,000

State $232,000

COP 2017: Agency and Earmark Allocations

COP 2017 Approval Meeting Out-brief ZIMBABWE · HTC HTC Pos TX_New TX_CURR Result Target All PEPFAR...

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