A Look Back to Move Forward
Reflecting on USAID’s achievements in assisting sub-Saharan African countries reach HIV epidemic control
Raymond Avosseh, FHI 360
USAID commemorates World AIDS Day 2020 by renewing our commitment to achieving HIV/AIDS epidemic control. We are focused on the future and what comes next in the fight against this epidemic, and are well positioned to lead the way in moving HIV/AIDS work forward — sustaining the gains and protecting investments achieved under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
This year marks the conclusion of the PEPFAR 2017–2020 Strategy for Accelerating HIV/AIDS Epidemic Control. The three-year strategy emphasized five action steps toward achieving epidemic control:
1. Acceleration of testing and treatment strategies
2. Expansion of prevention services
3. Continuous use of data to improve partner performance and program effectiveness
4. Engagement with faith-based organizations
5. Strengthened policies and financial contributions by governments.
Achieving epidemic control — that is when the total number of new HIV infections falls below the total number of deaths from all causes among HIV-infected individuals, ultimately ending the HIV/AIDS pandemic — remains the shared vision of PEPFAR, USAID, and other U.S. Government partners. As we prepare for the next phase of PEPFAR, we celebrate our progress by showcasing high-impact examples of how USAID has assisted many sub-Saharan African countries that have reached an important goal post — epidemic control.
Stories of Impact
Testing and Treatment
Index testing, an initiative that tracks the contacts of people who test positive for HIV, is an efficient and effective way to identify HIV-positive individuals. Prior to 2016, this method of testing was not the norm in Africa; USAID/Tanzania was an early adopter of the intervention. In 2015, USAID co-funded a study introducing and evaluating index testing. The study showed high uptake of partner notification among newly diagnosed individuals, with more than half of partners successfully referred for testing and a high positivity rate among those referred partners. Index testing quickly became an important way to increase early referral to care and to help reduce risk among uninfected, but high-risk partners. Last year in Tanzania, 58 percent of clients who tested positive for HIV were found as a result of index testing.
Prevention
USAID supports adolescent girls and young women (AGYW) by ensuring they receive the care they need to be healthy and safe through the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) partnership. Between October 2019 and March 2020, USAID had contributed to almost 1.4 million AGYW being enrolled in at least one program and 57 percent completed the primary package of programs, which include activities such as HIV and Violence Prevention, and Social Assets Building.
USAID/Zimbabwe has done innovative work with DREAMS Peer Adolescent Mobilizers and HIV Prevention Ambassadors, helping these young leaders increase their confidence to support AGYW with oral pre-exposure prophylaxis (PrEP) initiation and address continuation challenges. During the COVID-19 pandemic, AGYW are able to maintain access to PrEP services through multi-month dispensing (MMD) of medication and telehealth appointments. They’re also able to stay informed about PrEP through the DREAMS program’s social media platforms. As of August 2020, the USAID/Zimbabwe program had initiated 9,499 AGYW on PrEP.
Data
Over the past decade, USAID investments in supply chain management in Rwanda have led to the development of one of the strongest supply chain systems in the region. Key strategic interventions have led to data visibility, data triangulations, and commodity availability at all levels of the Rwanda supply chain.
The system now has the capability to track shipment movements like that of UPS; currently in Rwanda, health facilities can ascertain when their orders are put on trucks and when they will arrive at facilities. This has ensured continuous availability of critical HIV medication such as antiretrovirals (ARVs) and viral load supplies, as well as other laboratory commodities in Rwanda. USAID worked with 690 supply chain staffers across 30 districts.
As a result, data accuracy improved from 25 percent to 85 percent and medication distribution recording increased from 35 percent to 95 percent, ensuring sufficient supply of ARVs to those who need them. With accurate data and improved processes, regions in Rwanda have ensured consistent access to life-saving medication for the more than 200,000 people across the country who need it.
Faith-based Organizations
The Luke Commission (TLC) is a faith-based organization providing free, comprehensive health care to underserved populations in Eswatini. With support from PEPFAR, TLC’s USAID-funded mobile medical hospital outreach has provided free medical care to 456,000 patients (representing 35 percent of the country’s population) and provided 2.3 million medical services since 2006. Between October 2019 and June 2020, TLC enrolled 831 new patients on PrEP, a 322 percent increase above their 258 patient target. In partnership with the Eswatini Ministry of Health, TLC also serves as part of a national COVID-19 response team and has screened over 50,000 patients for COVID-19 since March 2020.
Government Policies and Financial Contributions
In an effort to decongest health facilities and ensure uninterrupted access to treatment during the COVID-19 response, USAID advocated for policy changes to MMD through Missions and U.S. Embassies; research has shown that clients enrolled in MMD have significantly greater treatment adherence and retention than clients following a monthly drug regimen. As a result, almost 30 PEPFAR-supported countries mandated changes to current MMD policy or reiterated the provision and/or scale-up of MMD. These changes include relaxed eligibility requirements, the inclusion of sub-populations previously prohibited from receiving MMD, and the introduction and scale-up of both three- and six-month medication dispensing. The benefits of these policy changes will last long beyond the COVID-19 pandemic.
About the Authors
The authors are staffers in the Office of HIV/AIDS in USAID’s Bureau for Global Health. Ellen Langhans is the Senior Communications Advisor. Christian Dorisca is the Public Affairs Advisor. Amy Wasserbach is the Program Analyst.
