Centers for Disease Control - CGH

Description

South Africa has the largest HIV epidemic in the world with an estimated 6.4 million persons infected with HIV (UNAIDS 2014) and an estimated 469,000 new infections per year (HSRC 2012). Significant strides have been made over the past several years with expansion of the antiretroviral treatment (ART) program and substantial reductions in transmission from mother to child (MTCT). Further scale-up of combination prevention and ART is needed urgently over the next few years to achieve epidemic control. The South African Minister of Health has endorsed 90-90-90 as a goal to be achieved by 2020. PEPFAR, in support of the South Africa government (SAG) 90-90-90 goals, has identified 27 priority districts to focus for further scale-up of prevention and treatment activities. In addition, in partnership with both the SAG and the private sector, PEPFAR will support implementation of the DREAMS initiative across 5 districts in Kwazulu-Natal and Gauteng provinces. DREAMS will support a set of core interventions designed to empower adolescent girls and young women (AGYW), mobilize communities, strengthen families, and reduce risk among the male sex partners of AGYW. On September 30, 2015, the WHO released new guidelines adopting test and start for all HIV infected persons and pre-exposure oral prophylaxis (PrEP) for HIV negative individuals at substantial risk of HIV infection. South Africa recently revised national guidelines to expand ART eligibility to include all asymptomatic persons with HIV infection and CD4 count <500 cells/mm3 and has expressed interest in policy changes that include Test and Start, as well as provision of PrEP to key populations such as MSM and HIV negative female sex workers (FSWs). In order to move more quickly, PEPFAR proposed that the DREAMS platform offered a unique opportunity to implement activities that can function as “bridge-to-scale-up” for Test and Start within four of the five DREAMS districts In addition to further reducing incident infections in these districts by supplementing DREAMS interventions, these activities would help inform the operational considerations needed for implementation of Test and Start on a national scale. PEPFAR SA proposed additional funding allocation would be calculated for an ART target of 1,202,939 by September 2016 and 1,395,146 by September 2017 for the four districts. The proposal would increase the net new target over the next two years by 261,589 patients on ART. It is important to note that 70,134 of this net new target increase is already included in the aggressive two-year scale-up targets that were set in COP15. The expectation was that the 70,134 new on ART target would be reached by September 2017, pending adoption of new guidelines by the SAG. A unit cost of $55 (for a ‘TA with limited DSD’ approach) was allocated to each of these targets in the COP15 approved funding. It is anticipated that COP16 will continue to include budgeting of $55 per new ART target. At this time gender disparities within the gap to 90% ART coverage cannot be fully quantified, but based on available cohort data one can assume that well over 50% of HIV+ not on treatment consists of men with HIV infection who are either not diagnosed or aware of their HIV infection but not currently on ART. In addition to DREAMS funding, the service delivery component of funding for Test and Start will support models specific to the needs of men in order to identify, link to care, initiate ART, and retain in care with viral suppression. Examples include mobile testing, after-hours clinics, adherence clubs for men, delivery of drugs to non-clinical settings, and extensive mapping to determine ideal locations for service delivery to men. DREAMS includes some funds to support linkage to services by specific targeting of male sexual partners identified through mapping and plans for addressing male norms using evidence based interventions. Rapid assessments of these interventions will be crucial to better determine which models have the greatest impact. Implementation of Test and Start for men will improve the health and productivity of HIV-infected men and achieve a more rapid reduction in community viral load by removing determination of eligibility as a barrier to ART initiation. Since there will be a delay before the SAG can fully implement a national Test and Start program, the SAG has not yet budgeted for the increase in the demand for commodities that will be required for Test and Start. It is suggested that all commodities will be purchased directly by the National Department of Health (NDoH) to achieve the comparative advantage of procurement of first-line medicines at SAG tender pricing. Costing scenarios have been made on a per patient cost for commodities of $100 for ARV drugs plus $31 for laboratory tests. The purpose of this supplemental Funding Opportunity Announcement is to purchase commodities and to pay for laboratory testing in order to implement Test and Start in four districts in South Africa with the goal of having 90% of PLHIV diagnosed and 80% of PLHIV on ART by the end of September 2017. This Test and Start bridge-to-scale-up will include leveraging DREAMS activities focused on identifying, linking to care, initiating and retaining on ART, men aged 20 – 49 within these 4 districts; with a goal of having 65% of males with HIV infection in care and on ART by Sept 2016 and 80% by Sept 2017.

Who can apply

• Others

Contact

Priyanka Rathod<br/>wnv9@cdc.gov<br/>
wnv9@cdc.gov