cop 2017 approval meeting presentation nigeria...lessons learned from johannesburg •increase size...

COP 2017 Approval Meeting Presentation

Nigeria June 16, 2017

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

Policy Overview

• The 2016 National Guidelines For HIV Prevention, Treatment, and Care provides policy support for test and start, same day ART initiation and self- testing.

• New guidelines launched WAD, 2016 – Nationwide Test and Start implementation gradually rolled out since then

• Also on WAD, 2016 – FMOH launched the “Fast-Track plan”

Key objective was to address linkage gaps by tracking back previously diagnosed PLHIV and put them on ART

GON commitment to lead a joint stakeholder effort to reach an additional 500,000 PLHIV with ARVs with 18 months

2


National and PEPFAR Trend: Individuals currently on Treatment

3

40,000

124,567

302,973

432,285

639,397

747,382 767,442

886,668

542,541 592,842

700,262

18,885 59,090

198,449

350,000

522,396

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

# P

atie

nt o

n Tr

eatm

ent

National Current PEPFAR Trend PEPFAR w/o ceding to GON/GF

70,000 to GF 36,700 to GON


Lessons Learned from Johannesburg

• Increase size estimates and targets for MSM

• Increase PTMCT services in Sustained SNUs

• The need for an AIDS Indicator Survey (AIS)

• Address poor linkage rates in Sustained SNUs

• Discontinued high-cost low-yield testing

• Home-based and Other Community HIV testing strategies stopped from Q3 of FY17

4


Status of COP16 Implementation: First 90

5


OU Level FY17 Q1 & Q2 HTS Achievements

Prioritization FY16

HTS_TST Achievement

FY16 HTC_TST %

Achievement

FY16 HTC_TST_POS

% Achievement

FY17 HTC_TST Target

FY17 HTC_TST SAPR

Achievement

FY17 HTC_TST %

Achievement

FY17 HTC_TST_POS Target

FY17 SAPR HTC_TST_POS Achievement

FY17 SAPR HTC_TST_POS

% Achievement

Scale Up 7,603,066 139% 32% 3,165,161

1,855,336 59% 88,830 32,251 36%

Sustained 4,986,420 122% 99% 3,200,774

2,071,988 65%

85,146 73,767 87%

Military 99,254 71% 137% 118,235

55,557 47%

4,580 2,571 56%

Total 12,688,740 131% 53% 6,484,170

3,982,881 61%

178,556 108,589 61%

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/


FY16 - FY17 Quarterly Improvements in Testing Efficiency

5,885 9,452 6,017 4,772 10,617 8,007

56,142 61,172 47,213 51,264

43,235 46,873

1,587,602

2,233,316 2,223,516

2,465,071

1,431,347

1,603,295

894,574

1,584,810

1,060,399

616,526

333,548

481,422

0

50,000

100,000

150,000

200,000

250,000

300,000

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

FY16 Q1 FY16 Q2 FY16 Q3 FY16 Q4 FY17 Q1 FY17 Q2

Nu

mb

er

Po

siti

ve

Nu

mb

er

Test

ed

Community Positives Facility Positives Facility HTC_TST Community HTC_TSTAll 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.



FY17Q1 & Q2 HTS_POS in Scale-up LGAs

0%

0%

1%

1%

2%

2%

3%

0

2,000

4,000

6,000

8,000

10,000

12,000

<10 years 10 - 14 Female 10 - 14 Male 15-19 Female 15-19 Male 20-24 Female 20-24 Male 25-49 Female 25-49 Male 50+ Female 50+ Male

Yie

ld

HTS

_TST

_PO

S

FY17 Q1 HTS_Pos FY17 Q2 HTS_Pos FY17 Q1 Yield FY17 Q2 YieldAll 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.



FY17Q1 & Q2 HTS_POS in Sustained LGAs

0%

1%

2%

3%

4%

5%

6%

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

<10 years 10 - 14 Female 10 - 14 Male 15-19 Female 15-19 Male 20-24 Female 20-24 Male 25-49 Female 25-49 Male 50+ Female 50+ Male

YIE

LD

HTS

_TST

_PO

S

FY17 Q1 HTS_Pos FY17 Q2 HTS_Pos FY17 Q1 Yield FY17 Q2 YieldAll 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.



FY17 Quarterly Testing Yield by Modality

Testing Modality

FY 17 Q1

Tested Pos Yield

FY 17 Q2

Tested Pos Yield

Home-Based Services 74,507 466 0.6% 105,413 697 0.7%

Index Testing Services 18,750 388 2.1% 3,125 464 14.8%

PITC Inpatient Services 33,513 1,743 5.2% 36,860 1,536 4.2%

PITC Malnutrition Clinics 28 - 0.0% 26 - 0.0%

Mobile Testing Services 236,720 5,490 2.3% 366,195 6,885 1.9%

Other Service (Community) 10,502 88 0.8% 8,551 79 0.9%

Other PITC Services 550,189 15,437 2.8% 609,222 15,319 2.5%

PITC Pediatric Services 15,190 388 2.6% 19,171 371 1.9%

PITC PMTCT (ANC Only) Clinics 321,180 3,542 1.1% 376,599 3,936 1.0%

PITC TB Clinics 27,521 2,002 7.3% 39,153 2,412 6.2%

VCT Co-located 606,476 24,117 4.0% 520,110 23,121 4.4%

Q1 FY17 Q2 FY17




COP17 HIV Testing Yield and Cost per Positive by Modality

* Cost per positives exclude costs for commodities, PM, and SI

Home-based

Mobile Testing

Other Community

Index Testing

PITC Inpatient

Other PITC PITC Pediatric

PITC TB

PITC PMTCT VCT Co-located

$(25.00)

$25.00

$75.00

$125.00

$175.00

$225.00

$275.00

$325.00

$375.00

$425.00

0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00%

CBTC PITC VCT

Co

st p

er p

osi

tive

FY17 Positivity Rate

National UE, HTC POS

Not shown: • PITC Malnutrition (16.39%, $7.75) • VCT Standalone (20.57%, $6.18)


Linkage to Treatment: Scale-up vs Sustained LGAs

46%

59%

74%

82%

92%

84%

56%

53%

63%

56% 60%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Linkage to Tx_Scale Up Linkage to Tx_Sustained




38,113

70,476

33,552

44,544

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Scale Up Sustained

SAPR17 Linkage Rate (Q1 & Q2)

HTC_Pos Tx_New

4,561

25,932

Linkage: 88%

Linkage: 63%

Improved Linkage Rate by SAPR 17

98,309

143,452

65,970

80,386

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Scale Up Sustained

APR16 Linkage Rate

HTC_Pos Tx_New

32,339

63,066

Linkage: 67%

Linkage: 56%




Status of COP16 Implementation: Prevention - PMTCT

14


FY16 PMTCT Cascade Nigeria | FY16 Q4 Cum.

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

Pregnant women who

attend ANC

Pregnant women with

known HIV status

0

10,000

20,000

30,000

40,000

50,000

60,000

HIV+ pregnant

women in reporting

periods

HIV+ pregnant

women receiving

ARVs

HIV exposed infants

tested by 2 months of

age

HIV exposed infants

tested by 12 months

of age

HIV exposed infants

uninfected not

breastfeeding

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

HIV infected infants

identified by 2 months

of age


identified by 12

months of age


new on ART

Uptake of Maternal HIV Testing Maternal/Infant Clinical Cascade HIV+ Infant Linkage to Treatment

●

FY16 Annual

Targets FY16 Annual

Achievements

Linkage 49%


Cumulative FY17 PMTCT Cascade FY17 Annual

Targets QFY17 Cumulative

Achievements PEPFAR PMTCT CASCADE

Nigeria | FY17 Q2 Cumulative Results

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

Pregnant women whoattend ANC

Pregnant women withknown HIV status

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

HIV+ pregnant women inreporting periods

HIV+ pregnant womenreceiving ARVs

HIV exposed infants testedby 2 months of age

HIV exposed infants testedby 12 months of age

0

200

400

600

800

1000

1200

1400

HIV infected infantsidentified by 2 months

of age

HIV infected infantsidentified by 12months of age

HIV infected infantsnew on ART

Uptake of Maternal HIV Testing Maternal/Infant Clinical Cascade HIV+ Infant Linkage to Treatment

●

Linkage 59%




COP 17 Programmatic Direction: Strategies – First 90

17


COP17 First 90 Strategies by LGA Categorization

18

* New in FY18

Targeted Outreach Testing:


Reaching Underserved Sub-populations

* New in FY18


Interventions to Improve Linkage

• Use of peer-navigators to ease flow of clients across the cascade of care

• Use of PLHIV volunteers as lay counsellors and referral escorts

• Incentivized case finding and linkage among KPs using redeemable coupons

• Same-day ART initiation including express lane for newly diagnosed PLHIV

• Fortnightly/monthly performance review with partners based on cascade

indicators


COP17 Strategies – PMTCT

21


PMTCT Strategies by LGA Categorization STRATEGIES SCALE-UP SUSTAINED PLUS SUSTAINED

PITC (opt out) at all ANCs X X X

Lifelong ART for all positives X X X

Enhanced PMTCT monitoring by smart phone

X X X

Enhanced ARVs for high risk HEI

X X X

Use of cohort registers X X X

Demand creation activities At community level – engage

TBAs Limited to mother-infant

pair tracking Limited to mother-infant pair

tracking

Intensity of services Scale up congregational PMTCT in

selected communities Transition out of low yield

sites Transition out of low yield

sites

Assessment of enhanced ARV prophylaxis for high risk HEI in selected tertiary facilities*

X

* New in FY18

* New in FY18


Strengthening EID Services in COP17

• Improving EID at 2months

Increase work hour by the labs to reduce TAT

Adoption of integrated transport system for DBS

Improve utilization of EID results

Improve commodity management

• Improving HIV+ infant linkage to treatment

MIP tracking by partners

Enhanced PMTCT monitoring on weekly bases

EID tracking tools

Facilitated referral of positives

23


Status of COP16 Implementation: Second 90

24


PEPFAR’s Contribution Towards 90-90-90 at Q2 by Gender and Age Bands

25

83,370

1,584,027

86,773

1,648,681

17,668

201,882

16,993

483,770

16,228

190,248

15,961

455,493

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

<15 >15 <15 >15

Male Female

# o

f P

ers

on

s

PLHIV # Current on Treatment # on treatment with suppressed VL (<1000 cps/ml)

Cumulative Treatment achievement at FY 17 Q2

168,119

78,096

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Acc

om

plis

hm

ent

No

. of

Pati

ents

TX_NEW

Targets Results % Accomplishment

832,599

720,313

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Acc

om

plis

hm

ent

No

.of

Pati

ents

TX_CURR

Targets Results % AccomplishmentAll PEPFAR FY 2017 Q2 program results and achievements included within this presentation were based upon preliminary reporting and may differ from the final submission



TX_NEW achievement at FY 17 Q2 by geo-prioritization

87,474

16,801

33,552

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

Annual Target FY17 Result at Q1 FY17 CumulativeResult at Q2

Per

cen

tage

Acc

om

plis

hm

en

t

No

. of

Pat

ien

ts

Period

Scale Up LGAs

Annual Target Result Percent Accomplishment

80,645

21,176

44,544

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Annual Target FY17 Result at Q1 FY17 CumulativeResult at Q2

Per

cen

tage

Acc

om

plis

hm

en

t

No

. of

Pat

ien

ts

Period

Sustained Support LGAs

Annual Target Result Percent Accomplishment



TX_CURR achievement at FY 17 Q2 by geo-prioritization

281,386

192,902

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

50,000

100,000

150,000

200,000

250,000

300,000

Annual Target FY17 Result at Q2

Per

cen

tage

Acc

om

plis

hm

en

t

No

. of

Pat

ien

ts

Reporting Period

Scale Up LGAs

Annual Target Result Percentage Accomplishment

551,213 527,411

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

100,000

200,000

300,000

400,000

500,000

600,000

Annual Target FY17 Result at Q2

Per

cen

tage

Acc

om

plis

hm

en

t

No

. of

Pat

ien

ts

Reporting Period

Sustained Support LGAs

Annual Target Results Percentage Accomplishment




Scale up LGAs - FY17 Q2 TX_NEW % Achievement

29

LGA

TX_NEW (N,

DSD) TARGET:

New on ART Oct

2016 to Sep 2017

TX_NEW (N,

DSD): New on

ART Oct 2016

to Mar 2017 % Achievement

ak Ikot Ekpene 3,156 1,057 33%

ak Okobo 3,457 450 13%

ak Oron 1,342 1,124 84%

ak Uruan 1,031 675 65%

ak Uyo 4,496 1,838 41%

be Buruku 3,184 1,076 34%

be Gwer West 3,698 557 15%

be Katsina-Ala 1,255 1,042 83%

be Konshisha 1,630 818 50%

be Logo 2,993 2,093 70%

be Tarka 1,384 606 44%

be Ushongo 1,003 602 60%

cr Calabar Municipal 907 1,529 169%

cr Calabar South 2,078 845 41%

fc Abuja Municipal Area Council 10,045 2,980 30%

fc Bwari 3,877 833 21%

LGA

TX_NEW (N,

DSD) TARGET:

New on ART Oct

2016 to Sep 2017

TX_NEW (N,

DSD): New on

ART Oct 2016

to Mar 2017 % Achievement

la Agege 1,955 848 43%

la Ajeromi-Ifelodun 2,085 975 47%

la Alimosho 10,126 1,244 12%

la Apapa 293 343 117%

la Ifako-Ijaiye 4,729 390 8%

la Ikeja 2,082 568 27%

la Mushin 3,052 618 20%

la Surulere 2,127 902 42%

na Doma 1,584 356 22%

na Karu 2,200 1,177 54%

na Lafia 3,689 1,801 49%

na Nasarawa 495 342 69%

na Obi 74 487 658%

ri Eleme 929 352 38%

ri Obio-Akpor 1,195 1,581 132%

ri Port-Harcourt 1,197 1,652 138%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.



Scale up LGAs: FY17 Q2 Treatment Coverage

30

LGA PLHIV

TX_CURR

(N, DSD):

Receiving

ART % Coverage

ak Ikot Ekpene 9,731 6,732 69%

ak Okobo 10,186 1,152 11%

ak Oron 8,918 5,198 58%

ak Uruan 8,899 2,101 24%

ak Uyo 18,746 6,190 33%

be Buruku 17,265 5,502 32%

be Gwer West 13,409 3,154 24%

be Katsina-Ala 18,145 5,443 30%

be Konshisha 14,994 3,918 26%

be Logo 24,175 10,764 45%

be Tarka 6,075 4,237 70%

be Ushongo 13,540 2,372 18%

cr Calabar Municipal 9,596 7,140 74%

cr Calabar South 5,122 2,549 50%

fc Abuja Municipal Area Council 83,830 26,031 31%

fc Bwari 14,802 7,042 48%

LGA PLHIV

TX_CURR

(N, DSD):

Receiving

ART % Coverage

la Agege 6,511 2,125 33%

la Ajeromi-Ifelodun 15,319 4,210 27%

la Alimosho 37,492 3,544 9%

la Apapa 5,005 1,093 22%

la Ifako-Ijaiye 6,074 1,832 30%

la Ikeja 4,996 5,898 118%

la Mushin 7,770 8,422 108%

la Surulere 11,300 1,575 14%

na Doma 6,411 2,601 41%

na Karu 9,949 6,583 66%

na Lafia 16,506 9,597 58%

na Nasarawa 6,810 945 14%

na Obi 10,654 1,510 14%

ri Eleme 15,110 901 6%

ri Obio-Akpor 20,034 7,408 37%

ri Port-Harcourt 17,841 7,068 40%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




Year-on-Year Retention Rate for Current on Treatment Clients

31

83%

95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Scale up LGAs Sustained Support LGAs

Ret

enti

on

Rat

e


COP17 Strategies - Second 90

32


Treatment strategies

• Test and start in all LGAs

• Same-day ART initiation

• Differentiated Service Delivery in all LGAs

Decentralization of clients from high volume

HFs to PHCs

Multi-month scripting

Fast track ART services/nurse refill

Community ART groups (client-managed

group model)

Community Pharmacy ARV refill

Community treatment initiation

• Strengthen retention

Enhanced adherence support

Defaulters tracking

Evening & weekend hours

• Intensify pediatric case finding

• Early identification and treatment of TB

• Optimal implementation of IPT

• Increased focus on linkage and retention for

adolescents and young women


PEPFAR Supported Treatment New Trend

126,215

146,356

168,119

261,016

-

50,000

100,000

150,000

200,000

250,000

300,000

FY2015 Results FY2016 Results FY2017 Targets FY2018 Targets

Nu

mb

er


COP17 Strategies - Third 90

35


11,388 19,200

38,798 46,581

58,008

84,272

4,839

6,496

11,510

12,156

19,943

27,968

0

20,000

40,000

60,000

80,000

100,000

120,000

FY16 Q1 FY16 Q2 FY16 Q3 FY16 Q4 FY17 Q1 FY17Q2

Nu

mb

er o

f vi

ral l

oad

tes

ts

VL<1000 VL >1000

36

Status of COP 2016 Implementation 3RD 90: Trend in Viral Load Scale-Up



Viral Load Suppression by Age and Sex

Adherence ARVs among Male Adherence to ARVs among females

50% 54% 56% 59% 50%

77%

50% 46% 44% 41% 50%

23%

0%

20%

40%

60%

80%

100%

120%

<1yr 1 to 4 5 to 9 10 to 14 15 to 19 20+

VL suppression - Male by age

<1000 >1000

40% 54% 59% 60%

68% 79%

60% 46% 41% 40%

32% 21%

0%

20%

40%

60%

80%

100%

120%

<1yr 1 to 4 5 to 9 10 to 14 15 to 19 20+

VL suppression - Female by age

<1000 >1000


5-Year Plan for Scaling Up Viral Load Testing

31%

66%

80%

85%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

FY16 FY17 FY18 FY19 FY20 FY21

% V

ira

l Lo

ad

Te

st

# o

f C

lie

nts

TX_CURR Targets VL Targets % Targets


Increasing Uptake of Viral Load and EID

• Develop cadre of clinical support/quality enhancement staff

• Support ordering and collection of specimens for viral load and EID testing.

• Ensure that results of viral load testing are communicated to providers and patients

• Facilitate appropriate action by clinical providers in response to non-suppressed viral load

• Outcomes

• Increase uptake of viral load and EID

• Improve viral load suppression

• Strengthen quality of HIV treatment services

39


COP17 Strategies – Key Populations

40


PEPFAR KP Achievement at FY17 Q2

Performance

Indicators FY17 Target

FY17 Q1

Results

FY17 Q2

Results

FY17 Cumulative

Results (Q1+Q2)

% FY17

Achievement

HTC_TST 187,582 46,896 60,389 107,285 57%

HTS_TST_POS 18,159 4,503 5,192 9,695 53%

TX_NEW 2,486 2,399 3,181 5,580 225%

TX_CURR 1,445 3,555 5,467 9,022 624%

KP_PREV 218,863 101,724 101,724 47%




Quarterly Testing Yield for KP

63,827 61,995

74,294

59,507

46,896

60,389

1,507 1,750 2,725 2,497 4,503 5,192

2% 3%

4% 4%

10%

9%

0%

2%

4%

6%

8%

10%

12%

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000


HIV

Ser

op

osi

tivi

ty

HIV

Tes

t an

d P

osi

tive

KPs

Iden

tifi

ed

HTC_TST HTC_TST_POS HIV SeropositivityAll PEPFAR FY 2017 Q2 program results and achievements included within this presentation were based upon preliminary reporting and may differ from the final submission




KP Seropositivity (FY17 Q1 & Q2)

43

76,265

19,385

11,389

246

6,229 2,529 902 35

8%

13%

8%

14%

0%

2%

4%

6%

8%

10%

12%

14%

16%

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

FSW MSM PWID TG

HIV

Ser

op

osi

tivi

ty

HIV

Tes

t an

d P

osi

tive

KPs

iden

tifi

ed

HTC_TST HTC_TST_POS HIV SeropositivityAll PEPFAR FY 2017 Q2 program results and achievements included within this presentation were based upon preliminary reporting and may differ from the final submission




4,503

5,192

9,695

2,399

3,181

5,580

53%

61% 58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

2,000

4,000

6,000

8,000

10,000

12,000

FY17 Q1 FY17 Q2 Overall

Lin

kage

rat

e

HIV

Po

siti

ve K

Ps id

enti

fied

an

d in

itia

ted

on

AR

T

HTC_TST_POS TX_NEW Linkage Rate

KP Program Linkage Rates FY17




COP17 Strategies – Key Populations

45

A New Era of Accountability, Transparency, and Solidarity to Accelerate IMPACT 46

KP Strategies for COP 17

Current Strategies

• Maintain case finding

• Improve linkage

• Assure retention

• Social media

• Inter TWG (KP,SI, Tx & Lab) collaborations

• Risk profile-based testing

Additional Strategies

• Alternative sites (KP designated)

• PrEP

• Self Testing

• Conduct KP Size Estimates


Status of COP16 Implementation: Prevention - OVC

47


SAPR 17 Results (OVC_ SERV)

SNU

Prioritization

FY15 Cum.

Result

FY16 Q2

Result

FY16 Cum.

Result

FY16

Targets

FY16 %

Achievement

FY17 Q2

Results

FY17

Targets

FY17 %

Achievement

Scale-up 186,274 260,560 378,875 461,066 82% 395,740 424,565 93%

Sustained 989,200 838,410 1,062,217 488,191 218% 791,533 704,641 112%

Total 1,175,474 1,098,970 1,441,092 949,257 152% 1,187,273 1,129,206 105%




OVC_SERV in Scale Up LGAs

49

187,638

46,058 45,704

22,887 23,235

166,435

48,703 49,434

30,952 31,637

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

0-9 10-14 (Female) 10-14 (Male) 15-17 (Female) 15-17 (Male)

OVC_SERV APR16 vs SAPR17

Scale-Up (APR16) Scale-Up (SAPR17)


OVC_SERV Results Participation Status


Status of COP16 Implementation: Supply Chain

51


PEPFAR Procured Commodities

52

Product COP16 Investment (US$) COP17 Investment (US$)

ARVs 103,007,897 104,496,155

RTK 8,731,849 20,200,771

OI 7,091,560 8,233,842

EID 959,714 1,488,580

VL 9,162,856 13,426,327

CD4 5,744,246 2,552,825

GeneXpert 540,500 3,651,468

Total 135,238,622 154,049,969


Nigeria Commodity Procurement Profile

53

Commodity Category

FY15 FY16

Total Expenditure (US$)

PEPFAR GF GON Total Expenditure

(US$) PEPFAR GF GON

ARVs 131,825,649 60% 36% 4% 112,265,530 59% 40% 1%

OI 9,944,277 48% 52% 0% 3,476,410 93% 0% 7%

RTKs 19,602,509 75% 0% 25% 19,036,354 89% 11% 0%

CD4 Reagents 5,371,685 60% 40% 0% 11,766,705 85% 13% 2%

EID Bundle Kits 4,933,923 25% 75% 0% 2,058,894 100% 0% 0%

Viral Load Reagents

21,105,295 100% 0% 0% 6,061,231 90% 9% 1%

Others 107,856 100% 0% 0%

TOTAL 192,783,338 154,772,981


Partner Management

54


FY17 TX_NEW: Progress towards Target Achievement by IPs

0%

20%

40%

60%

80%

100%

120%

140%

160%

0

10,000

20,000

30,000

40,000

50,000

60,000

AHNI APIN CCFN CCCRN CIHP ECEWS FHI 360 FGHiN DOD IHVN PHI MSH

Pe

rce

nt

of

PLH

IV

Nu

mb

er o

f P

LHIV

FY17 Target FY17 Cum. Results FY17 %


Case Study: Review of Case Finding Data with ECEWS

56

2,072

7,795

3,084

2,177 2,370 2,929

5,043

15,812

2,308 2,135

3,446 2,850

6,846

1,731

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

eb EzzaNorth

eb EzzaSouth

eb Ikwo eb Ishielu en Aninri en Awgu en Ezeagu en Oji River en Udi im EhimeMbano

im IhitteUboma

im IsialaMbano

im Obowo im Okigwe im Onuimo

HTS_TST FY17 Target HTS_TST FY17 Cum. Results HTS_TST_POS FY17 Target HTS_TST_POS FY17 Cum. Results TX_NEW FY17 Target TX_NEW FY17 Cum. Results

49,340

No HTC_TST Pos & TX_NEW Result

No HTC_TST Pos & TX_NEW Result


Case Study: Review of Linkage Data with ECEWS

57

0.0%

52.0% 50.0%

20.7%

0.0%

122.2%

0.0%

78.6%

128.4%

0.0% 0.0% 0.0%

82.5%

102.7%

0.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

0

1,000

2,000

3,000

4,000

5,000

eb EzzaNorth

eb EzzaSouth

eb Ikwo eb Ishielu en Aninri en Awgu en Ezeagu en Oji River en Udi im EhimeMbano

im IhitteUboma

im IsialaMbano

im Obowo im Okigwe im Onuimo

Lin

kage

Nu

mb

er o

f In

div

idu

als

HTS_TST FY17 Cum. Results HTS_TST_POS FY17 Cum. Results TX_NEW FY17 Cum. Results Linkage FY17 %


COP17 Investment Landscape

58


Annual Investment Profile

Table 1.2.1 Investment Profile By Program Areas (NASA 2014)

AIDS Spending Categories Government of

Nigeria %

Private Sector

%

PEPFAR % Global Fund %

Prevention 17% 7% 65% 9%

Care and Treatment 13% 1% 86% 1%

Orphans & Vulnerable Children (OVC) 4% 0% 76% 20%

Program Management & Amin 18% 1% 60% 20%

Human Resources 83% 0% 13% 3%

Social Protection and Social Services 0% 0% 98% 2%

Enabling Environment 1% 1% 98% 0%

HIV-Related Research 2% 0% 97% 2%

Total 27% 2% 64% 7%

59

A New Era of Accountability, Transparency, and Solidarity to Accelerate IMPACT 60

Stakeholder Engagement and Feedback

Engagement Feedback

• COP17 Launch meeting for CSOs, Government and DPs (2nd- 3rd Feb, 2017)

• Virtual engagement listserv till DCMM

• Documents disseminated by email and on the Mission web

• Several follow-on face to face meetings and feedback to email queries

• Inclusion of PrEP and AGYW interventions were appreciated

• Planned co-investment in the National AIS

• Concerned about the plan to discontinue support from 1,964 very low yield ANC sites

• NACA/MOH, CSOs and other partners onboard with key decisions and strategy positions

• CSOs recognize their critical role in helping to achieve targets


Global Fund Coordination

• Enhanced quarterly National HIV Performance Review with the Global Fund

• Nigeria submitted a full review application and the USG provided technical and financial support

• Joint TB/HIV funding request submitted on May 23

• Writing teams (Strategy, HIV, TB and RSSH) included strong USG participation (>30 personnel)

• PEPFAR Nigeria shared COP17 planning and implementation tools with GF

• GF adopted PEPFAR tools for the Funding Request (i.e. DataPack, PBAC)


COP17 Target Summary

62

COP17 Priority

FY18 Target TX_NEW

FY18 Target TX_CURR

HTS TST POS

[excluding PMTCT and EID]

HTC_TST [excluding EID, PMTCT

and KP]

OVC SERV (Without Incentive

Funds)

FY18 Target KP_PREV

FY18 Target PMTCT_STAT

FY18 Target PMTCT_EID

FY18 Target PMTCT_ART

TOTAL 267,708 949,594 263,682 7,291,295 1,263,018 246,822 2,471,725 65,368 65,368

Scale Up 68,070 242,384 66,694 2,500,827 745,074 135,834 431,118 14,185 14,185

Sustained 192,330 674,953 189,208 4,706,230 517,943 96,253 1,991,393 49,735 49,735

Mil 7,308 32,258 7,780 84,238 - 14,734 49,214 1,448 1,448


COP 2016 vs COP 2017 Budget Code Totals

63

$-

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

MTCT HVAB HMBL HMIN HVOP HVCT HBHC PDCS HKID HVTB HTXD PDTX HTXS HLAB HVSI OHSS M&O

Tho

usa

nd

s

COP17 BUDGET COP16 BUDGET


COP 2017 Agency Allocations and Pipeline

64


COP 2017 Central Funding

65


National AIDS Indicator Survey

• In the process of working with stakeholders to develop draft protocol

• Planning implementation for January 2018 with completion in 3 fiscal years

• Survey will be designed to measure impact of HIV control at the State level

• Biomarkers will be: • HIV Serology • HIV Incidence • VL Suppression • CD4 Count • Hep B & C (under consideration)

66


National AIDS Indicator Survey (2)

• Appreciate SGACs, GF, and GON’s contribution

• Estimated resource distribution over 3 fiscal years:

• Draft financing structure:

*Support from GON to coordinate and organized, which is not yet costed

67

FY18 FY19 FY20 20% 73% 7%

Funder FY18 FY19 FY20 Global Fund 8% 15% 0% PEPFAR Nigeria 12% 26% 7% PEPFAR Central 0% 33% 0%


Thank you!

68