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SPPHC-HIV Strengthening the Provision of Primary Health Care – HIV Services Cooperative Agreement Number AID-668-A-15-00001 COP19 (FY20) Semi-Annual Progress Report 1 October, 2019 – 31 March, 2020 Submitted April 30, 2020

This report is made possible by the generous support of the American people through the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID) Cooperative Agreement Number AID-668-A-15-00001. The contents are the responsibilities of the SPPHC project and do not necessarily reflect the views of PEPFAR, USAID or the United States Government.

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Cooperative Agreement Number AID-668-A-15-00001

Prepared for: Dr. Nicholas Baade (AOR)

Submitted by: Dr. Nyikadzino Mahachi (Chief of Party)

Jhpiego Goshen House, Kololo, Airport road-Juba, South Sudan

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Acronyms

AIDS Acquired immune deficiency syndrome

ANC Antenatal Care

ART Antiretroviral Therapy

ARV Antiretroviral

BHCs Boma Health Committees

CES Central Equatoria State

CHD County Health Department

CHW Community Health Worker

CIP County Implementing Partner

CMC Camp Management Committee

DBS Dried Blood Spot

DHIS District Health Information System

EID Early Infant Diagnosis

FP Family Planning

FSW Female Sex Worker

GRSS Government of the Republic of South Sudan

HHP Home Health Promoter

HEI HIV Exposed Infant

HIV Human Immunodeficiency Virus

HSSP Health Systems Strengthening Project

HTC HIV Testing and Counseling

IEC Information, Education and Communication

IYCF Infant and Young Child Feeding

MNCH Maternal, Newborn and Child Health

MOH Ministry of Health

MSM Men Who Have Sex with Men

OGAC Office of the U.S. Global AIDS Coordinator

PEPFAR President’s Emergency Plan for AIDS Relief

PHCC Primary Health Care Center

PHCU Primary Health Care Unit

PICT Provider Initiated Counseling and Testing

PMTCT Prevention of Mother-to-Child Transmission

PNC Postnatal Care

POC Protection of Civilian

PPFP Postpartum Family Planning

SIAPS Systems for Improved Access to Pharmaceuticals and Services

SPPHC Strengthening Provision of Primary Health Care HIV Services

SSAC South Sudan HIV/AIDS Commission

STI Sexually Transmitted Infection

TOT Training-Of-Trainers

TWG Technical Working Groups

UNAIDS The Joint United Nations Programme on HIV/AIDS

USAID United States Agency for International Development

USG United States Government

VCT Voluntary Counseling and Testing

WHO World Health Organization

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TABLE OF CONTENTS

Acronyms ............................................................................................. 3

Executive Summary ............................................................................. 5

Background .......................................................................................... 6

Narrative Report .................................................................................. 7

4.1 1st 95: Prevention .......................................................................................... 7

4.2 2st 95: Treatment Performance.................................................................... 12

4.3 3rd 95: Viral Suppression .............................................................................. 15

4.4 Monitoring and Evaluation .......................................................................... 17

Project Management ......................................................................... 19

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Executive Summary

This semi-annual report covers the period Oct 1, 2019 to March 31, 2020, the first two quarters of the PEPFAR COP19 period, for the Strengthening the Provision of Primary Health Care Services for HIV (SPPHC-HIV) project implemented by Jhpiego, which since 2015 has worked to increase access to quality, comprehensive HIV Care and Treatment services in South Sudan.

In COP19 so far, the project has built on its years of experience as a direct service delivery partner and as a technical leader to make significant gains in detecting new cases of HIV, and in ensuring linkage and lifelong adherence to life-saving ART, and viral suppression, in 10 project-supported sites in Central and Western Equatoria States.

The project in this period has made significant achievements to target, reflecting progress in scaling up testing and treatment for HIV in South Sudan. 1,057 new cases of HIV were detected in the last 6 months, from a total of 26,980 individuals receiving a HIV test for the first time. The represents a 4% yield – higher than the national prevalence estimates – and has been achieved by project efforts to scale up efficient and targeted Index testing services at community and facility level. A total of 1,142 clients were initiated on ART, and 5,362 are currently receiving care and treatment through the project.

Most significantly this year to date, the project has made progress in addressing the retention challenge identified in previous quarters. This has been through scaling up proven interventions: 98% of eligible clients were receiving the optimized TLD regimen; 25% of eligible clients were provided with 6 months MMD of ART; the partnership with CSOs NEPWU in Juba and direct engagement of community health workers in Tambura led to a significant improvement in the return rate for clients who missed ART refill appointments as well as clients lost to follow up. The return rate increased from 67% (593/885) in COP18 Q4 to 70% (234/335) in COP19 Q2, but most impressively, data from site-level client databases show that PLHIV under the care of project sites are adherent to treatment.

In COP19 Q3, the project will work to secure these gains, intensify tracking of LTFU and missed appointments and MMD 6months through client-centered care services and differentiated service delivery models (DSDM). Other priority areas will include enhancing counselling and messaging at the point of ART initiation, strengthening the work of CSOs/CHWs in tracking clients in the community and improving the quality of care at site level – and above all, as the COVID-19 pandemic looms, ensuring that PLHIV in South Sudan continue to have access to life-saving care and treatment.

26,980

Individuals tested and received their result

(HTS_TST)

1,057 People tested positive for HIV

(HTS_TST_POS)

4% Overall Yield rate

16% (126/793)

Index testing Yield rate

1,142 Initiated on ART (TX_NEW)

92%

ART initiation rate

234 LTFU Returned to care

(TX_ML)

70% Return rate

SPPHC COP19 SEMI ANNUAL PERFORMANCE

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Background

South Sudan has a generalized HIV epidemic of 2.5% (2019 UNAIDS Estimates Spectrum). However, of the estimated 186,817 People Living with HIV (PLHIV) in South Sudan, only 45,144 (24%) know their status. Of these, 22,113 (50%) are on ART, of whom, 74% are virally suppressed. Decades of conflict have disrupted critical infrastructure and service delivery, hence the critical need for interventions to aimed at supporting South Sudan’s health system towards reaching epidemic control. With funding from USAID/PEPFAR, the Strengthening the Provision of Primary Health Care Services for HIV (SPPHC-HIV) began in 2015 as a PMTCT Option B+ project, and has now expanded to supporting and increasing access to quality, comprehensive HTC, PMTCT and ART services in Juba and Tambura States. The project supports the continuum of care from HIV testing services to treatment and adherence at 10 Static facilities and 3 satellite sites in these regions, leveraging the primary health care system and community health workers in the respective catchment areas, to identify PLHIV and link them to life-saving care and treatment. The goal of the project support and increase access to quality, comprehensive HIV testing and counseling (HTC), PMTCT, and Antiretroviral Therapy (ART) services – including paediatric and adolescent HIV care – within Central and Western Equatoria States. Objectives:

1. Strengthen Western and Central Equatorial States MoH and County Health Departments (CHDs) capacity to effectively plan, implement, manage and coordinate HIV programs including HTC, PMTCT and ART services,

2. Develop institutional and human resource capacity in comprehensive HIV services; and

3. Provide quality, integrated, comprehensive HIV services that reduce new infections and keep HIV-positive patients healthy

Project Coverage SPPHC is implemented in 10 static sites and three satellite sites in Central Equatoria and Western Equatoria States, with the following services available at each site:

Facility HTS PMTCT EID ART VL TB

Aru Junction PHCU(Satellite) Yes No No Yes No No Gumbo PHCC Yes Yes No Yes No No Gurei PHCC Yes Yes Yes Yes Yes Yes Juba POC Yes Yes Yes Yes Yes Yes Kator PHCC Yes Yes Yes Yes Yes Yes Kimu PHCC (Satellite) Yes Yes Yes Yes Yes No Lutheran PHCC Yes Yes No Yes No No Munuki PHCC Yes Yes Yes Yes Yes Yes Mupoi PHCC Yes Yes No Yes No No Nyakuron PHCC Yes Yes Yes Yes Yes No Nagero PHCC(Satellite) Yes No No Yes No No Source Yubu PHCC Yes Yes Yes Yes Yes Refill Tambura PHCC Yes Yes Yes Yes Yes Yes Total 13 11 8 13 8 5

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Narrative Report

This section traces the activities and achievements of the SPPHC project results for the period Oct 1, 2019 to March 31, 2020, organizing along the clinical cascade and three 95s: Prevention, including HTS, Index testing, TB, PMTCT and EID; Treatment, including scale up of optimized regimens and retention efforts; and Viral Suppression. 1st 95: Prevention

4.1.1 HIV Testing Services (HTS) In the semi-annual period under review, the project identified 1,057 new HIV positive clients from 26,980 HIV tests done. This represents a performance to target of 57% (26,980/47097) for HTS_TST and 42% (1,057/2,518) for HTS_TST_POS and an average of 3.90% (1,057/26,980) across modalities. This yield was above the estimated national prevalence of 2.2% Over the quarters from COP18, the project maintained a relatively high yield, performance attributable to intensive demand generation for HIV testing services through health fare days and extended working hours. The project constantly analysed and reviewed data through a weekly dashboard, aimed at ensuring optimised performance in high volume sites such Kator, Munuki and Nyakuron.

Figure 1: Sustained High Yield Across Quarters, from COP18 Q1 to COP19Q2

Testing results by entry point showed that high yields were achieved through index testing (15% yield), VCT (7%yield) and TB Clinic (6% yield) (figure 2). Though PMTCT/ANC and Post ANC1 showed low yield at 2%, which affected the general performance, it contributed 35% of overall testing. The project will continue to deep dive into data and optimise testing around these high yielding entry points.

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97799068 9115

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HTS_POS and Yield Across Quarters -Q1FY18 to Q3FY20

HTS_TST HTS_Pos Yield

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Figure 2: Sustained High Yield Across Quarters, from COP19Q1 to COP19Q2

In the reporting period, SPPHC focussed on testing more men in line with national HIV estimates. Of all tests conducted, 26% (3,703/14,052) were males, of which 37% (1,359/3,703) were men aged 30-49 years. However, while men were under-represented in testing figures, they are over-represented in new cases identified: of the total 555 new HIV positive clients identified were men, 67% were males and of these, 44% (167) were men aged 30-34 years. In Q3, the project will continue to target men with HTS, particularly through index testing.

Figure 3: Age/Sex Distribution of HTS Results, Jan 1 to March 31, 2020

7%

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Yield by Entry Point - Oct 1, 2019 to Mar 31, 2020

FY20 TST_POS Yield

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Age/sex Distribution of new HIV Positive Clients (HTS_POS)- COP19Q2

N=555

Male Female

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312180387589568549381247182308

1,000 1,000 2,000 3,000 4,000

≤9 yrs10-14 yrs15-19 yrs20-24 yrs25-29 yrs30-34 yrs35_39 yrs40-44 yrs45-49 yrs

50+ yrs

Age/sex Distribution of new HIV Positive Clients (HTS_TST)- COP19Q2

N=14,052

HTS_TST Male HTS_TST Female

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4.1.2 Scaling up Index Testing to Optimise Yield In COP19 Q2, the SPPHC Project continued efforts to scale up index testing, building on the successes made in COP18, and increasing fidelity of testing by working to identify different categories of contacts: children, sexual partners and ART patients with a high viral load (>1000 copies/ml). In addition to facility-based services, Index testing services were extended to the community through SPPHC’s partner CSO and CHWs to reach sexual partners who normally do not visit the health facility, and help address disclosure issues in the process that have previously been identified as barriers to uptake of services. Through these efforts, an overall yield of 15% was achieved, for an elicitation ratio of 1:1.6, slightly higher than the 1:1.5 PEPFAR benchmark. Of the contacts elicited, 70% (780/1,119) were sexual partners – indicative of strengthened provider understanding of index testing fidelity. Of these, a yield of 26% (91/347) was realised while the yield for contacts aged below 15 years tested was 10% (33/339). Overall, index testing contributed 23% of HTS_POS achieved across all entry points and HIV testing modalities in this period. Going forward, the project will work to ensure that index testing constitutes above 30% of all tests and maintain the high elicitation ratio achieved during this period.

Figure 4: Jhpiego/SPPHC Project Index Case Testing Cascade, Oct 1, 2019 to March 31, 2020

4.1.3 Tuberculosis and HIV co-infection In this reporting period, the number of TB patients in SPPHC-supported sites tested for HIV improved from 93% coverage in Q1 to 99% (2,208/2,228) in Q2. Through increasing HIV testing coverage at TB sites, the project achieved 31% of its annual TB_STAT target, drawing on performance at all targeted sites plus Juba POC. In Q3, the project will scale-up strategies aimed at ensuring that all TB patients know their HIV status.

828 828683

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<15 yrs, 339

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Offered indextesting

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Contacts elicited Contacts testedfor HIV

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Index Testing Cascade - Oct 1, 2019 to Mar, 31 2020

Declined New HIV Positive HIV Negative Known Positive Yet to test

-82% Acceptance rate 1:1.6 elicitation ratio -16% Yield -91% initiated on ART

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Figure 5: TB_STAT coverage – Oct 1, 2019 to Mar 31, 2020 A total of 200 clients on TB treatment were identified as HIV positive, with 91% of these initiated on ART. A cumulative achievement of 67% (181/271) to the TB_ART target was achieved, as shown below. 4.1.3.1 TPT Scale-Up The project developed a roll-out plan for all facilities in line with guidance from MoH. The availability of INH contributed significantly to the effectiveness of this plan. In Q2FY20, 29% coverage was achieved, and no adverse effects were documented. Since the roll out in July FY19, 83-clients successfully completed the 6 months course, translating into a competition rate of 5%.

ART Sites / TPT Variables Gumbo Gurei Juba

POC Kator Lutheran Munuki Nyakuron Lutheran Source Yubu

Tambura Total

# of eligible Clients (IPT) 83 483 129 831 33 792 561 32 497 1658 5,362

# started on IPT 4 198 10 229 15 139 212 15 207 516 1,530

# of clients completed 0 0 0 74 0 19 0 0 0 0 83

Table 1: TPT Scale-up Results by Site – Oct 1, 2019 to Mar 31, 2020

4.1.4 PMTCT and Early Infant Diagnosis So far this year, the project has achieved 78% of its annual PMTCT_STAT target, largely though ensuring a very high coverage: of the 8,539 ANC clients from project-supported sites, 8,277 – 97% - received a HIV test. From those, a total of 184 new HIV positive clients were identified, with a 98% (182/184) ART initiation rate achieved. The two clients who were yet to initiate ART were identified in quarter 2, and Jhpiego PMTCT providers were actively tracing and following-up both clients.

2228 2208

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%TB_STAT target % TB_ART target

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A significant improvement was noted in PMTCT_EID performance (Figure 6) over the reporting period, especially in increasing the proportion of infants under 2 months receiving a virologic test. A total of 153 HEI had their first virologic HIV test within 12 months, translating to 73% performance to target. Of the infants tested for HIV, 70% (107/153) were aged two months and below. From those tests, a total of 12 infants were identified as HIV positive and all were initiated on ART. This improved performance in reaching infants as early as possible is attributed to the implementation of the ‘Expecting pregnant woman- mentor mother (M2M) pair model’. This model entails the realignment of client flow from PMTCT/ANC to maternity, EPI /postnatal and to PMTCT clinic. Expectant mothers are paired with mentor mothers, who actively follow-up until delivery and linkage to post-natal services, including EID and home delivery of ART prophylaxis.

Figure 6: HEI Cascade by Age Bracket, 1 October 2019 – 31 March 2020

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HEI Receiving a Virologic Test by 12 Months of Age- Oct 1, 2019 to Mar 31, 2020

<2 months 2-12 months

-70% of children tested were <2 months -100% initiation rate -73% (221/301) of annual target achieved

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4.1 2st 95: Treatment Performance

4.2.1 ART Initiation and Optimized Linkage to Treatment In line with WHO and National MOH guidance, project-supported sites are mentored closely to ensure Test and Start is implemented for as many clients as possible. In COP19 Q2, the cohort-based ART initiation rate was 98% - of the 555 new positives identified in the period, 545 were linked to Care and Treatment, up from 87% cohort linkage in the previous quarter. Following that below-standard performance in COP19 Q1, we reviewed the data and met with providers to understand why cohort linkage dropped below 90%. We learnt that, in that period, the majority of clients tested through index testing declined linkage to treatment: ART initiation rate for clients tested through the index modality in Q1 stood at 46%. As a result, in this quarter, we have worked with our facility-based providers and community mentor mothers to actively escort clients identified through both facility and community testing. The project achieved a cumulative ART initiation rate of 109%, largely attributed to community testing and referrals to Kator, Munuki, Gurei and Nyakuron by the E2A Key Populations project. These facilities provide KP friendly services including differentiated service models: fast tracking refills and community ART refills

Figure 7: Cohort-based ART initiation – Oct 1, 2019 to Mar 1, 2020.

4.2.2 TX_CURR Performance and Trends As of March 2020, a total of 5,362 clients were receiving ART from the 10 static and 3 satellite sites in Central and Western Equatoria states. Of these, 68% (3638/5362) were females and 5% (244/5,362) children aged below 15 years. The project achieved 67% (5,362/8,023) against annual TX_CURR target.

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ART initiation Across Quarters - Q4FY19 to Q2FY20

HTS_TST_POS TX_NEW ART initiation rate

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Figure 8: Number of ART Patients in SPPHC Health facilities against FY20 Targets

4.2.3 ART Optimization – TLD Transition and MMD Building on the success of Q4FY19, the project continued to scale-up TLD transition across all SPPHC supported facilities there by closing the gap as shown in figure 9 below. Coverage improved from 56% in COP18Q4 to 98% in COP19Q2. With improved supply of TLD 90 in Q2, the project reached 40% coverage, up from 6% in Q1. Transition to TLD, coupled with 6 months MMD, is one of the driving forces of improved retention outcomes (see below) as it addresses some of the reasons why clients drop out of treatment, such as long distance to service points, stigma and work commitments.

Figure 9: TLD transition by month – Jul 2019 to Mar,2020

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Figure 10: 6 Months MMD Scale-up – COP19Q2

Additionally, the project intensified transition to 6 months MMD (Figure 10) aimed at improving coverage across all health facilities. By the end of Q2, 25% of eligible clients now receiving 6 months ART.

4.2.4 Tracking Missed Appointments and Lost to Follow Up Retention improved significantly in the period under review, compared to previous quarters, with a positive TX_NET_NEW result reflecting significant gains in retention and return to care and treatment. Through increased efforts at the community and facility levels, the project achieved a TX_NET_NEW result of 803, against a TX_NEW result of 614, for a net gain of 189 (2%) clients in Q2COP19. That is to say: In Q1, the project’s reported 4,559 clients on treatment. In the 3 months since that reporting date, the project initiated an additional 614 PLHIV on care treatment. If the project achieved zero client attrition whatsoever, and only added the 614 new clients, the project’s TX_CURR would have been 5,173. Instead, however, the actual TX_CURR result realized by the project is 5,362 – an additional 189 clients receiving care and treatment, as well as the 4,559 TX_CURR from Q1 and 614 TX_NEW from Q2.

TX_CURR FY20 Q1

TX_CURR FY 20 Target

TX_CURR FY20 Q2

% Achieved

TX_NEW FY20 Q2

NET_NEW FY20 Q2

TX_NET NEW minus TX_ NEW

Max TX_CURR FY20 cum

(What IF) %

% Crude Attrition

A B C D E F=(C-A) G=(F-E) H=(E+A) I=H/C J=(G/B) 4559 8023 5362 67% 614 803 189 5173 64% 2%

Table 2: Client retention and LTFU This performance is significant, particularly given long-standing issues with retention reported across South Sudan, including in the SPPHC project historically. The success is attributed to a number of key strategies that have been implemented over the last few months. In particular, we have continued to emphasize monitoring clients’ daily attendance, and the focus of our supportive supervision and training has centered on this, focusing on the use of tracking tools, documentation issues, especially completeness, leading to a significant improvement in documentation in the concerned tools as well as subsequent reporting. Additionally, we have worked to strengthen data, through position data clerks and conducting quality reviews at facility level. We have been helped

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6 Months MMD Scale-Up in 11 SPPHC-Supported Health Facilities - COP19Q2

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by the TLD roll-out, discussed below, which provided a natural opportunity to scale up Multi-Month Dispensing (MMD), with 25% of eligible clients now receiving 6 months ART. Additionally, continued engagement of CSOs and CHWs to trace missed appointments and loss to follow up, for an TX_RTT result of 234 clients (Female 139 and male 95) of which 13% (31/234) were children returned to care this quarter.

4.2 3rd 95: Viral Suppression

Of the 3,464 clients eligible for a viral load test, 2,761 had a documented viral load result as of COP19Q2, for a viral load coverage result of 80%. Of the 2,761, 2,109 clients were virally suppressed, for a viral suppression rate of 76%. This represents a 48% performance to the TX_PVLS(N) annual target. The project enrolled 478 ART patients for enhanced adherence counselling sessions (EAC) during the period under review and of these, 89 completed the mandatory 3 sessions. In Q3, the project will continue to monitor viral load outcomes for ART patients and offer differentiated care.

Figure 11: Viral load cascade for ART patients in 13 SPPHC-supported health facilities - Q2FY20

Viral load suppression rate was higher (77%) among females compared to males (75%). The project experienced a significant improvement in paediatric viral suppression rates, from an average of 12% in Q1- to 39% as of Q2. However, overall, viral suppression remains lower among ages 5 – 14 than in the rest of the population. Closer integration with the OVC programming implemented by the ACHIEVE mechanism will provide an opportunity to ensure children and adolescents living with HIV are virally suppressed.

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• 80% viral load coverage • 76% virally suppressed

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Figure 12: Viral load suppression by Age in 13 SPPHC-supported health facilities - Q2FY20

Viral Load testing coverage varied across health facilities, with Tambura having the highest (88%) among high volume health facilities. This is attributed to an effective strategy whereby VL sample been collected at point of care by full time Jhpiego staff whereas in Juba facilities, samples are collected at the lab by government focal persons. Viral load services are fully implemented in eight supported sites while in the other facilities (Kimu, Lutheran, Gumbo and Mupoi), samples are collected and dispatched to the nearest sites for further processing. In Juba POC, SPPHC will collaborate with an implementing partner, PHL, to intensify viral load services. Additional volunteer counsellors and data clerks were also recruited to support this initiative.

Figure 13: Viral load suppression by health facility – COP19Q2

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4.3 Monitoring and Evaluation

4.4.1 Data Quality Assessment The project conducted monthly data verification exercises by comparing summary monthly report to tally sheet and registers as primary source documents, aimed at ensuring a minimal margin of error and high data quality. The project also took advantage of monthly data reviews to constantly emphasize the need for routine data validation. In Q3, the project will conduct a full DQA in high volume facilities. 4.4.2 Database Systems This quarter, the project migrated from an excel based database to DHIS 2 for all project supported sites. In Q3 and Q4, the project will add a monthly reporting form in DHIS2 and a DHIS2 tracker. This is expected to enhance the longitudinal monitoring of clients, to ease data analysis as well as reporting. 4.4.3 Dashboards To enhance project performance monitoring and timely decision making, Jhpiego developed a weekly dashboard which is shared with USAID weekly. Going forward, SPPHC will develop a dashboard in DHIS 2 for real-time data visualization. Jhpiego Dashboard PEPFAR Dashboard

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Table 3: Indicator Performance Table

Indicator Definition Data Sources COP19 COP19

Cum. % Achieved Status

Target Result

HTS_TST

Number of individuals who received HIV Testing Services and received their test result

HTS_Register 47,097 26,980 57%

HTS_POS

Number of individuals who were tested HIV positive HTS_Register 2,534 1,057 42%

PMTCT_STAT

Number of pregnant women with known HIV status at antenatal care (includes women knew their HIV status prior to ANC 1)

ANC register 10,763 8,495 80%

PMTCT_EID

Number of infants born to HIV-positive women who received a first virologic HIV test by 12 months of age

EID register 301 221 73%

TB_STAT Number of new and relapse TB cases with documented HIV status

TB register, HTS register 7,012 1,942 28%

HTS_INDEX

Number of individuals who were identified and tested using Index testing services and received their results

Index contact register 889 793 89%

TX_CURR

Number of adults and children currently receiving antiretroviral therapy

ART register, Treatment database

8,023 5,362 67%

TX_NEW

Number of adults and children newly enrolled on antiretroviral therapy

ART register, Treatment database

2,516 1,142 45%

PMTCT_ART

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

PMTCT/ANC register

354 399 113%

TB_ART

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

TB treatment register

271 181 67%

TX_PLVS

Number of ART patients with a suppressed viral load (VL) result (<1000 copies/ml) documented within the past 12 months

VL register 4,411 2,109 48%

TB_PREV

Number of ART patients who were initiated on any course of TPT during the previous reporting period

ITP register 516 1,530 297%

TX_TB

Number of ART patients who were started on TB treatment during the semi-annual reporting period. TB register N/A 5,198 N/A

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TX_RTT

Number of ART patients with no clinical contact or ARV pick-up for greater than 28 days since their last expected contact who restarted ARVs within the reporting period

Missed appointments and LTFU register N/A 234 N/A

TX_ML

Number of ART patients (who were on ART at the beginning of the quarterly reporting period) and then had no clinical contact since their last expected contact

Missed appointment and LTFU register N/A 232 N/A

Project Management

Coordination with USAID Jhpiego continued to monitor project performance through weekly dashboard to USAID and the newly developed dashboard for PEPFAR project as to compare performance between IPs. Jhpiego enjoys regular weekly meetings with USAID, and has also participated in PEPFAR TWG meetings, where we have been able to share feedback on areas of concern, such as retention commodity issues and MMD. Coordination with Other Partners As USAID’s Care and Treatment partner in South Sudan, the project has close working relationships with the following USAID/PEPFAR Implementing Partners (IPs)/projects and non-PEPFAR NGOs:

Intrahealth International

Key Populations identified by the Evidence to Action (E2A) project, are referred to of SPPHC static sites (Munuki, Kator, Nyakuron and Gurei PHCC) to receive HIV services (ART, VL testing). We will continue to partner with IHI to ensure person-centered services are provided to KPs

AMREF VL/EID sample testing for all PEPFAR Implementing Partners is managed by AMREF under their CDC-funded Labs project. This year, we have coordinated closely with Amref through regular meetings and data sharing on turnaround times

International Medical Corps

In POC1 and 3, IMC is the humanitarian partner operating the POC health care clinic, acting as a host to SPPHC services and activities. As such, the project works closely with IMC to coordinate activities and referrals to/from OPD services operated by IMC.

CRS OVC under 4Children some of which were assessing ART in Jhpiego supported facilities before the program transitioned to Jhpiego. Jhpiego and CRS had also collaboration on community outreaches.

COVID-19 Response At the end of the reporting period, in March 2020, the first cases of the global COVID-19 pandemic were detected in South Sudan. Jhpiego’s response to the global pandemic has been to coordinate with MOH, USAID, and other partners to ensure PLHIV in South Sudan are able to continue to access life-saving HIV Care and Treatment services in the midst of the pandemic. Details of this support are still in finalization at time of writing, but will be documented in the next quarterly report.