TRACE country updatesDecember 12, 2018

Kenya

Kenya’s Key PlayersCDC country team• Surveillance & Epi Branch

• Zielinski-Gutierrez, Young

• Health Systems and Eval Branch • Barker

• Lab Services Branch• Junghae, Mwangi

• Western Kenya Branch & Health Service Delivery Branch• Muttai, Miruka, Joseph• Mwangi

• OD: Lucy Nganga

§ National AIDS and STI Control Programme and National Public Health Laboratories• Mamo Umuro (Head NPHLS)• Dr. Kigen Bartilol (Head NASCOP)

• Dr. Joyce Wamiswe (Lead NASCOP SI)

§ Implementing Partner(s)• UCSF (local award) • UMB >> Kenya Medical Research

Institute (HDSS area) • KEMSA (procurement through

USAID)• DOD interested also

Kenya’s HIV Recent Infection Surveillance Progress§ Current status of project and projected timeline

• DREAMS recency in ANC to launch in January as Step 1

• National recency protocol draft circulated widely, awaiting final Atlanta and GOK comments to submit to clearance

• Work for procurement ongoing with KEMSA

• Hopeful that testing could begin by June 2018 if all ducks line up

§ Challenges • Prioritization of available tests (using high burden sentinel sites, a focal sub-county,

and ‘emerging areas’) [[ Can we optimize approach for incidence calculation? ]]

• Rapid test validation (ongoing) and registration

• Acceptability of some aspects of protocol may be interesting

• Linkage to case-based surveillance data given limited digitization at HTS

Kenya’s HIV Recent Infection Surveillance Progress

§ Opportunities for support/TA• Development of effective and efficient data systems (HIS) • Practical ways in which recency results can be employed for

PNS/prioritization and social/sexual network tools• Interpretation of recency results (e.g. trends, comparisons across

geographic areas, etc.)• On-the-ground support with QA and monitoring (local staff always

stretched)

Botswana

Botswana’s Key Players• CDC country team

• Alpa Patel-Larson (ADP) • Tebogo Segolodi (Lab BC)• Peter Loeto (HTS, HIV Services)• Khuteletso Bagapi (Surveillance, SI)• Phenyo Lekone (SI BC)• Mpho Letebele (HIV Services BC)

• PEPFAR partners• ITECH (Lab support)• BUMMHI (HR, SI, Implementation)

§ Ministry of Health• Judith Nawa (M&E) • Pankie Mogomotsi (HTS)• Dinah Ramaabya (ART) • Ngidi (Lab)

§ Implementing Partner(s)• MOHw (Facility)• BUMMHI, ITECH (Facility)

§ Other• Tebogo Madidimalo (WHO)

Botswana’s HIV Recent Infection Surveillance Progress [1]§ Current status of project?

• Currently rolling out CBS to 11 PEPFAR supported districts (this will form

backbone for recency implementation)

• Adapting CDC CBS/recency generic protocol to country setting

• Validation of recency test in the Botswana setting

• Continued MOHw engagement for buy-in

§ Projected timeline?• Expected protocol submission date: End of January, 2019

• Validation done by April, 2019

• Training of HTS staff May, 2019 (11 districts)

• Phase 1 rollout to scale-up and sustained districts by June, 2019

• Phase 2 rollout to rest of the country by October, 2019

Botswana’s HIV Recent Infection Surveillance Progress [2]§ What are the challenges (if any)?

• MOHw Surveillance lead transferred to another Ministry• MOHw buy-in and ownership

• Concern about changing HTS guidelines

§ Where would you like support/TA? • Continued dialogue with MOHw • Finalization of protocol• Validation of the test• Development of implementation plan

Cote d’Ivoire

Côte d’Ivoire’s Key Players• CDC country team

• Dr Laissa Ouedraogo• Dr Christiane Adje• Dr Roger Lobognon• Dr Natacha Kohemun• Dr Judith Hedje• Nicole Doumatey• Fathim Kamagate

§ Ministry of Health• Dr Aoua Aka-Camara• Dr Adam Sanogo Pongathie• Dr Abo Kouame

§ Implementing Partner (ICAP)• Dr Stephania Koblavi-Deme• Hermann Brou

CI’s HIV Recent Infection Surveillance Progress§ Current status and projected timeline

o Initial protocol submission to CDC/DGHT ADS in October, waiting for reviewer comments, aim for approval and training in February and implementation in March

o Shared protocol with ICAP in Novembero Received local IRB approval in November and sent it to ICAP-CI

§ Challengeso Not being able to perform the 10,000 tests due to lack of funding

§ Support/TA neededo Technical support throughout the implementation processo Connect with countries that have implemented to get input and learn from

their challenges and successes

Eswatini

Eswatini Key Players CDC Eswatini– Caroline Ryan: Country Director– “Pasi” Munyaradzi Pasipamire: Co-investigator,

Recency Technical Lead– Sikhathele Mazibuko: Care & Treatment Lead– Samuel Kudhlande: SI Lead, ICAP EPI/SHIMS CoAg

Activity Manager – Phumzile Mndzebele: HTS Lead– Dan Gama: Lab CoAg Activity Manager – “Chi-Chi” Chinonye Egbulem: PHI Fellow – “Tony” Trong Ao – Previous Recency Technical

Lead

USAID/Eswatini

– Munamato Mirira: Senior Clinical Advisor

– Hamfrey Sanhokwe: SI Lead

Implementing Partners– ICAP through Epi/SHIMS CoAg mechanism– MOH

CDC Atlanta– Thu-Ha Dinh: ESB iSME– Dobbs, Trudy : Lab iSME– Lupoli, Kathryn : Lab iSME– Arons, Melissa: EIS Officer– Tad Wuhib: HIS– Shane Diekman: Prevention DOD (Washington and Eswatini)Peace Corp (Washington and Eswatini)USAID/Washington– Rachel Golin: OHA Recency Testing Co-lead,

Care and Treatment

Eswatini HIV Recent Infection Surveillance Progress

§ Key project activities? • Weekly meetings with IP, weekly meetings with PITT, Biweekly

interagency calls• Recency Webinars for capacity building

§ What are the challenges?• Discussion on Surveillance or Research approach, resolved Dec 11th

• NOA pending• Delay in writing protocol, now scheduled January 15th – 17th 2019

§ Where would you like support/TA? • Protocol development, facilitation when procuring test kits

Implementation Plan§ Stand alone surveillance of recent infections

§ Protocol undergoing development and to be finalized by February

§ Test kit verification once verification panels and test kits arrive in-country

§ Test procurement pending receipt of funding

§ Agreement with blood bank established

§ Geographic area, returning results and data collection platform not finalized

Ethiopia

Ethiopia’s Key Players

• CDC country team• Frehywot Eshetu (Surveillance/SI) • Jelaludin Ahmed (Statistics/SI) • Aklilu Asrat (informatics/SI)• Ashenafi Haile (SI) • Dereje Habte (M&E)• Biniyam Eskinder (M&E)• Sisay Alemayehu (M&E)• Yared Tedla (Lab)• Misgina Gebremedhin (Care & Treatment)• Yohannes Tesfaye (IT)• Steven Becknell (OD)• Christine Ross (OD)

§ PEPFAR partners• Ethiopian Public

Health institute (PI) • Regional Health

Bureaus• CU-ICAP in Ethiopia• ASLM• PSM

• Ministry of Health• HIV case team • Maternal and Child Health

• Implementing Partner(s)• Ethiopian Public Health

institute• Addis Ababa City Health Bureau• Oromia Health Bureau• Amhara Health Bureau• South NNP Health Bureau• CU-ICAP in Ethiopia• ASLM

• Other• Federal HIV Prevention and

Control Office (FHAPCO)

Ethiopia HIV Recent Infection Surveillance Progress• Recent infection surveillance is integrated into broader HIV case-based surveillance• National CBS TWG established, EPHI HIV directorate is the chair and PHEM director is the co-chair• National Sensitization and consensus building workshop (Aug 2018)• Protocol approved by local and CDC IRBs• Training of Trainers (TOT) on Rapid Recency Assay (Oct 2018)• Preparation of quality control and training panels for recency assay (Oct 2018)• TOT on newly identified HIV case reporting (Nov 2018)• EPHI has applied for registration of REDCap License, and has been granted access• Stepdown training to start in Bahar Dar (Amhara) and Addis Ababa in (Dec 2018)• Placement of all data security tools at facilities and at all levels (Dec 2018)• Complete configuration of central data repository- Upload the Case-Reporting data dictionary and

configure pre-defined user access rights for CR data entry at EPHI (Mid Dec 2018)• Start HIV case reporting: Data collection and submission from 15 HFs in Addis and Amhara (3rd

week of Dec 2018)

Ethiopia HIV Recent Infection Surveillance Progress§ Challenges

• Exclusion of attained and emerging regions from HIV case reporting • Rapid recency assay supply delay

§ Areas requiring support/TA • Support in Red-Cap data base configuration at EPHI and RHBs with all required data security and

confidentiality measures• Introduction of standard data quality monitoring tool• Continuous Quality Improvement of rapid recency assay • De-duplication and matching algorithm development and practical use• Simplified data analysis framework/dashboard • Support for defining “response” actions and associated protocols • Technical assistance with defining “watch, alert, and response” functions supported by PHEM network• Geospatial analysis and hotspot mapping• Template design for surveillance bulletin, with dummy tables, graphs, maps – ideally integrated with

routine PHEM surveillance bulletin – TA effort could focus on the larger bulletin, if so desired by EPHI

Haiti

Haiti’s Key Players§ USG country Team

• CDC• Mireille Kalou• Jean-Baptiste Koama• Valerie Pelletier• George Perrin• Manise Pierre• Lara Hall

• USAID• Regine Jean Louis• Daniel Dure• Pierre Julien

§ Ministry of Health (MSPP)• PNLS

• Joelle Deas• Ermane Robin

• LNSP• Jacques Boncy• Josiane Buteau

§ PEPFAR partners• UCSF

§ Local IP• NASTAD

Haiti’s HIV Recent Infection Surveillance Progress§ Current status of project

• Protocol developed and to be submitted to ADS by 12/14• Series of meetings with key stakeholders, including civil society• Initial discussion with HQ grantee and local IP• Initial review and revision of data capture tools: lab, HTS register, EMR

• Procurement arrangements with PSM for Recency test kits

§ Projected timelines

§ Anticipated challenges• Coordination of multi-layer partners • Limited mobility and access to sites due to ongoing protest and violence

§ TA needs• Training

20 sites selected in West and Artibonitefor phased implementation.Sites Include:• 3 hybrid sites (sites with mixed

general population and key population specific services)

• 1 site: Key population specific site

09/18 - 02/19

Protocol development &

approval

03/19 - 04/19

Trainings

04/19 – 05/19

Roll out at initial 15--20 sites

08/19 Preliminary analysis &

Planning for expansion

02/20 – 04/20Analysis initial phase &

Report write up

Lesotho

Lesotho Key Players• CDC country office

• Andy Pelletier (Country Director) • King Winifred (Deputy Country Director) • Fred Asiimwe (Medical Officer/Lead) • Yohannes Eshete (Lab Advisor)

• Martha Conkling (SI Advisor)

• Ministry of Health• Tsietso Mots’oane (Lab Director,

MOH) motsoanets@gmail.com

§ Implementing Partner(s)• EGPAF -Vincent Tukei Director Public

Health Evaluations EGPAF-Lesotho vtukei@pedaids.org

• ICAP Lesotho - Tsigereda GadisatChief of Party, Strengthening Strategic Information (SI) for Health Project gadisat@icap.org.ls

Lesotho HIV Recent Infection Surveillance Progress§ Protocol development completed

§ CDC and MOH IRBs reviews and approvals ongoing

• Submitted to MOH IRB (awaiting full committee review)

• Submitted to CDC ADS (awaiting response/comments)

§ Challenges

• CDC COP 18 funds arrival; IPs completed COP 18 realignment work

plans, TR completed but NOA haven’t been issued (delays subsequent

activities: procurement of recent POC tests and other related activities)

• Delays with protocol approval affect subsequent activities (trainings,

site sensitizations)

Lesotho TA Needs/Support § Recency tools MOH adaptation (Guidelines, training materials, reporting

tools etc)

§ Guidance for data systems (DHIS II tracker systems establishment)

§ Fast tracking the protocol approvals

§ Initial trainings for IPs, MOH staff and trainers of facility staff trainers

§ Considerations for FY20 recency roll-out

Malawi

Introduction to Malawi’s Key Players

CDC country office§ Andrew Auld – CD§ Evelyn Kim – ADS§ Nellie Wadonda-Kabondo – ESI Branch

Chief§ Innocent Zungu – Lab Specialist§ Mtemwa Nyangulu – HTS Specialist§ Brittney Baack – Epidemiologist§ Linda Mattocks – Informatics Team Lead§ Danielle Payne – HIV Surveillance Data

Analyst

Ministry of Health§ Rose Nyirenda, Director, Dept. of HIV & AIDS

§ Thoko Kalua, Deputy Director, Dept. of HIV & AIDS

§ Andreas Jahn, M&E TA, Dept. of HIV & AIDS

Implementing Partner(s)§ Gabrielle O’Malley – University of

Washington, PI

§ Yusuf Babaye - I-TECH CD

§ George Bello – I-TECH Surveillance Technical Lead

Malawi’s HIV Recent Infection Surveillance Progress§ Current status of project? Projected timeline?

• Plan: POC recency testing at HTS entry points at sites covering 80% of new positives nationally

• Protocol submitted to ADS (Nov 30) and Malawi IRB (Dec 4)• ILB completed TOT and specimen panel prep in country (Dec 6)• Currently preparing for health facility staff training for Jan 21 start

§ What are the challenges (if any)?• Planning for phased, national scale up (253 sites to manage/monitor)• MER reporting expected soon

§ Where would you like support/TA? • Monitoring, Data Management, Training

§ Preliminary results§ 589/1,159 (51%) tested by RITA§ 68/589 (11.7%) tested recent*

§ Lessons learned§ Difficult to enroll a specific age group

during busy ANC§ Need to use a dedicated testing cadre to

perform test at clinic§ Asante results vs. LAg very similar to

CDC HQ results

88.1 86.3 89.3 94.7

11.9 13.7 10.7 5.3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Blantyre(n=184)

Lilongwe(n=224)

Machinga(n=83)

Zomba(n=98)

Proportion newly diagnosed PLHIV testing RITA recent by district*

RITA long term RITA recent

Malawi: Pilot in 4 DREAMS and DREAMS-like districts Preliminary Data & Lessons Learned

* Weighted percentages

Namibia

Namibia’s Key Players• CDC country office

• Country Director: Eric Dziuban • Deputy Director: Robert Swayzer• Clinical Services: Steven Hong• SI/Surveillance: Adam Wolkon• Lab: Anita Beukes• HTS: Ismelda Pietersen• Care & Tx: Gram Mutandi• ADS: Leigh Ann Miller

§ Ministry of Health• Leonard Bikinesi• Assegid Tassew Mengistu• Edington Dzinotyiweyi• Nicholus Mutenda

§ Namibia Institute of Pathology• Douglas Chiwara• Boniface Makumbi

§ UCSF• George Rutherford• Mike Grasso• Susie Welty

Namibia HIV Recent Infection Surveillance Progress§ Protocol in development

• Submit to CDC and MoHSS in December/January

§ ToT and rollout in April/May

§ What are the challenges (if any)?• Procurement• SI

§ Where would you like support/TA?

Rwanda

Introduction to Rwanda’s Key Players

• CDC country office• Laboratory Branch • SI and Science Branch• Prevention Branch• Care &Treatment Branch

• PEPFAR partners• ICAP (new HQ mechanism)

§ Ministry of Health (MoH)• MoH Clinical Services (CS)• Rwanda Biomedical Centre

(RBC)

§ Implementing Partner(s)• MoH CS• RBC• Emory/ PSF• University of Maryland

Baltimore (UMB)

Rwanda: HIV Recent Infection Surveillance Progress§ Current status of project? Projected timeline?

• Recency testing initiated (mid-Oct 18) in 23 sites in Kigali; provided along routine HTS and integrated into CBS;

• Preceded by CBS protocol development and other preparatory activities (protocol approval, training of Nurses and Laboratorians, kit procurement,) with MoH, RBC and other partners in FY18;

• National rollout expected in FY19;• Recency and confirmatory VL testing is conducted at central and regional VL hubs (9 labs)

§ What are the challenges (if any)?• Forecasting and acquisition of Asante and related VL need; Data collection and reporting;

In-house QC material; Counseling messaging and informed consent process; Return of final results to Clinic within 14 days to accommodate confirmatory VL requirements

§ Where would you like support/TA? • Training packages on Lab testing and Counseling and Improving VL testing TAT• Data management systems for Recency results and active case finding (CBS)

§ Preliminary results (Nov 2018)§ 15/112 (13%) tested recent§ 10/112 (9%) tested by RITA

§ Lessons learned• Need thoroughly trained

healthcare providers on client counseling, consenting and return of results

• Use of Asante Readers is problematic; seen inconsistency with visual read results

• Recency testing requires VL to confirm recent infection

Rwanda: Preliminary Data & Lessons Learned

Tanzania

Tanzania’s Key Players

• CDC country office• Kathy Hageman• George Mgomella • Michael Mwasekaga• Oscar Rwabiyago

• ICAP country office• Haruka Maruyama• Julie Franks • Claire Steiner• Vanessa Anyoti• Fernando Morales

§ Ministry of Health• Angela Ramadhani• Geoffrey Somi• Peris Urasa• Jackson Lija• Neema Makyao

§ Other• Nyambura Moremi (National Lab)• Albina Chuwa (National Bureau of

Statistics)

Tanzania’s HIV Recent Infection Surveillance Progress§ Protocol in development § 19 HIV+ blood units collected for panel preparation§ What are the challenges (if any)? Coordination of moving pieces with

National Lab and key stakeholders§ Where would you like support/TA? Technical review of near-final

protocol draft, roll-out

Uganda

Uganda ’s Key Players

• CDC country office• Jennifer Galbraith*• Herbert Kiyingi*• Christina Mwangi• Lisa Mills• Lisa Nelson• Madina Apolot• Ray Ransom• Stella Alamo

• PEPFAR partners• UCSF

§ Ministry of Health• Joshua Musinguzi • Wilford Kirungi• Emmy Mubangi

§ Implementing Partner(s)• Monitoring and Evaluation Technical Support

(METS)• Uganda Viral Research Institute (UVRI)

§ Other: • Comprehensive IPs: IDI, Baylor, RHSP• Other USG: Rachel Kwezi, USAID, other USG

stakeholders will be added

* Primary POCs

Uganda HIV Recent Infection Surveillance Progress§ HIV recent infection surveillance will be integrated into a broader

surveillance activity, the surveillance of newly Dx HIV cases § Progress:

• UVRI has completed first validation and will complete second validation using Uganda samples by mid-January

• Protocol is under development and will be submitted to SIB Atlanta by Dec 19th

• Stakeholders meeting in mid-January• Procurement of tests has started• Hope to begin recency testing by mid-April

Uganda HIV Recent Infection Surveillance Progress§ Challenges:

• Time for protocol approval and procurement of tests• Concerns with how test will perform with HIV subtype A and D

§ Where would you like support/TA?• Reviewing the EMR system à develop an automate program to

extract data from the national repository to CBS database (in discussion with HIS team in HQ)

• Developing training materials, and SOP(s) for implementation at clinics, dashboard, visualization

• Will work with in-country IP and MOH to identify additional TA needed

Zambia

Zambia’s Key Players• CDC country office

• Sam Yingst• Margaret Riggs• Jason Bedford• Dailes Nsofwa

• USAID partners• Heidi O’Bra

§ Ministry of Health• Aaron Lunda Shibemba

§ Implementing Partner(s)• Innocent Bwalya • Mathias Tembo

Zambia’s HIV Recent Infection Surveillance Progress§ Updates:

• Zambia has been approved of a DREAMS Phase 1 rollout of Recency in 40 DREAMS Health Facilities: ANC women between ages of 15-24

• Have begun collecting data as of November 19th

• Will amend protocol to include all ages and both sexes within the 40 DREAMS health facilities

§ Challenges:• Because Recency is not an FDA or WHO approved test, need validation with

MOH§ Support:

• Would like support for TOT of lab technicians for country-wide rollout

Zimbabwe

Zimbabwe’s Key Players• CDC country office

• Elizabeth Gonese• John Rogers • Prisca Chikwanda• Kelsey Mirkovic

• PEPFAR partners• ICAP Zimbabwe

§ Ministry of Health• Owen Mugurungi• Tsitsi Apollo• Brian Moyo

§ Implementing Partner(s)• Godfrey Musuka

§ Other: RTI, NMRL

Zimbabwe HIV Recent Infection Surveillance Progress§ HIV recent infection surveillance will be integrated into a broader

surveillance activity, the surveillance of newly Dx HIV cases § Progress:

• 33+ rejected blood bags have been collected and stored at NMRL for proficiency panels and QC

• Protocol has been written and submitted SIB Atlanta • TOT training for lab technicians will be the first week of February• Training for clinics in Harare and national trainers: last week of

February or first week of March

Zimbabwe HIV Recent Infection Surveillance Progress§ Challenges:

• Registration for RTRI test kits to be used in Zimbabwe. Waiting for the recency testing panel and a box of test kits to be sent from ILB

• Politics in the country (e.g. site selection, EHR vs EPMS, CBS form)

§ Where would you like support/TA?• Reviewing the EHR system à develop an automated program to

extract data from the national repository to CBS database (in discussion with HIS team in HQ)

• Developing training materials and SOP(s) for implementation at clinics, dashboard, visualization