[vc_row][vc_column][vc_column_text]Anova’s approach to achieving the UNAIDS 90-90-90 targets

Anova is committed to curbing the AIDS epidemic in South Africa by focusing on the UNAIDS 90-90-90 targets, namely, diagnosing 90% of the HIV-infected population, treating 90% of those with a diagnosis and attaining viral suppression in 90% of those on treatment. In order to achieve these targets, we have to focus our operational efforts on the right things, in the right places, in the right way.

The traditional approach, used by many organisations, is to use cascade analyses to determine programme gaps that need to be addressed, to identify under-performing facilities for increased support and to implement best practice models based on literature and past experience.

Anova has now developed a novel approach that enables us to more specifically focus our operational efforts toward achieving the ‘right things’ in the ‘right places’ by identifying target groups who are missing from HIV care and mapping where these groups can be found. The method, which is based on triangulation of epidemiological and monitoring and evaluation (M&E) data, has the potential to enhance the focus of our efforts to improve outcomes of the HIV programme in South Africa and similar settings.

Anova’s novel approach to focus for impact

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Sample map showing which wards to focus on to most efficiently identify the target group, in this case, men aged 30-39 years:

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Lessons learned

Treatment coverage is variable in the different age and gender groups and it is therefore essential to assess programme performance for each group. Triangulating epidemiological and M&E data is a highly valuable approach to provide a nuanced understanding regarding who the HIV programme is serving, and can therefore guide efforts towards addressing gaps in the programme by identifying specific age and gender groups who are being missed.

Using maps to visualise population and programme data in these target groups can identify wards with the greatest Programme Gaps that are the most efficient to target, thereby directing HIV service provision to the right people in the right places in the most efficient way.

Anova is committed to using such evidence-based decision making to further fine-tune efforts toward achieving the 90-90-90 targets, which is increasingly important in a South African context where nuanced efforts are required to address gaps in our maturing HIV programme.[/vc_column_text][/vc_column][/vc_row]

Anova took part in the Southern African AIDS Conference (SA AIDS 2017),  June 13-15, 2017 in Durban, South Africa, where we presented some highlights of our work as achieved in partnership with the Department of Health and various organisations across the country.

We are working hard as a district development support partner to improve access to and quality of healthcare services, in particular for HIV, TB and STIs. The team supporting the City of Johannesburg presented a poster showing exciting data of a successful innovative way of attracting men to HIV counselling and testing services. An integrated approach that improves viral load uptake was also presented. Anova’s paediatric programme aims to ensure that all HIV-infected children are receiving quality care. The posters from this group show the value of different approaches to identify and link HIV-infected children to care, demonstrate the usefulness of active follow-up on birth PCR results to link HIV-infected children to care, and highlight the importance of psychosocial assessment and support to these children to retain them in care.

Support to the ward-based outreach team programme is an important aspect of Anova’s work in Mopani district (Limpopo). We presented two posters showing that programme reach and quality of service provision is promising and identify ways to further enhance the contribution of these ward-based outreach teams to the HIV programme. Another poster demonstrated how the face of TB epidemic has changed over time following implementation of the Xpert MTB/Rif testing algorithm, illustrating that some focus shift in TB programme support may be required.

Our work in the Cape Winelands (Western Cape) focused around supporting ‘hotspot’ clinics, i.e. facilities supporting communities with relatively high HIV prevalence and a large programme gap. We presented a poster describing our innovative ‘3x90 hotspot model’, that combines an approach of direct support and technical assistance with a focus on sustainability to improve such sites. In addition, Dr Nelis Grobbelaar provided an oral presentation on lessons learnt implementing universal test and treat in the POPART study.

Highlighting Anova’s work cross-cutting these three districts, Prof Remco Peters had two oral presentations on the limitations of syndromic management of sexually transmitted infections (STIs) and the challenges that may present when managing pregnant women with STIs.

Our Health4Men programme, focusing on men who have sex with men (MSM), presented two very exciting posters. The pre-exposure prophylaxis (PrEP) demonstration project for MSM in Johannesburg provides the first safety data from this setting. It shows that renal function changes may occur, albeit uncommon, and that monitoring of renal function is recommended. Another study emphasizes the complexity of factors that impact on ART adherence in a group of HIV-infected transgender female sex workers.

Links to all our posters:

Carol Tait: Linking HIV-infected children into care

Geoff Jobson: Circles of secrecy

K Monchwe: HIV-PCR testing: closing the linkage-to-care gap

Kate Rees: TB diagnosis after Xpert MTB/RIF implementation in Greater Tzaneen Sub-district

Kate Rees: What is needed to implement differentiated models of care?

Moyahabo Mabistsi: VL QI Intervention

Moyahabo Mabitsi: HCT in Men

Nelis Grobbelaar: Hotspots in Cape Winelands

Kevin Rebe: PrEP Early Safety

Johan Hugo: Exploring factors contributing to adherence in HIV+ transgender FSW

R Tumba: A psychosocial approach to improving comprehensive HIV care in children and adolescents

Nireshni Naidoo: Qualitative WBOTs

Nireshni Naidoo: CHW contribution to healthcare in Mopani

 

Community Health Workers (CHWs) provide a promising health structure to improve the HIV programme by the prevention of HIV infection, linkage of patients to care, ART adherence support, and by identifying individuals with treatment failure.

Anova Health Institute is supporting the Department of Health in implementing the CHW programme with regards to HIV, TB, and maternal health services in the Mopani District and the City of Johannesburg. An important component of this support is a multi-faceted evaluation that determines the impact of the CHW programme on HIV services and identifies ways to improve such impact.

In light of this, Anova embarked on a household survey to determine the reach of CHWs in the rural Greater Giyani and Greater Letaba sub-districts of Mopani district in Limpopo. Research staff successfully conducted household visits to 534 households from January 2016 through August 2016. Experiences with CHWs, health education, access to care, and referrals were evaluated. Anova’s Prof Remco Peters says: “It’s important to invest in community health structure and improve service delivery through high-quality research.”

The preliminary results show that there is a good yield in provision of HIV services by CHWs although a substantial part of the population may not be at home when CHWs visit. The community were overall happy with the CHWs and satisfied with the services rendered with regards to HIV. However, there is room to improve geographic reach and operational aspects of the CHW programme.

Nireshni Naidoo, epidemiologist at Anova, says that these findings corroborate the fact that community healthcare provides an important component of the South African healthcare system, with high promise to support the usually overcrowded healthcare facilities in provision of HIV services. Anova is committed to further support the Department of Health in provision of HIV, TB, and maternal health services by the CHWs and to strengthen the impact that this structure has on improving healthcare in rural areas.

Written by Nireshni Naidoo

South Africa has the largest paediatric HIV treatment programme in the world, with over 160 000 HIV infected children receiving antiretroviral therapy (ART).  The provision of high quality care for these children is dependent, among other factors, on an effective monitoring and evaluation system, and to this end, the South African National Department of Health adopted a software application for monitoring patients on ART known as TIER.Net. Routine data captured electronically in TIER.Net provide a rich source of information regarding the paediatric ART programme and allow for detailed analysis of programme performance over time.

In a recent publication (Lilian et al, A 10-year cohort analysis of routine paediatric ART data in a rural South African setting. Epidemiol Infect. 2016 Sep 9:1-11. [Epub ahead of print]), Rivka Lilian, Public Health Analyst at Anova, and her colleagues present an analysis of TIER.Net data for HIV infected children aged less than 15 years who initiated ART in Mopani district of Limpopo Province between 2005 and 2014.

They found substantial growth of the paediatric ART programme over time in line with national guidelines. However, challenges remain with regard to virological testing, suppression rates and retention in care, particularly in children living in poorer socio-economic areas, infants and children aged less than 3 years receiving abacavir-based regimens. These children need to be targeted for improved care, and programme planning and implementation, including supply chain management, needs to be enhanced if paediatric outcomes are to be improved.

This publication demonstrates the value of TIER.Net data in providing enhanced insights into the performance of the paediatric ART programme, highlighting interventions to improve the long-term effectiveness of the programme.

Click links below for more:

Publication online - Cambridge University Press page

PDF document

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