Think global, act local: the experience of Global Fund and PEPFAR joint cascade assessments to harmonize and strengthen key population HIV programmes in eight countries

Lillie, T. A., Baer, J., et al.

INTRODUCTION: The Global Fund and the US President's Emergency Plan for AIDS Relief (PEPFAR) are major donors to HIV services with key populations (KPs) to achieve the UNAIDS 95-95-95 epidemic control goals. The programmes they fund are not always well aligned or coordinated, decreasing their effectiveness. Joint assessments are designed and led by LINKAGES, a project funded by PEPFAR and the US Agency for International Development, to improve coordination among donors and on-the-ground implementation of KP HIV programmes. Joint assessments help identify barriers that prevent KPs from accessing interventions along the cascade of prevention, diagnosis and treatment services, and provide recommendations to improve and align programmes. Detailed reports from eight assessments in Malawi, Cameroon, Swaziland, Haiti, Angola, Nepal, Côte d'Ivoire and Botswana were analysed for thematic challenges, and recommendations are presented. The purpose of the paper is to identify commonalities across KP HIV programmes that were found through the assessments so others can learn and then strengthen their programmes to become more effective.

DISCUSSION: The joint cascade assessments offered countries feedback on HIV programme challenges and recommendations for strengthening them at national, subnational and local levels. Shared intervention areas included: (1) robust population size estimates to inform service delivery targets and to budget resources for KP outreach; (2) accessible and KP-friendly services most relevant to individuals to increase retention in the HIV cascade; (3) decentralized, community-based services for HIV testing and antiretroviral therapy, and new approaches including self-testing and PrEP; (4) addressing structural issues of stigma, discrimination and violence against KPs to create a more enabling environment; and (5) more effective and continual tracking of KPs across the cascade, and coordinated, harmonized monitoring tools and reporting systems between donor-funded and national programmes.

CONCLUSIONS: The assessment teams and country stakeholders viewed the assessments as a best practice for coordinating donor-funded programmes that may overlap or inefficiently serve KPs. Global and national HIV programmes need investments of time, resources, and commitment from stakeholders to continually course-correct to align and improve programmes for sustained impact. The type of continued partnership demonstrated by the joint assessments is key to address HIV among KPs globally.

August 3, 2018
Year of publication
2018
Resource types
Journal and research articles
Tags
PEPFAR, HIV services, key populations, Global Fund, donors, program implementation

Similar Resources

This report presents progress made after two years of implementation of the ESA Commitment (2013-2015). Significant progress has already been made thanks to concerted action by governments, civil society, and development partners at national and regional level.

Despite considerable efforts to scale up voluntary medical male circumcision (VMMC) for HIV prevention in priority countries over the last five years, implementation has faced important challenges. Seeking to enhance the effect of VMMC programs for greatest and most immediate impact, the U. S.…

The Primary Health Care Performance Initiative (PHCPI) is a new partnership that brings together country policymakers, health system managers, practitioners, advocates and other development partners to catalyze improvements in primary health care (PHC) in low- and middle-income countries through…

In our second issue, we have assembled 84 abstracts published from February through March 2018 that feature articles from Botswana (4), DRC (1), Lesotho (5), Malawi (16), South Africa (39), Swaziland (5), Zambia (5) and Zimbabwe (9).
In our third issue, we have assembled 72 abstracts published from April through May 2018 that feature articles from Botswana (4), Lesotho (2), Malawi (7), Mozambique (5), South Africa (43), Swaziland (2), Tanzania (4), Zambia (2) and Zimbabwe (9).
In our fourth issue, we have assembled 68 abstracts published from June through July 2018 that feature evidence from Angola (1), Botswana (1), Eswatini (2), Malawi (11), Mozambique (3), South Africa (36), Zambia (6) and Zimbabwe (10).
In our fifth issue, we have assembled 70 abstracts published from August through September 2018 that feature evidence from Botswana (3), Eswatini (5), Lesotho (2), Malawi (8), Mozambique (3), Namibia (3), South Africa (40), Tanzania (1), Zambia (12) and Zimbabwe (9).
In our sixth issue, we have assembled 105 abstracts published from October through December 2018 that feature evidence from Botswana (4), Eswatini (5), Lesotho (2), Malawi (8), Mozambique (6), Namibia (2), South Africa (62), Tanzania (1), Zambia (12) and Zimbabwe (10).
In this, our 7th, issue, we have assembled 67 abstracts published from January through February 2019 that feature evidence from Botswana (3), Eswatini (2), Lesotho (2), Malawi (16), Mozambique (3), South Africa (40), Tanzania (2), Zambia (3) and Zimbabwe (7).