AAA presentation_ Review Meeting -GC7-Q1 2024.pptx

TBHIV Program progress report

1. Name of project: Integrating Services for Maximum Impact (SSD-C-UNDP) SR/Organisation: Arkangelo Ali Association (AAA). Meeting Venue: Pyramid Hotel-Juba Global Fund Project – GC7 Sub-Recipient Quarterly Review Meeting January – March 2024 13 May 2024

2. List Key Activities/Deliverables for Q1 (Jan-Mar 2024) Overall Grant Related Finalization of SR Capacity Assessment prior to GC7 Grant Agreement engagement and signing for 2024-2026. Signing of SR Agreement between AAA and PR UNDP on 02/02/2024 and formalization by PR UNDP on 08/02/2024 for GC7 Grant 2024-2026 of USD 4,762,513.93. Receipt of first disbursement from PR UNDP for GC7. Engagement in Optimization workshop for GC7 implementation for improved grant results. Development of Workplan(s) and sharing with PR UNDP for GC7 (finalized). Development of Performance Framework for GC7 (finalized). Start-up of engagements with partner Networks (NEPWU and SSNeP +) on modalities of implementing some activities in GC7 (unfinalized with SSNeP +) Closure of 2021-2023 NFM3 through external annual audits and LFA SR Expenditure reviews/verification – Deliverable of Unmodified Audit Opinion.

3. List of Key Activities… cont … Quarterly Results Related – (linked with slide 4 – 9 next) Conduct outreach activities in IDP camps DR-TB supportive supervision for increased coverage Conduct monthly follow up clinics of DR-TB patients ( tracking adverse events) Supportive supervision to ensure quality HTS in facilities Supportive supervision and mentorship to strengthen and maintain quality of care Conduct quarterly review meetings for DR-TB patients Carried out Engagement event to strengthen community engagement and outreach interventions in some facilities

4. Key achievements/completed activities for Q1 BL Activity Description Remarks 17 Supportive supervision to Ensure quality of HTS services in prioritized facilities - AAA Activity adequately planned with SMoH and jointly conducted at State levels. 3 States ( WBeG , Warrap and NBeG ) covered where AAA is implementing HIV collaboratively with TB. 209 Enhance mentoring and supportive supervision for increased coverage and update of baseline investigations - DR supportive supervision quarterly for 5 days. Activity adequately planned with SMoH and jointly conducted in at State levels. Only 3 States ( WBeG , Warrap and NBeG ) covered in Q1 due to limited budget with focus was on high burden sites with DR-TB identifications and initiations. 216 Provision of package of practical support for individuals undergoing DR-TB - AAA Activity conducted for 86 MDR TB patients (newly diagnosed in Q1 and those continuing from 2023) from 14 MDR-TB treatment centres in the 5 out of the 10 States of AAA coverage. An average of 3 to 15 individualized meetings took place in the quarter depending on patient’s status.

5. Key achievements/completed activities for Q1 cont … BL Activity Description Remarks 218 Support quarterly review meetings for DR-TB patients requiring individualized SLD regimens - Concilium of xperts - Quarterly 1-day meeting in 10 states - AAA Activity conducted at State level in the 5 out of the 10 States of AAA coverage as AAA has DR TB registrations from various HFs situated therein. 45 Incentives for Community outreach workers (mentor mothers) - AAA Engagement with NEPWU ensued in Q1. As of April 2024, Activity is to be implemented after successful finalization with NEPWU by signing of MoU and verification of 60 mentor mothers. 240 Provide enablers (transport) to all DR-TB patients during care - AAA Activity conducted for 86 MDR TB patients (newly diagnosed in Q1 and those continuing from 2023) from 14 MDR TB treatment centres in the 5 out of the 10 States of AAA coverage.

6. Key achievements/completed activities for Q1 cont … BL Activity Description Remarks 243 Provide enablers (nutrition) to all DR-TB patients during care - AAA Activity conducted for 86 MDR TB patients (newly diagnosed in Q1 and those continuing from 2023) from 14 MDR-TB treatment centers in the 5 out of the 10 States of AAA coverage. 246 Establish monthly follow-up clinics of DR-TB patients and track adverse events - AAA Data gathering of the existing MDR patients and any newly registered went on ; thus, monthly clinics and meetings conducted and adhered to. 36 DR-TB monthly meetings were done and all 86 MDR TB patients (newly diagnosed in Q1 and those continuing from 2023) were all involved for treatment adherence purposes. 251 Active case finding among mobile populations - 3 outreaches per year, each testing 200 people at each - AAA 4 outreaches were carried out in priority population and had the following results from the outreaches: - 3,732 were screened for TB and reached with TBHIV information - 350 were identified with TB symptoms - 338 were tested in the lab - 24 were bacteriologically confirmed - 2 other types of TB (1 EP and 1 SN) were identified. - Total of 26 TB patients were enrolled on therapy.

7. Key achievements/completed activities for Q1 cont … BL Activity Description Remarks 263 Incentives for Community Volunteers// peer navigators TB-related stigma and discrimination - AAA Not done in Q1 as was pending selection of and engagement of the related cadres based on intervention area experience. Selection finalized by end of Q1 and implementation to commence in April. 152 Incentives for HCWs at ART, PMTCT and TB sites - AAA Implemented as planned in the 5 States of AAA coverage 185 Supportive supervision and mentorship to strengthening and maintain quality of care, monitoring and reporting - AAA Activity conducted at State level in the 5 out of the 10 States of AAA coverage in various HFs

8. Key achievements/completed activities for Q1 cont … BL Activity Description Remarks 224 Incentives to support State HIV/TB coordinators - AAA Implemented as planned in all 5 States of AAA coverage 150 & 154 Provide operational support to 130 facilities providing ART/PMTCT - Operating costs - AAA Support provided across 84 reporting TBHIV sites. Implemented as planned in all 5 States of AAA coverage. 151 Engagement event to strengthen community engagement and outreach interventions at prioritized facilities - AAA Activity conducted in NBeG and Lakes States. Challenges encountered at Wedwill Returnee /Refugee Camp in Aweil West County hence activity conducted in 2 Military Barracks and 2 Prisons as Congregate settings within the 2 States.

9. Key achievements/completed activities for Q1 cont … BL Activity Description Remarks 153 Incentives for Expert Patients and Community outreach workers - AAA Engagement with SSNeP + ensued in Q1. No tangible outcome as of April 2024 as far as finalization with SSNeP + by signing of MoU and verification of 84 Expert Patients is concerned.

10. TB Key Achievements…..Graphically

11. TB Key Achievements…Graphically

12. 1 st 95 HTS, Positive and linkage

13. HTS and Yield by testing modality

14. PMTCT STAT

15. EID Results by Age Groups

16. 2 nd 95

17. 3 rd 95

18. TB Programmatic performance (Achievements A gainst Targets) Indicator Reporting period Target Results % Achievements TBDT-1 Number of patients with of all forms of TB notified (i.e., bacteriologically confirmed + clinically diagnosed); *includes only those with new and relapse TB   January- March   2264   1993   88% TBDT-2 Treatment success rate- all forms: Percentage of patients with all forms of TB, bacteriologically confirmed plus clinically diagnosed, successfully treated (cured plus treatment completed) among all TB patients notified during a specified period; *includes only those with new and relapse TB   January-March     85%     92%     108% DRTB-2 Number of people with confirmed RR-TB and/or MDR-TB notified   January-March 15   25   167% DRTB-3 Percentage of people with confirmed RR-TB and/or MDR-TB that began second-line treatment   January-March 94%   100%   106% MDR TB-9 Treatment success rate of RR TB and/or MDR-TB: Percentage of cases with RR and/or MDR-TB successfully treated   January- March 83% 95%   114% TB/HIV-5 Percentage of registered new and relapse TB patients with documented HIV status   January-March 93% 97%     104% TB/HIV-6 Percentage of HIV-positive new and relapse TB patients on ART during TB treatment   January -March   90%   90%   100%

19. TB Programmatic performance… Indicator Reporting period Target Results % Achievements TB/HIV-7.1 Number of people living with HIV currently enrolled on antiretroviral therapy who started TB preventive treatment (TPT) during the reporting period   January-March       51     0  TBDT-4 Number of new and relapse TB patients tested using WHO recommended rapid diagnostic ( mWRD ) tests at the time of diagnosis. January-March 568   RSSH/PP LAB-3 Percentage of laboratories successfully participating in external quality assurance (EQA) or proficiency testing (PT) schemes January-March 85% 38/41(93%) 109% RSSH/PP M&E-1 Completeness of reporting: Percentage of expected monthly reports (for the reporting period) that are actually received January-March 90% 100% 111%

20. HIV programmatic performance… Indicator Reporting period Target Results % Achievements TCS-10 Percentage of pregnant women living with HIV who received antiretroviral medicine to reduce the risk of vertical transmission of HIV   January-March 4%   2.3%   58% VT-2 Percentage of HIV-exposed infants receiving a virological test for HIV within 2 months of birth   January- March 1%   0.2% 22% TCS-1.1 ⁽ ᴹ ⁾ Percentage of people on ART among all people living with HIV at the end of the reporting period   January-March 2%   2.7% 135% TCS-1b Percentage of adults (15 and above) on ART among all adults living with HIV at the end of the reporting period   January-March 2%   2.7%   135% TCS-1c Percentage of children (under 15) on ART among all children living with HIV at the end of the reporting period January-March 1%   1.8% 180%

21. Financial performance Planned Resources for Q1: USD 384,843.26 Resources Disbursed Q1: USD 384,843.26 Cumulative Absorption Q1: USD 339,109.75 Variance Q1 2022: USD 45,733.51 - thus; Absorption rate of 88%. 12% Unabsorbed is because - (Reasons for variance from planned resources ) Unpaid incentives for 60 Mentor Mothers and 84 Expert Patients – as were pending list of names for verification by AAA by end of Q1 and MoU signing with NEPWU and SSNeP +. Unpaid incentives for 34 Peer Navigators as were pending selection and engagement based on intervention area experience – delayed research phase in Q1 following slight delay in agreement signing which was finalized on 08/02/24. AAA’s 3rd participation to some programme activities following slight delay in agreement signing - thus some savings which projected to be utilized in Q2 implementation for continuing activities.

22. Financial Performance (detailed) GC7_Q1... No.1 Budget Line(s) Module Intervention(s) Activity Description Approved budget Q1 Expenditure (Actual) Q1 Variance (Budget Vs Actual) Q1 Reasons for Variance Figures in USD Currency 17 Differentiated HIV Testing Services Facility-based testing outside of key population (KP) and adolescent girls and young women (AGYW) programs Supportive supervision to Ensure quality of HTS services in prioritized facilities - AAA 2,052 2,051 1 100% absorption. - Activity on track as planned, budgeted and approved 209, 216 & 218 Drug-resistant (DR)-TB diagnosis, treatment and care 1. DR-TB diagnosis/drug susceptibility testing (DST) 2. DR-TB treatment, care and support 1. Supportive supervision for increased coverage and update of baseline investigations – DR 2. Provision of package of practical support for individuals undergoing DR-TB. 3. Quarterly review meetings – DR-TB patients 12,407.20 12,406 1.20 100% absorption. Activities on track as planned, budgeted and approved

23. Financial Performance (detailed) GC7_Q1... No.2 Budget Line(s) Module Intervention(s) Activity Description Approved budget Q1 Expenditure (Actual) Q1 Variance (Budget Vs Actual) Q1 Reasons for Variance Figures in USD Currency 45 Elimination of vertical transmission of HIV, syphilis and hepatitis B Integrated testing of pregnant women for HIV, syphilis and hepatitis B Incentives for Community outreach workers (mentor mothers) - AAA 9,000 - 9,000 100% unabsorbed. Unpaid Q1 incentives –pending mentor mothers list of 60, verification and MoU signing with NEPWU 240, 243, 246 & 251 Key and vulnerable populations (KVP) – TB/DR-TB 1. KVP - Children and adolescents. 2. KVP - Mobile population (migrants/ refugees / IDPs ) 1.Provide enablers (transport, nutrition) and monthly follow-up clinics to all DR-TB patients during care. 2. Active case finding among mobile populations - 3 outreaches per year, each testing 200 people at each - AAA 17,165 17,165 - 100% absorption. Activities on track as planned, budgeted and approved

24. Financial Performance (detailed) GC7_Q1... No.3 Budget Line(s) Module Intervention(s) Activity Description Approved budget Q1 Expenditure (Actual) Q1 Variance (Budget Vs Actual) Q1 Reasons for Variance Figures in USD Currency 263 Reducing human rights-related barriers to HIV/TB services Eliminating stigma and discrimination in all settings Incentives for Community Volunteers// peer navigators TB-related stigma and discrimination - AAA 5,100 - 5,100 100% unabsorbed. as was pending selection of and engagement based on intervention area experience 152 RSSH/PP: Human resources for health (HRH) and quality of care RSSH/PP: Community health workers: contracting, remuneration and retention Incentives for HCWs at ART, PMTCT and TB sites - AAA 146,700 146,700 - 100% absorption. Activity on track as planned, budgeted and Approved

25. Financial Performance (detailed) GC7_Q1... No.4 Budget Line(s) Module Intervention(s) Activity Description Approved budget Q1 Expenditure (Actual) Q1 Variance (Budget Vs Actual) Q1 Reasons for Variance Figures in USD Currency 185, 194, 196, 197 TB diagnosis, treatment and care 1. TB screening and diagnosis 2. TB treatment, care and support 1. Supportive supervision and mentorship to strengthening and maintain quality of care, monitoring 2. AAA Direct Programme Implementation HR cost; Field HR cost & Operational costs 118,462.40 104,458 14,004.40 88% absorption. 12% unabsorbed due to: - AAA 3 rd participation to some costs. - Internal remuneration reviews and probation contracts 224 TB/HIV TB/HIV - Collaborative interventions Incentives to support State HIV/TB coordinators - AAA 3,000 3,000 - 100% absorption. Activity on track as planned, budgeted and Approved

26. Financial Performance (detailed) GC7_Q1... No.5 Budget Line(s) Module Intervention(s) Activity Description Approved budget Q1 Expenditure (Actual) Q1 Variance (Budget Vs Actual) Q1 Reasons for Variance Figures in USD Currency 150, 151, 153, 154, Treatment, Care and support HIV treatment and differentiated service delivery - adults (15 and above) 1. Provide operational support to 130 facilities providing ART/PMTCT - Operating costs. 2. Engagement event to strengthen community engagement and outreach interventions at prioritized facilities. 3. Incentives for Expert patients and Outreach workers - AAA 45,780 31,145 14,635 68% absorption. 32% unabsorbed due to: - Unpaid Q1 incentives –pending Expert Patients list of 84, verification and MoU signing with SSNeP + - AAA 3 rd participation to some operational costs.

27. Financial Performance (detailed) GC7_Q1... No.6 Budget Line(s) Module Intervention Activity Description Approved budget Q1 Expenditure (Actual) Q1 Variance (Budget Vs Actual) Q1 Reasons for Variance Figures in USD Currency 500 Program management Grant Management AAA ICR – 7% 25,176.66 22,184.75 2,991.91 12% unutilized due to reasons explained in variances per Module/Intervention. Total 384.843.26 339,109.75 45,733.51

28. Challenges/lessons learnt/areas to improve for Q2 Challenges: DHIS2 Reporting delays due to no data bundles. No Usernames and passwords assigned by the MOH to some tablet holders Last Mile Delivery Lack of TPT registers and commodities Utilization of the facility staff mentored on Optimization due to HR eg MaryHelp Hospital in WAU Knowledge gap among the service providers Sample Transportation remained a challenge as samples could not be shipped from the spokes to the hubs Implementation of some activities aligned with budgetary obligations on behalf of some implementing partners – in this case SSNeP +. Clear distinction of the Scope/Role of AAA as an SR with only budgetary obligation of paying out incentives of only 84 Expert Patients in AAA operational areas. Unclear implementation plan for WES sites to be transitioned from former IP Cordaid to AAA - especially on HR involved in the HFs, operational budget and logistical means.

29. Challenges/lessons learnt/areas to improve for Q2 cont … Recommendation/Solutions: Timely provision of data bundles to tablet holders for DHIS2 reporting by the responsible IP. Budgetary provisions for LMD and Sample Transportation; and, and on SSNeP + and WES implementation issues, joint meeting with the PR and IPs involved for closure and finalization in order to have a smooth implementation in Q2. Intensify supportive supervision and on the job coaching and mentorship Moving and starting the TBHIV service implementation in the WE State facilities The warehouse to expedite the process of delivery of all tools and commodities already ordered The PR to consider allocating funds for samples transportation

30. Next Steps for Q2 M&E/MOH should train and assign usernames and passwords to tablet holders Intensify supportive supervision visits in the selected facilities for optimization To ensure TB/HIV services in Western Equatoria State facilities are implemented Follow-up with MOH/PR to ensure airtime and data bundles are loaded to the tablet users for timely data entry into the DHIS2 AAA should get the go-ahead from the MOH/PR so as to start the TBHIV service implementation in the 11 facilities in Western Equatoria State (Note: TB and HIV targets for these facilities have already been assigned)

31. AOB AAA, SSNeP +, and PR to schedule a meeting so as to agree on the implementation modalities (list of expert clients and their assigned facilities)