Comprehensive Provision of Integrated, High-Quality Community- and Facility-Based HIV and TB Services in Namibia under PEPFAR. - PROJECT ABSTRACT Context: Recent data indicate Namibia’s significant progress toward HIV epidemic control: 92% of people living with HIV (PLHIV) are aware of their HIV status, 99% of those aware are on antiretroviral therapy (ART), and 94% of those on ART have viral load suppression (VLS). Yet, challenges persist, with substantial regional, gender, and population disparities and underlying health system weaknesses. New HIV infections are disproportionate among women, key populations (KPs), adolescent girls and young women (AGYW), and men. KPs have higher HIV prevalence and lower VLS than the general population. Notable gender gaps persist, with lower case finding, HIV testing uptake, ART coverage, and VLS among men. Case identification lags in children who have low early infant diagnosis (EID) coverage at two months and lower ART coverage compared to other populations. With one of the highest TB and multidrug-resistant TB burdens in the world, Tuberculosis (TB) compounds Namibia’s HIV epidemic. These challenges are underscored by a health system lacking standardized tools for quality management (QM) implementation2/.7 timely, quality data accessible at health facilities (HFs) to inform decisions; and interoperability among different components of the health management information system (HMIS). There are marked human resources for health (HRH) shortages and regional disparities. Purpose and outcomes: The project aims to accelerate country capacity to provide high-quality, comprehensive HIV prevention, care, and treatment services to achieve and sustain the 95-95-95 targets and epidemic control and to reduce overall HIV and TB-related mortality in Namibia. To do so, the project team will strengthen comprehensive and integrated HIV prevention and treatment through HF- and community-based implementation targeting priority populations (PPs; women of reproductive age, HIV-exposed infants [HEIs], children and adolescents, and men) in high prevalence project regions (Zambezi, Oshikoto, Omusati, Kavango East and West, Oshana, and Ohangwena); strengthen individual and institutional capacity for HIV and TB response; and increase data-driven program oversight and HRH within CDC-supported national and regional programs. Project team: Since 2014, IntraHealth Namibia (IHN) has worked extensively in Namibia as a key partner of the Government of Namibia through the US President’s Emergency Plan for AIDS Relief (PEPFAR). It has worked in collaboration with the Ministry of Health and Social Services (MHSS) to strengthen and support MHSS’s efforts toward person-centered service delivery in HIV prevention, case identification, treatment linkage, and continuity in support of the national response to reach 95-95-95 targets and sustain epidemic control. IntraHealth International (IntraHealth) has also worked extensively in Namibia to ensure quality data to inform program decision-making; strengthen strategic information (SI) systems at all levels to optimize HIV monitoring, evaluation, and reporting systems; and strengthen HRH. Tonata is a network of over 18,000 PLHIV that works closely with MHSS and civil society, strengthening community support and conducting a variety of communication and advocacy activities throughout Namibia. Project strategies and activities: Project activities cluster into seven main strategies: (1) strengthen HIV case finding and linkage to care services through targeted high-yield HIV case identification and linkage to treatment strategies; (2) strengthen continuity of adult and pediatric HIV/TB care and treatment services; (3) strengthen QM systems and continuous quality improvement (CQI) initiatives; (4) strengthen maternal, neonatal, and child health (MNCH) services; (5) strengthen HIV prevention services; (6) strengthen SI systems for a sustained HIV response; and (7) strengthen HRH systems for a sustained HIV response.
