President's Emergency Plan For AIDS Relief Research Articles

The impact of COVID-19 restrictions on HIV prevention and treatment services for key populations in South Africa: an interrupted time series analysis

BackgroundKey populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery.MethodsWe leveraged programmatic data collected by the US President’s Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization.ResultsBetween January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the ‘pre-restriction’ period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the ‘high-level restriction’ period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased.ConclusionService provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.

Impact of a monitoring and evaluation training in 3 PEPFAR-supported countries

BackgroundThe second phase of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) transitioned from scaling up HIV prevention and treatment to promoting sustainability and capacity building for programs monitoring performance and evaluating key program indicators. We assessed the success of a monitoring and evaluation (M&E) curriculum designed to build capacity in three PEPFAR-supported countries. MethodsWe customized M&E trainings based on country-specific epidemic control priorities in Ethiopia, Guatemala, and Cameroon. The M&E curriculum included five modules and three evaluation activities to assess impact: (i) in-person pre-post confidence assessment surveys (CAS), (ii) in-person pre-post knowledge tests (PPKT), and (iii) electronic 6–12 months post-training translating knowledge into practice (TKP) surveys. Pre- and post-training results were compared within and across countries and triangulation with the qualitative data evaluated overall success. ResultsAmong 188 participants attending M&E trainings, 154 (82 %) responded to CAS and 165 (88 %) participants from Ethiopia and Cameroon completed PPKT. Overall CAS scores between pre- and post-test improved [Score mean difference:1.5–1.9]. PPKT indicated statistically significant knowledge gained. One out of five TKP respondents provided direct application examples from the M&E training. ConclusionWhile feedback was predominantly positive overall, revisions were recommended for three of the five modules. Developing a customizable and adaptable M&E curriculum may sustain countries’ ability to monitor their progress towards epidemic control.

Biosocial Analysis of the DREAMS Program in Tanzania

In Tanzania, the HIV epidemic is impacting many people throughout the country. However, this impact is not equally distributed among all people. Different areas in Tanzania suffer higher prevalence rates of HIV than others. In addition, females, especially adolescent girls and young women (AGYW), are at greater risk when it comes to HIV infection. These inequitable prevalence rates are caused by a number of factors, including but not limited to gender-based violence, lack of education, and involvement in transactional sex and sex work. In order to address HIV in Tanzania, U.S.-based groups including President's Emergency Plan for AIDS Relief (PEPFAR), the Centers for Disease Control and Prevention (CDC), and ICAP have designed and implemented the DREAMS program, which aims to protect AGYW from HIV infection via empowerment, education, and testing services. While this is a multi-faceted intervention that aims to protect women and address more than just the biological factors that spread disease, there are possible unintended consequences that can lead to harm.

An exploration of multi-level factors affecting routine linkage to HIV care in Zambia's PEPFAR-supported treatment program in the treat all era.

Multiple steps from HIV diagnosis to treatment initiation and confirmed engagement with the health system are required for people living with HIV to establish full linkage to care in the modern treat all era. We undertook a qualitative study to gain an in-depth understanding of the impeding and enabling factors at each step of this linkage pathway. In-depth interviews were conducted with fifty-eight people living with HIV recruited from ten routine HIV care settings supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in Lusaka, Zambia. Using a semi-structured interview guide informed by an established conceptual framework for linkage to care, questions explored the reasons behind late, missed, and early linkage into HIV treatment, as well as factors influencing the decision to silently transfer to a different clinic after an HIV diagnosis. We identified previously established and intersecting barriers of internal and external HIV-related stigma, concerns about ART side effects, substance use, uncertainties for the future, and a perceived lack of partner and social support that impeded linkage to care at every step of the linkage pathway. However, we also uncovered newer themes specific to the current test and treat era related to the rapidity of ART initiation and insufficient patient-centered post-test counseling that appeared to exacerbate these well-known barriers, including callous health workers and limited time to process a new HIV diagnosis before treatment. Long travel distance to the clinic where they were diagnosed was the most common reason for silently transferring to another clinic for treatment. On the other hand, individual resilience, quality counseling, patient-centered health workers, and a supportive and empathetic social network mitigated these barriers. These findings highlight potential areas for strengthening linkage to care and addressing early treatment interruption and silent transfer in the test and treat era in Zambia.

Prioritizing Mental Health within HIV and Tuberculosis Services in PEPFAR.

Underprioritization of mental health is a global problem and threatens the decades-long progress of the US President's Emergency Plan for AIDS Relief (PEPFAR) program. In recent years, mental health has become globally recognized as a part of universal healthcare, making this an opportune moment for the global community to integrate mental health services into routine programming. PEPFAR is well positioned to lead by example. We conceptualized 5 key strategies that might help serve as a framework to support mental health programming as part of PEPFAR's current 5-year strategic plan. PEPFAR and the global community have an opportunity to identify mental health service gaps and interweave global mental health priorities with actions to end the HIV and TB epidemics by 2030.

Tuberculosis Preventive Treatment Update - U.S. President's Emergency Plan for AIDS Relief, 36 Countries, 2016-2023.

Tuberculosis (TB) is the leading cause of death among persons with HIV. In 2022, an estimated 167,000 TB-related deaths occurred globally among persons with HIV. TB preventive treatment (TPT) helps prevent TB disease and is recommended for persons at high risk for developing TB, including those with HIV. TPT, when taken with antiretroviral treatment (ART), can reduce TB-attributable deaths among persons with HIV. In 2018, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) program committed to offer one course of TPT to all eligible clients receiving ART. This analysis describes trends in TPT initiation and completion among PEPFAR-supported programs in 36 countries in Africa, Central and South America, and Asia during fiscal years (FYs) 2017-2023. Overall, TPT initiation rates peaked in FY19, a possible sign of programmatic saturation. TPT initiation among clients who had been on ART <6 months reached 59%, and overall completion rates up to 87% were reported. Approximately 13 million persons with HIV have completed TPT since FY17, but widespread adoption of shorter regimens, patient-centered approaches, and electronic medical record systems might be needed to ensure full TPT coverage. Through PEPFAR's partnership with national HIV programs, TPT has become the standard of care for persons with HIV.

The impact ofshifts inPEPFAR funding policy onHIV services inEastern Uganda (2015-21).

Although donor transitions from HIV programmes are increasingly common in low-and middle-income countries, there are limited analyses of long-term impacts on HIV services. We examined the impact of changes in President's Emergency Plan for AIDS Relief (PEPFAR) funding policy on HIV services in Eastern Uganda between 2015 and 2021.We conducted a qualitative case study of two districts in Eastern Uganda (Luuka and Bulambuli), which were affected by shifts in PEPFAR funding policy. In-depth interviews were conducted with PEPFAR officials at national and sub-national levels (n = 46) as well as with district health officers (n = 8). Data were collected between May and November 2017 (Round 1) and February and June 2022 (Round 2). We identified four significant donor policy transition milestones: (1) between 2015 and 2017, site-level support was withdrawn from 241 facilities following the categorization of case study districts as having a 'low HIV burden'. Following the implementation of this policy, participants perceived a decline in the quality of HIV services and more frequent commodity stock-outs. (2) From 2018 to 2020, HIV clinic managers in transitioned districts reported drastic drops in investments in HIV programming, resulting in increased patient attrition, declining viral load suppression rates and increased reports of patient deaths. (3) District officials reported a resumption of site-level PEPFAR support in October 2020 with stringent targets to reverse declines in HIV indicators. However, PEPFAR declared less HIV-specific funding. (4) In December 2021, district health officers reported shifts by PEPFAR of routing aid away from international to local implementing partner organizations. We found that, unlike districts that retained PEPFAR support, the transitioned districts (Luuka and Bulambuli) fell behind the rest of the country in implementing changes to the national HIV treatment guidelines adopted between 2017 and 2020. Our study highlights the heavy dependence on PEPFAR and the need for increasing domestic financial responsibility for the national HIV response.

Pediatric and adolescent HIV viral load coverage and suppression rates in the context of the COVID-19 pandemic in 12 PEPFAR-supported sub-Saharan African countries in 2019 and 2020.

The early period of the COVID-19 pandemic limited access to HIV services for children and adolescents living with HIV (C/ALHIV). To determine progress in providing care and treatment services, we describe viral load coverage (VLC) and suppression (VLS) (<1000 copies/ mL) rates during the COVID-19 pandemic in 12 United States President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries. Data for children (0-9 years) and adolescents (10-19 years) on VLC and VLS were analyzed for 12 sub-Saharan African (SSA) countries between 2019 (pre-COVID-19) and 2020 (during COVID-19). We report the number of viral load (VL) tests, and percent change in VLC and VLS for patients on ART. For 12 countries, 181,192 children had a VL test during the pre-COVID-19 period compared with 177,683 December 2020 during COVID-19. VLC decreased from 68.8% to 68.3% overall. However, 9 countries experienced an increase ranging from a 0.7%-point increase for Tanzania and Zimbabwe to a 15.3%-point increase for Nigeria. VLS increased for all countries from 71.2% to 77.7%. For adolescents the number with a VL test increased from 377,342 to 402,792. VLC decreased from 77.4% to 77.1%. However, 7 countries experienced an increase ranging from 1.8% for Mozambique to 13.8% for Cameroon. VLS increased for all countries from 76.8% to 83.8%. This analysis shows variation in HIV VLC across 12 SSA countries. VLS consistently improved across all countries demonstrating resilience of countries during 2020. Countries should continue to improve clinical outcomes from C/ALHIV despite service disruptions that may occur during pandemic response.

Towards Shared and Effective Self-Care: A User-Centric Framework for Enhancing HIV Prevention

Background: Despite a declining trend in Human immunodeficiency virus (HIV) prevalence across sub-Saharan Africa, specific vulnerable groups continue to be disproportionately impacted (29.9% for sex workers, 12.9% for gay men having sex with men (MSM) vs 5.9% for adults). In the face of this challenge, it is critical to tailor demand creation for prevention, in particular self-care, for maximum impact and cost-efficiency. This study seeks to provide a behavioral understanding towards HIV prevention that shape the efficacy of prevention strategies among priority populations (female sex workers, MSM and adolescent girls and young women) in southern and eastern Africa. Methods: This study involved a literature review of 110 articles, focusing on HIV prevention in priority populations, behavioral interventions, and policy priorities from governments and funders. Additionally, insights were gained from 11 in-depth interviews and a workshop with 10 experts at the AIDS Impact 2023 conference. Participants included behavioral researchers and program leaders from Global Fund, United States Agency for International Development (USAID), U.S. President's Emergency Plan for AIDS Relief (PEPFAR), Bill and Melinda Gates Foundation, FHI360, Population Services International and Genesis Analytics. A user-centric behavioral framework was devised to identify actionable drivers and barriers in HIV prevention during the consultation exercise. Results: The study highlights the importance of shared and effective self-care in enhancing HIV prevention, particularly in vulnerable groups. The behavioral framework integrates the decision-making contexts and the health ecosystem layers to inform research and demand strategy. Key findings include: (1) effective self-care is not the same as continuous use of Pre-exposure prophylaxis and therefore, programs and policies need to measure them differently; (2) users exercise choice through a combination of prevention products and focus on a few may be sub-optimal, and (3) perceived risk is transient and hence risk-based messaging lacks sustained relevance. Conclusion: Effective self-care strategies extend beyond overcoming access and availability issues. Examining the underlying factors causing the barriers is essential. The behavioral framework presented here suggests that: (a) Self-care is a shared responsibility between the user and healthcare system and (b) demand creation should be de-medicalised, away from products and towards meeting the needs and preferences of users.

Predictors of tuberculosis treatment outcomes among people living with HIV in some States in Nigeria.

tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health threats globally and worse when they co-exist in susceptible individuals. The study examined TB treatment outcomes and their predictive factors among people living with HIV (PLHIVs). a review of TB/HIV co-infected patients who had TB treatments across comprehensive antiretroviral therapy (ART) sites with ≥500 patients was conducted in seven United States of America President's Emergency Plan for AIDS Relief (PEPFAR)-supported States in Nigeria. Data on patient background, HIV and TB care, and TB treatment outcomes were collected using an Excel abstraction template. The data was analyzed using SPSS and an association was examined using a chi-square test while binary logistic regression was used to determine predictors of TB treatment outcomes (P< 0.05). two thousand six hundred and fifty-two co-infected patients participated in the study. The mean age of participants was 37 ± 14 years. A majority had TB treatment success (cured = 1059 (39.9%), completed = 1186 (44.7%)). Participants who had pulmonary TB, virally suppressed and commenced isoniazid (INH) before TB diagnosis were more likely to have a favorable TB treatment outcome compared to those who had extrapulmonary TB (AOR = 7.110, 95% CI = 1.506 - 33.565), virally unsuppressed (AOR = 1.677, 95% CI = 1.036 - 2.716) or did not commence INH before TB diagnosis (AOR = 1.486, 95% CI = 1.047 - 2.109). site of infection, immune status, exposure to ART, and INH prophylaxis were found to predict TB treatment outcomes among PLHIVs. Stakeholders should ensure early commencement of ART and INH prophylaxis for PLHIVs.

A community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho (Early Morning Star): a cluster-randomised, controlled trial

When caregivers live in remote settings characterised by extreme poverty, poor access to health services, and high rates of HIV/AIDS, their caregiving ability and children's development might be compromised. We aimed to test the effectiveness of a community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho. We implemented a matched cluster-randomised, controlled trial in the Mokhotlong district in northeastern Lesotho with 34 community clusters randomly assigned to intervention or wait-list control groups within a pair. Eligible clusters were villages with non-governmental organisation partner presence and an active preschool. Participants were caregiver-child dyads, where the child was 12-60 months old at baseline. The intervention consisted of eight group sessions delivered at informal preschools to all children in each village. Mobile health events were hosted for all intervention (n=17) and control (n=17) clusters, offering HIV testing and other health services to all community members. Primary outcomes were caregiver-reported child HIV testing, child language development, and child attention. Assessments were done at baseline, immediately post-intervention (3 months post-baseline), and 12 months post-intervention. We assessed child language by means of one caregiver-report measure (MacArthur-Bates Communicative Development Inventory [CDI]) and used two observational assessments of receptive language (the Mullen Scales of Early Learning receptive language subscale, and the Peabody Picture Vocabulary Test 4th edn). Child attention was assessed by means of the Early Childhood Vigilance Task. Assessors were masked to group assignment. Analysis was by intention to treat. This trial was registered with ISRCTN.com, ISRCTN16654287 and is completed. Between Aug 8, 2015, and Dec 10, 2017, 1040 children (531 intervention; 509 control) and their caregivers were enrolled in 34 clusters (17 intervention; 17 control). Compared with controls, the intervention group reported significantly higher child HIV testing at the 12-month follow-up (relative risk [RR] 1·46, 95% CI 1·29 to 1·65, p<0·0001), but not immediately post-intervention. The intervention group showed significantly higher child receptive language on the caregiver report (CDI) at immediate (effect size 3·79, 95% CI 0·78 to 6·79, p=0·028) but not at 12-month follow-up (effect size 2·96, 95% CI -0·10 to 5·98, p=0·056). There were no significant group differences for the direct assessments of receptive language. Child expressive language and child attention did not differ significantly between groups. Integrated child health and parenting interventions, delivered by trained and supervised lay health workers, can improve both child HIV testing and child development. United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR).

Evaluation of the impact of PEPFAR transition on retention in care in South Africa's Western Cape Province.

Research on the impact of the US President's Emergency Plan for AIDS Relief (PEPFAR) transition in South Africa (SA) in 2012 found varying results in retention in care (RIC) of people living with HIV (PLWH). To investigate the factors that impacted RIC during the PEPFAR transition in Western Cape Province, SA, in 2012. We used aggregate data from 61 facilities supported by four non-governmental organisations from 2007 to 2015. The main outcome was RIC 12 months after antiretroviral therapy initiation for two periods - during PEPFAR and post PEPFAR. We used adjusted quantile regression to estimate the effect of the PEPFAR pull-out on RIC. Regression models (50th quantile) for 12-month RIC showed a 4.0% (95% CI -7.7 - -0.4%) decline in RIC post-direct service. Facilities supported by Anova/Kheth'impilo fared worst post PEFPAR, with a decline in RIC of -4.9% (95% CI -8.8 - -1.0%), while TB, HIV/AIDS, Treatment Support, and Integrated Therapy (that'sit) fared best (3.6% increase in RIC; 95% CI: -0.2 - 7.3%). There was a decrease in RIC when comparing urban with rural areas (-7.8%; 95% CI -12.8 - -2.9%). City of Cape Town combined with Western Cape Government health facilities showed a substantial decrease (-6.1%; 95% CI -10.6 - -1.7%), while community health clinic (v. central day clinics) declined (-6.4; 95% CI -10.6 - -2.1%) in RIC. We observed no RIC difference by facility size and a slight increase when two or more human resources transitioned from PEPFAR to the government. When PEPFAR funding decreased in 2012, there was a decrease in RIC. To ensure the continuity of HIV care when a major funder withdraws sufficient and stable transition resources, investment in organisations that understand the local context, joint planning and co-ordination are required.

Analysis of economic and educational spillover effects in PEPFAR countries.

The United States President's Emergency Plan for AIDS Relief (PEPFAR) has been credited with saving millions lives and helping to change the trajectory of the global human immunodeficiency virus (HIV) epidemic. This study assesses whether PEPFAR has had impacts beyond health by examining changes in five economic and educational outcomes in PEPFAR countries: the gross domestic product (GDP) per capita growth rate; the share of girls and share of boys, respectively, who are out of school; and female and male employment rates. We constructed a panel data set for 157 low- and middle-income countries between 1990 and 2018 to estimate the macroeconomic impacts of PEPFAR. Our PEPFAR group included 90 countries that had received PEPFAR support over the period. Our comparison group included 67 low- and middle-income countries that had not received any PEPFAR support or had received minimal PEPFAR support (<$1M or <$.05 per capita) between 2004 and 2018. We used differences in differences (DID) methods to estimate the program impacts on the five economic and educational outcome measures. This study finds that PEPFAR is associated with increases in the GDP per capita growth rate and educational outcomes. In some models, we find that PEPFAR is associated with reductions in male and female employment. However, these effects appear to be due to trends in the comparison group countries rather than programmatic impacts of PEPFAR. We show that these impacts are most pronounced in COP countries receiving the highest levels of PEPFAR investment.

Analysis of maternal and child health spillover effects in PEPFAR countries

ObjectivesThis study examined whether the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding had effects beyond HIV, specifically on several measures of maternal and child health in low-income and...

1036. Reporting of SARS-CoV-2 testing results among PEPFAR and non-PEPFAR countries in Sub-Saharan Africa during the first year of the COVID-19 pandemic

Abstract Background The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest global health program dedicated to addressing a single disease. In its first ten years, PEPFAR invested one-fifth of country budgets on governance and health systems strengthening, including laboratories, surveillance networks, and long-term training of health care workers. In addition to furthering the HIV response and promoting the sustainability of health programs, it has been argued these investments built capacity to respond to novel public health threats such as SARS-CoV-2. Methods Testing data from 1/1/2020 through 2/17/2021 were downloaded from Our World in Data, an online database that collates information from national and international health agencies. These data were cross-referenced against publicly reported testing totals from Africa CDC and the World Health Organization. The data set did not include testing reported by governments through non-machine-readable formats such as social media or press releases. PEPFAR data were drawn from PEPFAR.gov. Results Of the 18 countries in sub-Saharan Africa (SSA) that reported testing data one year into the pandemic, 16 (88.9%) were PEPFAR countries (Table 1). Among PEPFAR countries in SSA, 16 of 27 countries (59.3%) reported SARS-CoV-2 tests performed, compared with 2 of 21 non-PEPFAR countries (9.5%, OR = 13.8). Among countries that reported testing, PEPFAR countries had a per-capita testing rate nearly 3 times that of non-PEPFAR countries (28.7 tests per 1,000 people vs. 9.6 tests per 1,000 people), suggesting greater testing capacity. PEPFAR countries reported higher COVID-19 case rates, likely due to increased testing, however this could also be due to regional differences in incidence (Table 2). Mean GDP per capita was 62% higher in non-PEPFAR SSA countries, making it unlikely that financial resources alone account for the observed differences.Figure 1.Countries that have received PEPFAR funding and countries that reported SARS-CoV-2 testing totals during the first year of the coronavirus pandemicTable 1.Reporting of SARS-CoV-2 testing in sub-Saharan Africa among PEPFAR and non-PEPFAR countries 1 year into the COVID-19 pandemicTable 2.COVID-19 indicators and characteristics of PEPFAR and non-PEPFAR countries in sub-Saharan Africa Conclusion PEPFAR countries in SSA were more likely than non-PEPFAR countries to report SARS-CoV-2 testing during the first year of the COVID-19 pandemic and also reported higher per-capita testing rates. This further supports anecdotal evidence that PEPFAR’s historical investments in health systems strengthened local capacity to respond to non-HIV public health emergencies such as COVID-19. Disclosures All Authors: No reported disclosures

2068. Progress in the Infection Prevention and Control Monitoring System for the United States President’s Emergency Plan for AIDS Relief (PEPFAR) Programs and Supported Facilities

Abstract Background The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) prioritizes infection prevention and control (IPC) activities in its 40,000 supported facilities in over 50 countries. PEPFAR’s 2015 quality assurance tool included four IPC indicators (tuberculosis IPC [TBIPC], waste management [WM], injection safety [IS], laboratory biosafety [LB]). In 2022, four new IPC indicators were added (IPC program [IP], environmental cleaning [EC], availability of personal protective equipment [PPE], medical device reprocessing [MD]). As of October 2022, PEPFAR programs are required to assess IPC indicators in 10% of facilities over the course of one year. We report quarter one data results. Methods Indicator data from October 1 - December 31, 2022 were analyzed. Scores were calculated based on compliance with 2-4 criteria each: green, yellow, and red represented good, fair, and poor compliance, respectively. Percentages of yellow and red scores were combined, to represent the percent of facilities requiring improvement. Results A total of 272 sites were assessed across 15 countries; each PEPFAR program selects the indicators to assess in each site. For existing indicators (TBIPC, WM, IS, LB), 16%, 34%, 22%, and 57% of sites assessed scored red or yellow, respectively; for indicators added in 2022 (IP, EC, PPE, MD), 74%, 67%, 64%, and 61% scored red or yellow, respectively (Figure). Specific gaps include: 63% of facilities lack adequate IPC leadership; ∼50% lack adequate environmental cleaning staff, protocols, and methods; 41% lack respirators; 30% lack device reprocessing protocols.Figure:Infection Prevention and Control (IPC) Indicator Scores from PEPFAR Panorama for Quarter 1 (October 1 – December 31, 2022) Conclusion Unknown IPC weaknesses were identified in PEPFAR supported facilities. PEPFAR requires that facilities with fair or poor compliance be reassessed within six months to monitor improvements. Strengthening IPC leadership is a priority. Improvement activities will require collaboration between facilities, implementing partners, and Ministries of Health (MOH). Future plans include increasing compliance with conducting required IPC indicator assessments; timely, data driven identification of gaps and advancements towards IPC standards; and developing guidance and resources to facilitate improvements. MOHs can leverage data to inform priorities and design context-specific interventions. Disclosures All Authors: No reported disclosures

Measuring training effectiveness of laboratory biosafety program offered at African Center for Integrated Laboratory Training in 22 President’s Emergency Plan for AIDS Relief supported countries (2008–2014)

IntroductionThe African Center for Integrated Laboratory Training (ACILT) in Johannesburg, South Africa offered a laboratory biosafety program to improve laboratory biosafety practices in 22 President’s Emergency Plan for AIDS Relief (PEPFAR) supported countries. This manuscript evaluates the transference of newly gained knowledge and skills to the participants’ place of employment for HIV and TB diagnostic laboratory programs. It also serves as a follow-on to a previously published manuscript that measured training effectiveness for all courses offered at ACILT.MethodsACILT offered 20 Laboratory Biosafety and Infrastructure courses (2008–2014), also referred as biosafety course/course comprising of 14 core laboratory safety elements to 402 participants from 22 countries. In 2015, participants received 22 e-questions divided into four categories: (1) Safety Policies, (2) Management’s Engagement, (3) Safety Programs and (4) Assessments of Safety Practices to determine retrospectively the training effectiveness of biosafety practices in their place of employment 6 months before and after attending their course. We used Kirkpatrick model to assess the transference of knowledge, skills and obstructive factors.Results20% (81/402) of the participants completed the e-questionnaire. The overall percentage of positive responses indicating implementation of new safety practices increased from 50% to 84%. Improvement occurred in all four categories after attending the course, with the greatest increases in Safety Policies (67–94%) and Safety Programs (43–91%). Creating a safety committee, allocating resources, and establishing a facility safety policy were important drivers for implementing and maintaining laboratory safety practices. In addition, accredited laboratories and countries with national safety regulations or policies had a higher percentage of improvements. The most reported challenges were inadequate funding and lack of management enforcement.ConclusionsPEPFAR and other partners’ investments in training institutions, such as ACILT, were effective in building sustainable country ownership to strengthen biosafety practices and were leveraged to combat zoonotic diseases and COVID-19. Although support continues at the national/regional level, a standardized, coordinated and continent-wide sustainable approach to offer a biosafety program-like ACILT is missing. Continuous offerings of biosafety programs similar to ACILT could contribute to sustainable strengthening of laboratory biosafety, QMS and pandemic preparedness.

Impact of HIV treat-all and complementary policies on ART linkage in 13 PEPFAR-supported African countries

BackgroundIn 2015, the World Health Organization recommended that all people living with HIV begin antiretroviral treatment (ART) regardless of immune status, a policy known as ‘Treat-All to end AIDS’, commonly referred to as Treat-All. Almost all low- and middle-income countries adopted this policy by 2019. This study describes how linkage to treatment of newly diagnosed persons changed between 2015 and 2018 and how complementary policies may have similarly increased linkage for 13 African countries. These countries adopted and implemented Treat-All policies between 2015 and 2018 and were supported by the U.S. Government’s President’s Emergency Plan for AIDS Relief (PEPFAR). The focuses of this research were to understand 1) linkage rates to ART initiation before and after the adoption of Treat-All in each country; 2) how Treat-All implementation differed across these countries; and 3) whether complementary policies (including same-day treatment initiation, task-shifting, reduced ART visits, and reduced ART pickups) implemented around the same time may have increased ART linkage.MethodsHIV testing and treatment data were collected by PEPFAR country programs in 13 African countries from 2015 to 2018. These countries were chosen based on the completeness of policy data and availability of program data during the study period. Program data were used to calculate proxy linkage rates. These rates were compared relative to the Treat All adoption period and the adoption of complementary policies.ResultsThe 13 countries experienced an average increase in ART linkage of 29.3% over the entire study period. In examining individual countries, all but two showed increases in linkage to treatment immediately after Treat All adoption. Across all countries, those that had adopted four or more complementary policies showed an average increased linkage of 39.8% compared to 13.9% in countries with fewer than four complementary policies.ConclusionsEleven of 13 country programs examined in this study demonstrated an increase in ART linkage after Treat-All policy adoption. Increases in linkage were associated with complementary policies. When exploring new public health policies, policymakers may consider which complementary policies might also help achieve the desired outcome of the public health policy.

Who Will Suffer Most if US AIDS Funding Ends.

The President's Emergency Plan for AIDS Relief (PEPFAR) is among the most successful US global health programs. It has moved HIV/AIDS from a certain death to a treatable disease. PEPFAR is now in danger of not being renewed. This perspective seeks to highlight the voice of perinatally HIV-infected Tanzanian youth.

Assessing sex differences in viral load suppression and reported deaths using routinely collected program data from PEPFAR-supported countries in sub-Saharan Africa

BackgroundIn sub-Saharan Africa, more women than men access HIV testing and treatment and may have better viral load suppression (VLS). We utilized routinely reported aggregated HIV program data from 21 sub-Saharan African countries to examine sex differences in VLS and death rates within antiretroviral therapy (ART) programs supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR).MethodsWe included VLS and reported death data for persons aged 15 + years on ART from October–December 2020 disaggregated by sex and age for each subnational unit (SNU). We used linear mixed-model regression to estimate VLS proportion and negative binomial mixed-model regression to estimate the rates of death and death plus interruptions in treatment (IIT). All models were weighted for SNU-level ART population size and adjusted for sex, age, HIV/tuberculosis coinfection, country, and SNU; models for reported deaths and deaths plus IIT were also adjusted for SNU-level VLS.ResultsMean VLS proportion was higher among women than men (93.0% vs. 92.0%, p-value < 0.0001) and 50 + than 15–49 age group (93.7% vs. 91.2%, p-value < 0.0001). The mean rate of reported deaths was higher among men than women (2.37 vs. 1.51 per 1000 persons, p-value < 0.0001) and 50 + than 15–49 age group (2.39 vs. 1.50 per 1000, p-value < 0.0001); the mean rate of reported deaths plus IIT was higher among men (30.1 in men vs. 26.0 in women per 1000, p-value < 0.0001) and higher among 15–49 than 50 + age group (34.7 vs. 22.6 per 1000, p-value < 0.0001).ConclusionsThe mean rate of reported deaths was higher among men in most models despite adjusting for VLS. Further exploration into differences in care-seeking behaviors; coverage of screening, prophylaxis, and/or treatment of opportunistic infections; and more extensive testing options for men to include CD4 is recommended.