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

Abstract

IntroductionThe 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.DiscussionThe 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.ConclusionsThe 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.

High pre-exposure prophylaxis awareness and willingness to pay for pre-exposure prophylaxis among young adults in Western Kenya: results from a population-based survey

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“…To better refine key population programming at country level, Lillie et al . describe a partnership between PEPFAR and The Global Fund to conduct key populations cascade assessments . By jointly participating in these assessments, major funders and national stakeholders are able to better align packages of services, training, geographic coverage, innovations, data collection and quality improvement efforts.…”

Geographies of sexualities in sub-Saharan Africa: Positioning and critically engaging with international human rights and related ascendant discourses

“…Research is also highlighting how it is important to target such groups to reduce the total HIV burden of different states (Mannava et al, 2013; Mukandavire et al, 2018). With the support of international funding bodies such as the US Centres for Disease Control (CDC), the US Agency for International Development (USAID) and The Global Fund to Fight TB, HIV and Malaria (commonly referred to as The Global Fund), countries in sub-Saharan Africa where the epidemic is particularly severe have started to implement programming for KPs, including support for tailored clinical services and community-engagement HIV prevention and testing programmes (Lillie et al, 2018; Wolf et al, 2018). Public health research has also started to comprehensively consider how stigma and discrimination inhibit safer-sex behaviour and also inhibit the likelihood of being able to access medical care and other forms of social support (Fay et al, 2011; Stahlman et al, 2015).…”