Despite progress toward controlling the human immunodeficiency virus (HIV) epidemic, testing gaps remain, particularly among men and young persons in sub-Saharan Africa (1). This observational study used routinely collected programmatic data from 20 African countries reported to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) from October 2018 to September 2019 to assess HIV testing coverage and case finding among adults (defined as persons aged ≥15 years). Indicators included number of HIV tests conducted, number of HIV-positive test results, and percentage positivity rate. Overall, the majority of countries reported higher HIV case finding among women than among men. However, a slightly higher percentage positivity was recorded among men (4.7%) than among women (4.1%). Provider-initiated counseling and testing (PITC) in health facilities identified approximately two thirds of all new cases, but index testing had the highest percentage positivity in all countries among both sexes. Yields from voluntary counseling and testing (VCT) and mobile testing varied by sex and by country. These findings highlight the need to identify and implement the most efficient strategies for HIV case finding in these countries to close coverage Continuing Education examination available at https://www.cdc.gov/mmwr/mmwr_continuingEducation.html INSIDE

Background The United States President’s Emergency Plan for AIDS Relief (PEPFAR) in Democratic Republic of the Congo (DRC) continues to fund a robust portfolio of programs aimed at achieving epidemic control in three provinces where 30 percent of people living with HIV/AIDS in the country reside. Challenges around human resources for health (HRH), including inadequate staffing and limited capacity, impede the delivery of quality HIV/AIDS services in DRC.Methods In partnership with the United States Health Resources and Services Administration (HRSA), PEPFAR, and DRC Ministry of Health (MoH), ICAP at Columbia University worked with 16 PEPFAR-identified high-priority health facilities (HFs) in DRC and developed HRH-specific interventions to address challenges in achieving 95-95-95 targets. These potential interventions were then prioritized for implementation using a collaborative, criteria-driven approach considering factors such as feasibility, viability, and time-to-impact. Through interviews at all 16 HFs, the joint teams developed an intervention framework, determined short-term priorities, and prepared to implement short-term HRH improvements to reach 95-95-95 targets across all HFs. Interviews used an adapted version of the PEPFAR HRH Rapid Assessment tool to capture key HRH information including staffing levels by type of clinical or administrative position, key barriers to achieving 95-95-95 targets, and perceptions of needed HRH-specific improvements. Results Site-level interviews occurred in April 2019, and the in-country team created a list of possible interventions across six domains: staffing, training, workplace environment, medical supplies and equipment, and monitoring and evaluation. Thirty-five interventions were hypothesized and prioritized into short, medium, and long-term priorities using a framework focused on desirability, feasibility, viability, and time-to-impact. Some interventions were applicable to all HFs while others applied only to selected HFs, the national MoH, or to implementation partners. Twelve interventions were selected as highest priority, and budget allocations and task planning were developed for each of the high-priority interventions. These high-priority interventions were then launched for implementation and evaluation within six months.Conclusions The supply and quality of HRH are critical to achieving epidemic control. This assessment delineated necessary interventions to address site-specific HRH barriers, HRH interventions focused on ensuring adequate staffing, optimal utilization of health workers, and strengthening health workers’ capacity to provide quality HIV/AIDS services to achieve epidemic control. Downstream tracking and reporting of key PEPFAR metrics, including key Monitoring, Evaluation, and Reporting (MER) indicators, will allow intervention teams to conduct program evaluations of key interventions and their impacts on PEPFAR targets.

The Democratic Republic of the Congo (DRC) has taken the option of implementing the HIV self-testing to boost the first “95” of the UNAIDS 95-95-95 targets by 2025. This study aims to assess the performances and usability of the Exacto ® Test HIV (Biosynex, Strasbourg, France) self-test in the lab and in the field. The Exacto ® Test HIV self-test demonstrated high virological performances (sensitivity, 99.6%; specificity, 100%) in the lab and in the field in the hand of untrained users (sensitivity, 100%; specificity, 98.9%). Taken together, the excellent performances and usability characteristics of Exacto ® Test HIV (Biosynex) self-test make the kit a viable option for HIV self-testing in the DRC.

Background The United States President's Emergency Plan for AIDS Relief (PEPFAR) in Democratic Republic of the Congo (DRC) continues to fund a robust portfolio of programs aimed at achieving epidemic control in three provinces where 30 percent of people living with HIV/AIDS in the country reside.Challenges around human resources for health (HRH), including inadequate sta ng and limited capacity, impede the delivery of quality HIV/AIDS services in DRC.Methods In partnership with the United States Health Resources and Services Administration (HRSA), PEPFAR, and DRC Ministry of Health (MoH), ICAP at Columbia University worked with 16 PEPFARidenti ed high-priority health facilities (HFs) in DRC and developed HRH-speci c interventions to address challenges in achieving 95-95-95 targets. These potential interventions were then prioritized for implementation using a collaborative, criteria-driven approach considering factors such as feasibility, viability, and time-to-impact. Through interviews at all 16 HFs, the joint teams developed an intervention framework, determined short-term priorities, and prepared to implement short-term HRH improvements to reach 95-95-95 targets across all HFs. Interviews used an adapted version of the PEPFAR HRH Rapid Assessment tool to capture key HRH information including sta ng levels by type of clinical or administrative position, key barriers to achieving 95-95-95 targets, and perceptions of needed HRHspeci c improvements.Results Site-level interviews occurred in April 2019, and the in-country team created a list of possible interventions across six domains: sta ng, training, workplace environment, medical supplies and equipment, and monitoring and evaluation. Thirty-ve interventions were hypothesized and prioritized into short, medium, and long-term priorities using a framework focused on desirability, feasibility, viability, and time-to-impact. Some interventions were applicable to all HFs while others applied only to selected HFs, the national MoH, or to implementation partners. Twelve interventions were selected as highest priority, and budget allocations and task planning were developed for each of the high-priority interventions. These high-priority interventions were then launched for implementation and evaluation within six months.Conclusions The supply and quality of HRH are critical to achieving epidemic control. This assessment delineated necessary interventions to address site-speci c HRH barriers, HRH interventions focused on ensuring adequate sta ng, optimal utilization of health workers, and strengthening health workers' capacity to provide quality HIV/AIDS services to achieve epidemic control. Downstream tracking and reporting of key PEPFAR metrics, including key Monitoring, Evaluation, and Reporting (MER) indicators, will allow intervention teams to conduct program evaluations of key interventions and their impacts on PEPFAR targets.

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