Mitigating the Impact of COVID-19 on Key-Population-Focused HIV Programs - Shared screen with speaker view
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Hi all, Kiran Bam from LINKAGES Nepal
And, please direct comments to all panelists and attendees (not to panelists only).
Hello all, Godswill Agada, STA,PCT and KP lead,FHI360 GF project,Nigeria
DR MAIMOONA Emmad
Salaam Dr Maimoona from Pakistan-Manager Surveillance-National AIDS CONTROL PROGRAM PAKISTAN
Hi All, Purvi Shah, Technical Specialist, FHI 360 HQ (Based in New Delhi, India)
Hello, Kathryn Rosecrans with Save the Children Myanmar, Global Fund PR
Hi all, Sandar Aye from Save the Children Myanmar, Global Fund PR
Good morning good afternoon good evening - Clint Trout, Heartland Alliance. Thank you for this much-needed webinar
ly nguyen from CDC, Vietnam.
Hi all - Anna Grimsrud from the International AIDS Society in South Africa.
Hello everyone, Elizabeth Amuli from Management and Development for Health, Tanzania.
Hi all, Samuel Engulu JSI USAID RHITES Lango project Uganda
hi All, Dorcas Tohon, technical officer EPIC-KPIF, FHI360 from Togo
Hello all, Joe McMartin from Frontline AIDS
Hi, Christopher Arineitwe FHI 360 Uganda
Hi everyone, Solange Baptiste - ITPC Global
Hello all, Dr. Ugochi Ezenwelu STA - Lab FHI360/GF Nigeria
Ndoungou Salla Ba
good afternoon all, Ndoungou Salla Ba from WHO AFRO
Hi everyone, Humphrey Ndondo- Snr. Technical Specialist- PSI, Zimbabwe
Hello everyone, Gloria Gonese, Head of Program Zim-TTECH, Zimbabwe.
Good Afternoon.. Nanna Gonji kP IHVN
Revati Chawla, Frontline AIDS, UK. Hello to the panellists and colleagues.
Hi all - Helen Savva, CDC/South Africa
Hi all, Dr Mariette Slabbert from South Africa
Salam, Tall Madani, LINKAGES/Mali
Hello, Dorica Boyee, SI, Tanzania
Hi everyone - Carey Johnson, KP Sr Tech Advisor, PSI Zimbabwe and National AIDS Council - thanks for this!
Gaston Djomand, KP Team, CDC Atlanta
Are presentations going to be shared? Dr Phibion Manyanga from Zimbabwe
Hi everyone. Meg DiCarlo, LINKAGES and EpiC, FHI 360
Hello Dee Adams, LINKAGES Eswatini
Hello all. Njambi Njuguna, EpiC Kenya-
Since COVID-19 is not yet vulgarized to Community level in most of emerging countries, such as in DRC-my coutry, how can we ensure KP continue their activity without geopardizing their safety vis-à-vis to COVID-19??
Thank you George for the comprehensive presentation on key issues experienced by the most marginalised. keen to hear some of the responses from networks. We have heard from INPUD on some of the responses for people who use drugs and will check the links you sent.
Andrew Lambert, FHI 360, KP STA, Based in South Africa
Hey good morning, good Afternoon every on HIV Private Sector Network
DR MAIMOONA Emmad
Thnakyou for the presentation
Hi everyone, Hardwin Sithole, PSI Zimbabwe
Hello everyone, Joshua Gotom, IHVNigeria
Good morning/afternoon/evening all - Daniel Levitt here :)
George, thank you for the focus on discrimination, stigma, and access to services relative to KPs. Could you provide citations for the claims as well as whether those particular case studies are isolated or can they be aggregated rigorously, and then, can and should be generalized and then addressed or considered globally in a COVID1-19 response? What arguments might you marshal to counter-claims that a broad-based response is sufficient (no need for focused population specific programming)? What recommendations might you have for democracy, human rights and governance programming to include not only a KP focus, but also other populations at risk, e.g. TB and infectious diseases? Finally, from a rights holder lens, how might a KP approach build upon & mutually reinforce minority groups expressing concerns (migrants, as you point out, TIP survivors, people with disabilities, indigenous peoples, etc and overlap thereof, where appropriate?) Ajit Joshi - USAID/Washington, Senior Human Rights & Inclusion Advisor
Hi all! Michael Cassell from FHI 360 HQ, but based in Hanoi
Hi all, Rachel Eersel, Suriname
hello all, Halleluah , Key populations Officer , PSI, Zimbabwe
Hey good morning good afternoon everyone, HIV Private Sector Network Jamaica
Hi all, Tania Kambel, Suriname
hello all, lucy OConnell , keypopulations focal point, MSF Southern Africa
Hi all, Sandra Georges, CARE CoP for CHAMP project in Cameroon
Hi everyone, Wame Dikobe, FHI360, COP for KP, EpiC project Botswana
Don't forget to write your questions and comments here!
Hi everyone, Liz Kariuki, Program Manager, FHI 360, South Africa
Hello, Caitlin Loehr from IntraHealth International
DR MAIMOONA Emmad
WHO has to take the lead in issuing strict vigilance and advisory on ART multi drug dispensing among adherent and virally suppressed clients registered with ART centers. Also Harm reduction outreach should be assured at spots
DR MAIMOONA Emmad
can WHO provide implementation examples how that is ensured
Relative to harm reduction in Morocco (WHO), could you speak more to the yoga and related interventions provided as complementary/integrative tools? Did interventions also include breathwork (pranayama), systematic relaxation (including yoga nidra), and meditation? What was the monitoring done on that intervention? Was it based on evaluations of those tools used effectively with KPs? Are these effective psychosocial, non mental health tools that have been used in KPs and documented in the literature for improving KP outcomes? Ajit Joshi, USAID/Washington, Senior Human Rights and Inclusion Advisor
I am am so thankful Lady Gaga on is on this slide
DR MAIMOONA Emmad
every country has a different beat and service delivery is getting a serious issue in Pakistan,
What is impact on PEPFAR of Birx working on COVID 19?
Question to WHO: Please clarify 1 meter social distancing. Most other guidelines prescribe 6 feet or 2 metres
Jill Gay... Ambassador Birx remains in charge of PEPFAR. Her deputy is running the day-to-day, but I understand that Amb Birx still speaks with her every day. I don't know if there is someone else here from OGAC that would like to comment.
Can you please elaborate further on condom dispensing/distributions through pharmacies?
WHO 2013 regarding Stopping NNRTI-based ART (use of a “tail”). Because of the prolonged half-life of EFV (and NVP), suddenly stopping an NNRTI-based regimen risks developing NNRTI resistance. Pharmacokinetic modelling reviewed for the guidelines suggests that, if the NRTI backbone included TDF, such a tail may not be needed, but if the NRTI backbone included AZT, a two-week tail is advisable (EFV has a longer half-life than NVP). Is that still applicable in case of inevitable interruption of ART. Just for contingency planning.
Do we know of any evidence of shortages of ARVs? At least here in the USA (in Georgia) I have been told of pharmacies declining to fill prescriptions for 3 month supplies though it is being widely recommended to have extra medications on hand. Wondering if this may be a concern and could be the underlying reason for not allowing people to access 3 month supplies?
Yes, we will share all slides and a recording of the webinar for further distribution.
In Kenya, the government has reiterated that drugs are sufficient. Currently guidelines state dispensing for 3 months for all
Hi Nicolas - was on a webinar yesterday about multi-month dispensing and ARV supply chain. I can share some slides from this ( just email me at firstname.lastname@example.org) and there is some concern that there may be challenges because of the India lockdown. My understanding is that PEPFAR will be “tempering” their guidance on 3-6M refills later today.
DR MAIMOONA Emmad
Thank you Anna!
Is there any guidance that can be shared on engaging media reporting on individual cases of COVID 19 particularly where infection is traceable to index clients. we are concerned with the blatant public notification, disregard for privacy and confidentiality and forced contact tracing and Covid 19 status disclosure.
From Marie (UNAIDS WCA Office ) to WHO: The shift to MMD does not necessarily modify the overall quantification of need, but it does have an impact with respect to whether or not sufficient stocks have been ordered and are “on hand” for massive/accelerated distribution while protecting buffer stocks . A question for WCA is how many countries actually have this stock-in-hand. If countries shift to MMD and deplete their buffer stocks in so doing, they need to be sure of timely new supplies to make up for that difference. That is where the second concern – that global ARV manufacturers may face disruption in supplies of basic ingredients and/or in production and delivery of new stocks due to COVID-19 – that adds a second complexity. Countries need to be “guaranteed” that if they liquidate their buffers the new supply can both be ordered and delivered in an accelerated manner.
Could you pls share the latest update on efforts by WHO Global Fund, PEPFAR, and other key partners (such as RECs eg WAHO?) to guarantee adequate supply of drugs to countries.
In Eswatini we are working to use Online demand creation to help decongest clinics and support MMD at our DIC.
What has been the general thinking on community adherence group (CAG) distribution of ART?
How can we support distribution of products/services (i.e. HIVST, ART, etc) while protecting the confidentiality of KP clients?
Desy Natalia Sagala
Is there any guidance or strategic and systematic recommendations to do the VL testing in this physical distancing situation?
We distribute HIV ST, Condoms and Lubricants in locations that are still accessible during lockdowns. We leave them with security guards, and are looking to expand to Bottle Stores. We provide contact information if assistance is needed for the HIV ST confirmations or HIV ST overall, including WhatsApp support
@AnnaGrimsrud - with insecure ARV supplies in Indonesia, it will not be possible to offer even 2-month MMD. Focus now is being placed on provision of broad home-based ARV delivery
Daniel - this has been working very well in Kenya. Also distribution through the peer navigators to their peers
We also now do ePSS consultations. there has been a big demand, and allows social distancing but still addressing the increase in mental health needs during COVID
Thank you, Njambi.
There are many options for decentralized drug distribution... including CAGs, home delivery, greater use of private pharmacies and lockers.
I have realised that the moment outreach workers reach out for community refills wearing the PPE during this COVID period neighbours tend to suspect that the clients are covid suspects - how do we maintain confidentiality and protect our communities?
All are valid approaches - and depends on what structures already exist.
Chris, regarding your point on ARTs and the supply chain, are you raising this concern with those looking at the supply chain from economic stability perspectives, or others that advocate for standards, accountability, and governance on supply chain -- trafficking, labor standards, environmental standards? Ajit Joshi, Senior Human Rights and Inclusion Advisor, USAID/Washington
DR MAIMOONA Emmad
rising FP/RH needs among key population ,,, we continuously talk about KP , but neglected vulnerable populations like spouses of PWID. inclusion of PHC with outreach??
David Olusegun Oyedeji
KP CARE 2 project as part of covid-19 mitigation plan is using community care service points like PPMVs, Pharmacy and Laboratory for HIV testing, enrollment in care with MMD 3months and community refill. Peer navigators who live less than 10 meters from the service delivery points are monitoring and supporting the KPs
Thank you Chris - great presentation
i would like to hear how do we increase the resources to ensure increase in staff to support the adaptations through covid,
more nurses fast
and more training for comunity health workers
You will get all slides
We have seen that a small added amount of data to our outreach workers they are able to easily reach out to clients to check in on KPs, including helping to link to clinics or COVID-19 related services. Also the Going Online platform has really helped as well
DR MAIMOONA Emmad
Pakistan has spots where outreach service delivery is ensured and those spots have not even clean safe drinking water, I am confused for online virtual and airtime hotline communication
DR MAIMOONA Emmad
We must not forget countries with lowest education and inabililty to access online
Would be great to get ahold of the strategies for living at home safely for LGBT youth, especially if you have in multiple languages (e.g. French)
The FSW led CBO here has been working to get some hot spots that are still active, and lack water to make Tippy Tap options (a small barrel with water) and depending on where access to soap. But they are providing during that time
Robyn, on outcome one relative to isolation and mental health, how might lesbians, trans men, bi women who may not be an immediate KP focus or within the definition be included from a safety perspective? I see on concern two a switch in terminology to LGBT youth, for example; hence, I'm trying to better understand population focus and how to ensure safety. Also, from an intersectional approach, for both concerns one and two, how might more specific outreach be done for those who are also indigenous, not speaking a major language, and have a disability, and if so, in what ways? And, on concern three, what language might you recommend to decision makers so that GBV approaches do not default to focusing primarily on cisgender, heterosexual women from prevention and support approaches to the detriment of the KPs we have been speaking about? Ajit Joshi, Senior Human Rights and Inclusion Advisor, USAID/Washington
I think the COVID pandemic has forced us to adopt a more humanitarian approach - if people don't have water to drink (like in Pakistan), HIV is not the first ting on their minds. it is an opportunity - and need - to work more closely with the Humanitarian sectors.
Dan here are some related resources:1. Frontline Defenders (27 March 2020) Physical, emotional and digital protection while using home as office in times of COVID-19. https://www.frontlinedefenders.org/en/statement-report/physical-emotional-and-digital-protection-while-using-home-office-times-covid-19
DR MAIMOONA Emmad
we received 7 calls from FSW network for SRH needs and just confirmed two expired using traditional methods, Mortality will rise if access isn't ensured in person, how we can achieve that
DR MAIMOONA Emmad
Covid will force many to understand that diseases know no borders and we must make guidelines taking everyone on board
which organizations are tracking globally access to contraception and safe abortion services globally by country?
Robyn, on concern three, actions suggested (just before the opportunities section) what suggestions might you have for those managing grants and contracts so that workers become more aware of their rights and implementing partners prioritize mental health and psychosocial services of their staff? Does there need to be a broad based policy? If so, what should it look like? Ajit Joshi, Senior Human Rights and Inclusion Advisor, USAID/Washington
Dan: some CDC resources here: https://www.cdc.gov/lgbthealth/youth-resources.htm
There have been a lot of questions here regarding how countries can provide MMD when there are issues with stock. In the case of PEPFAR, I know there is a whole team that is working on this issue, working with suppliers in India and elsewhere to ensure that stocks can get to where they need to be. We do not have someone who can address this question directly on this webinar, but we will share your questions with the supply chain team at USAID and try to get back to you.
Fantastic, thanks, Michael.
I don't know if there is someone who can answer these same questions from Global Fund?
GF has advised countries to use 5% of their current or future grants towards COVID19
Noted and thanks Hally for your response.
DR MAIMOONA Emmad
countries advise larger measures for physical distancing but the WHO recommendation remains at a minimum of at least 1 m.
Thanks Ben. In Kenya for some of our CSOs, we realized that a sizeable proportion of sex workers do not have smart phones thus cannot be reached by WhatsApp or going online approach. We are now exploring use of bulk sms service for health chats, information on GBV and tips for mitigation. It would also help them feel connected to the CSOs. We are also going to use this venue to widely distribute the hotline numbers for the CSOS
can anyone please share the experience of maintaining the life-saving prevention activities like condom distribution and HIV testing where online outreach is not feasible?
Robyn and George... there have been several questions regarding tracking criminalization examples (do we have anyone formally tracking).
Hot of the press Global Fund COVID_19 Information Note: Considerations for Global Fund HIV Support - https://www.theglobalfund.org/media/9512/covid19_hiv_infonote_en.pdf?u=637218468240000000
Also... there was a question about how we are ensuring that GBV prevention doesn't just focus on cis-gender women.
Annette... there was an earlier question asking what statements WHO will be making regarding pushing governments to take on MMD and other decentralized harm reduction approaches.
Is there a way to save this chat content? It is also very useful. I am trying to Ctrl+C but it isn't picking.
Emily... is there a link to information about that?
@sandar We asked each out reach worker to find a location within their community (as most normal hotspots are closed or paroled by police) that is walkable and doesn't encourage large groups. We have then linked with a person there (often security guard) have shifted to HIV ST, Condom and Lubricants pick ups. We then tell people to go there for pick up. Or one on one distribution occurs where people just drop what is needed (in a normal bag) so people can pick it up and there is no close contact.
In terms of making sure that GBV screening is not only for cisgender women, we encourage that all members of key populations be screened for violence. Full guidance on violence prevention and response in KP programs can be found here - https://www.fhi360.org/resource/linkages-violence-prevention-and-response-series
Chris and anyone else... there were questions on how community-based testing can continue during this time
unassisted HIVST is the priority HIV testing modality at this time
There were also questions about whether PEPFAR programs can purchase PPE. Please see the documents Kent just posted links to regarding that question.
Hi, there was a question on tracking criminal laws. ICNL has a tracker on laws affecting rights and freedoms including some criminal laws https://www.icnl.org/covid19tracker/
What incentives have you used for participation for your digital/ online solutions
Fair Trials also has a tracker
Benjamin, how are you supporting KP needs that are beyond HIV through these platforms? Are outreach workers trained to speak to and addressoOther health needs, food security, economic livelihood, access to rights and reporting experiences of discrimination, violence, blackmail, and scapegoating that George and Robyn referenced? Can they point users to the right resources? Does the user interface in your platforms allow for users to input these other issues? Ajit Joshi, Senior Human Rights and Inclusion Advisor, USAID/Washington
If community testing is still allowable, ensure that PPE are available for staff/beneficiaries
Orasure Technologies has a webinar titled “Innovative Strategies for HIV screening during COVID” scheduled for Thursday, April 9, 2020, at 1:00 pm EST. You can register here: orasure.zoom.us/webinar/register/...
Fantastic session - well organized and absolutely relevant. Thanks to the EpiC team for organizing, and very much looking forward to the next webinar.
Fair trials looking at laws and access to justice https://www.fairtrials.org/covid19justice?field_tags_tid%5B0%5D=1165
Can we publish the questions and answers and circulated all slides?
Second Georg. Can't copy/paste the chat. Thanks all for a great webinar.
Really wonderful webinar, so much useful information. Look forward to receiving the additional documents. Thank you
as I mentioned, WHO recommends multi dose take home for OST
Thank you everyone, great presentations and appreciate everyone's questions and comments in the chat!
Chris - the link you sent did not come through fully.