EpiC Jamaica Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021)

HCJ provided high-quality HIV testing, care, and treatment services to approximately 171 clients across three of the four health regions in Jamaica. The program established a network of 23 private sector clinicians, three private laboratories, and one psychotherapy services provider. HCJ demonstrated notable progress toward achieving their TX_CURR target but struggled with other assigned targets, including HTS_INDEX and TX_NEW. EpiC Jamaica's capacity development support aimed to strengthen both technical and programmatic operations. The program focused on capacity development to prepare HCJ for a transition to direct funding from USAID at the end of the subaward under EpiC. Much of the second quarter was centered on project close-out and transition activities, including preparing final deliverables, ensuring compliance with the subaward, and delivering key trainings to support future management of direct funding and independent technical implementation and PEPFAR reporting. During the reporting period, HCJ tested 19 individuals for HIV, four of whom tested positive. Five persons were newly initiated on treatment, corresponding to achieving 25% of the total TX_NEW target for the timeframe. HCJ offered index testing services to 48 clients, with 43 (90%) accepting index testing services and 59 contacts being elicited. The index testing case finding rate was 21.1%, with case finding being higher among female contacts (60%) compared to male contacts (8%). To support an increase in the case finding rate, HCJ added an additional Contact Investigator to the staff in November 2020. Of the 171 persons on treatment, 72 received viral load testing, and 50 were found to be virally suppressed, for a 69% viral suppression rate. Despite the success of the HCJ's loss to follow-up (LFTU) campaign in FY20 Q4, the MOHW made the decision to discontinue sharing of the LFTU list with the HCJ in early Q1 2021, resulting in a significant decrease in the HCJ's on-boarding rate and impacting achievement of targets. The HCJ is now solely dependent on demand generation and index testing activities to identify and onboard new clients. To support demand generation, HCJ engaged a marketing firm to support online marketing initiatives and contracted a total of five new physicians and one additional lab, bringing the total number of contracted network clinicians to 23 and the total number of labs to three. This increase in network providers has expanded service delivery to cover three of the four health regions, namely, South East, Southern, and Western. Negotiations are underway to engage an additional four clinicians and one additional lab. The HCJ also finalized the Online Reservation Application (ORA) platform for the EpiC partners and received capacity building to use ORA to track records for case management and index testing and to use built-in analytic features for internal and external reporting. EpiC supported the HCJ to recruit four new staff to address gaps in the management and functioning of the HCJ Coordinating Unit. The positions filled included Monitoring and Evaluation Officer, Data Officer, Program Administrator, and Finance Officer. EpiC supported the creation of the job descriptions, shortlisting CVs, and participating in interviews, when requested to do so. A consultant, Professor Marvin Reid of the University of the West Indies, was engaged to evaluate the client Vulnerability Assessment Tool (VAT) developed in FY20 for use by the HCJ to assess client eligibility for free services. The review of the tool was useful to ensure that the weighting assigned to each question in the tool would accurately determine level of client vulnerability, ensuring that only the most vulnerable would benefit from free service from the HCJ.