EpiC Lesotho Semi-Annual Progress Report (October 2020 to March 2021)

During the reporting period from October 1, 2020, to March 31, 2021, program activities were conducted under four main interventions focusing on key populations, decentralized drug distribution, cross-border activities, and human resources for health. Key Population Activities were implemented under the KP program, with Key Populations Investment Funds (KPIF) used to complement the Country Operational Plan (COP) activities. EpiC Lesotho started direct implementation of Pre-Exposure Prophylaxis (PrEP) services through the engagement of three nurses hired to support PrEP initiations and refills. Introductory meetings with District Health Management Teams (DHMTs) and facilities on the support required for PrEP commodities were held on October 15, 2020. The team successfully conducted and facilitated the recruitment and appointments of project positions that were vacant during the reporting period. Decentralized Drugs Distribution (DDD) activities in Lesotho, implemented through Right to Care (RTC), were initially funded through the Headquarter Bridge Funding (HBF) funds and were transitioned to COP funds beginning October 1, 2020. There were delays in starting activity implementation due to delays in signing of the memorandum of understanding (MOU) between RTC and the Ministry of Health (MOH), particularly due to changes in senior leadership at the MOH. Travel restrictions due to the COVID-19 pandemic also contributed to the delays and impacted some of the startup activities like setting up of the call center. The MOU was finalized and signed in January 2021. The DDD activities implemented during this reporting period included conducting baseline and feasibility assessments in high priority sites, conducting orientation and training for staff in all five high priority sites, installing and commissioned IT Infrastructure for script acquisition and electronic transmission to central dispensing units (CDU), and disseminating site branding material on BonoloMeds program to all onboarded facilities. The team also assessed 21 alternative pick up points (PuPs), mapped and contracted collection services for centers enrolled onto the programme, and completed and commissioned CDU premises infrastructure with a capacity of 1.2m repeat dispenses annually. Cross-Border Activities under the EpiC Lesotho project involved sensitizing district management teams in the 10 focus districts and gaining access to facility data. RTC commenced data matching between Lesotho and South Africa and dashboards with patient line-list upload and outcomes are ongoing and set to be completed by the end of May. RTC started data mining on February 25, 2021, and completed data mining with a focus on Interruption In Treatment (IIT) in five districts (Berea, Mafeteng, Maseru, Leribe, and Mohale’s Hoek). Data matching is currently ongoing from the South Africa site. The EpiC Lesotho project has made significant progress in achieving its objectives, with all of the Q2 targets for core indicators being surpassed. The project has also faced several challenges, including delayed approval of the MOU by the MOH, misunderstanding of the project approach between EpiC and some of the MOH departments, and anxiety in health facilities due to new technologies that are brought as a result of program implementation. However, these challenges have been resolved, and the project is continuing to make progress in its implementation.