LINKAGES Quarterly Report (July 1 to September 30, 2019) - LIBERIA

The project focused on providing reliable coverage across the continuum of care for men who have sex with men and transgender women. In the fourth quarter of fiscal year 2019, LINKAGES Liberia accelerated and intensified HIV case finding among key populations, priority populations, and early initiation of treatment, treatment retention, and viral load testing among all people living with HIV. The project reached 13,295 individuals, including 2,626 female sex workers, 1,197 men who have sex with men, 187 transgender people, and 9,285 other individuals at high risk, with HIV prevention education and referrals. Of these individuals, 12,474 were tested for HIV and received their results after post-test counseling. A total of 741 individuals tested positive for HIV, with an overall HIV case finding of 6 percent among all populations and 4.2 percent among key populations. LINKAGES Liberia also supported client follow-up, initiation of case profiling to advance differentiated, focused services, and high-frequency review and reporting of data to support continuous quality improvement. The project conducted workshops with implementing partners in collaboration with the National AIDS and STI Control Program and the County Health Team to optimize HIV case finding, treatment initiation, and viral load testing among key populations. The project exceeded its targets for outreach, testing, and newly initiated on treatment. A total of 650 people living with HIV were newly initiated on antiretroviral therapy, with 619 (95 percent) being newly diagnosed HIV positive this quarter and newly initiated on treatment in this quarter. The project also trained 58 peer educators and 14 outreach workers on the Enhanced Peer Outreach Approach and established nine crisis response teams at nine different hot spots. In addition, LINKAGES Liberia conducted hot spot mapping and population size estimation in two new districts to inform and plan outreach activities for fiscal year 2020. The project also completed the transition plan from LINKAGES to the new Meeting Targets and Maintaining Epidemic Control project, which became effective October 1, 2019. The LINKAGES Liberia team participated in a regional training workshop in Ghana on index testing, experience sharing, and work planning. The project also focused on increasing the availability of comprehensive prevention, care, and treatment services, including reliable coverage across the continuum of care for men who have sex with men and transgender women. Index testing was provided to sexual and injecting partners and biological children of HIV-positive index clients, with a case finding of 7 percent. A total of 72 PLHIV offered index testing accepted and referred 374 sexual partners and biological children for index testing. Viral load testing was also a key focus area, with 2,928 (36 percent) of 8,234 people living with HIV on antiretroviral therapy reported eligible for viral load testing. A total of 2,221 out of 2,928 (76 percent) provided blood samples for viral load testing, with 1,723 (78 percent) receiving their results. The main reasons for low viral load testing remain minimal awareness of viral load testing and irregular supply of reagents at various health centers. The project has supported a campaign to increase viral load awareness through meetings with various stakeholders, including the National AIDS and STI Control Program and health facility authorities. The project has also improved tracking and coordination between facilities and viral load labs, with no systematic mechanism for the facility to track if referred patients indeed go for viral load testing and for the lab to flag the need to re-test to the facility in charge of the patient in case of unsuccessful samples or invalid analysis.