South Sudan

NFM-3 Global Fund Project

Progress Review Meeting
17th
to 20th May 2022

WBGS State presentation

Prepared by Team : JAMES-JOHN- GEORGE

Presented By: JOHN AKILE
State TB/HIV Coordinator
 State Profile Overview

• Total population of WBGS =526,625 NBS

• Geographic administrative areas
1-Three counties , Wau ,Raja and Jur River county.
2-payam = 15 payams
3-Boma= 96 Bomas
• Total Number of Health facilities is 100:
1-Hospitals =5 hospitals
2- PHCC =24 PHCC
3-PHCU = 71 PHCU
 Main implementing partners and areas of support
S/No Implementing partner Areas of support Facility

1 CORDAID TB/HIV Supportive supervisions/motivation

2 AAA TB/HIV Supporting Non PEPFAR
2 ICAP ART/ PMTCT One .W.T.H ART/PMTCT
3 IMC ART/PMTCT POC Clinic ART/PMTCT
4 Health Net PMTCT 2 Facilities in Raja county
5 RTI ART One facility Wau Military Hospital
6 Mission TB/HIV Three Facilities
7 Yo`Care HIV Key Population
8 Elsabreen Association /PLHIV HIV Key population and community

9 NEPWU/PLHIV HIV Key population and community

 Number of facilities providing ART
• 6 Facilities provides ART services
- Wau Teaching Hospital ,Mapel PHCC , Wau Military Hospital ,Raja county Hospital ,POC
IMC Clinic and Sikka Hadid PHCC
• 28 facilities provide ANC, PMTCT and EID services
.
• 26 Facility provide HTS
20 New to Facilities
Modalities of HTS:
-Targeted Testing i.e in TB Clinics, TFCU centres, Wards, Index testing, ANC Community
Mobile Outreaches
 HIV Status in the State
• Type of epidemic is generalised.
• Prevalence =1.9% ANC 2017
• Incidence=IR in 2020=19% per1000
.IR in 2021=25.2%per1000
• Estimated number of new infections in the state is 213 in 2020 and 316 in 2021
• Mortality =56 in 3 years
Updates on performance indicators with focus on the three 95s

HTS/ART Cascade Analysis 2020-2022

20000
18871

18000

16000

14192
14000

12000

Axis Title 10000

8000

6000
4702
4000

2000 1252 1384

1117
207 172 316 320 97 82
0
2020 2021 2022
 ANC/PMTCT Cascade from 2020 -2021 to 2022

ANC/PMTCT
35000

31281
30000

25000

20000 19498

Axis Title
15000
11933

10000 8589
8197 8291
6492

5000
3030 2638

217 408 67 22 43 14
0
Total ANC Visit First visit Tested HIV Tested positive On option B+
 HIV Exposed infant services

S/No Case Total Male infant Female Infants

1 Old EID clients 505 261 244

2 New EID clients 103 51 52

3 Tested positive after 18 months 4 4 0

4 Linked to care 4 4 0

5 Discharged ( Tested Negative) 28 11 17

 EID services:

HIV Exposed Infant Services

600

505
500

400
402

300

200

100
103
4 4 28
0
TotalClients New EID clints old EID client Tested positive after 18 months Linked to Care Discharged ( tested Neg)
 Viral Load Cascade Analysis:

Viral load 2021

1000

900 859
800 778
712
700

600

500

400

300

200

100 66 44 29
0
sample collected Result Returned High VL V L supressed Smple rejected pending
TB Case Notification for Jan 2021-Jan 2022
Block 1: All TB cases registered during the New Relapse Previously treated (excluding Previous treatment history unknown Total
jan2021-Jan2022b relapse)

Pulmonary, bacteriologically confirmed

692 20 2 0  714
Pulmonary, clinically diagnosed
106 0 0 0  106
Extrapulmonary, bacteriologically confirmed or
clinically diagnosed 115 0 0  0 115

Block 2. All new and relapse cases (bacteriologically confirmed or clinically diagnosed) registered during the quarter by age group and sex 

Total (New
0-4 5-14 15-24 25-34 35-44 45-54 55-64 >65 &
Relapses)
 
Male 8 48 126 178 120 86 40 28 634
Female 7 35 84 62 53 38 13 15 307

Block 3: Laboratory diagnostic activity

Patients with presumptive TB with

Patients with presumptive TB undergoing bacteriological examination 3283 positive bacteriological
examination result
718
 TB Case Notification Cont..
Block 4: TB/HIV activities (all new and relapse TB cases registered during the quarter)

Patients tested for HIV at the time of TB diagnosis or with known

HIV-positive TB patients HIV-positive TB patients on ART HIV-positive TB patients on CPT
HIV status at the time of TB diagnosis

933 63 63  63

Block 5. TB/HIV co-infected patients among new and relapse registered during the quarter by age group and sex 

0-4 5-14 15-24 25-34 35-44 45-54 55-64 >65 Total (New & Relapses)
 
Male 0 0 2 1 5 0 0  0  8
Female 0 1 2 3 0 1 0   0 7
Number of new bacteriologically confirmed pulmonary TB cases registered in Sputum smear microscopy Sputum smear microscopy Sputum Conversion Rate
the quarter recorded above2 not done at either 2 or 3 Conversion at:
(a) months 2 months 3 months e x100
(b) (c) (d) a

117 4 102 11 96.6%

Total converted at 2 and 3 months (e):
113
 TB Treatment outcome Q1-Q3 2019
Block 1: TB treatment outcomes
Treatment outcomes
Total number
Total number of
Treatment Treatment Lost to Not evaluated for
patients Cured Died
Type of case completed failed 2
follow-up evaluated outcomes:
registered during
quarter * (1) (3)
(2) (4) (5) (6) (sum of 1 to 5)

New bacteriologically confirmed TB cases 636 633 0  2 1  0  0 636

New cases of TB clinically diagnosed (smear-negative, smear not
done and extrapulmonary TB)  193  0  183  8  0  0  1 193
Relapse  17  15  0  2  1  0  0 17
Treatment after failure  0  0  0  0  0  0  0 0
Treatment after lost to follow-up  0  0  0  0  0  0  0 0
Other previously treated 3  0  0  0  0  0  0  0 0

Block 2: TB/HIV activities (same quarter analysed as Block 1)  

No. patients tested for HIV 4 No. patients HIV-positive(a) 4 No. patients on ARV treatment 5 No. patients on CPT 6

All TB cases 846  44  44 44

TB Treatment outcome
Block 3: TB treatment outcomes of HIV-positive patients
Treatment outcomes

Total number
Total number of
HIV-positive TB Treatment Treatment Lost to Not evaluated for
Type of case Cured Died outcomes:
patients Block 2, completed failed 2 follow-up evaluated
Column (a) (1) (3) (sum of 1 to 5)
(2) (4) (5) (6)

All TB cases 44  28 12  4  0 0  0  44

Block 4: Treatment outcomes for TB cases in children (0-14 years)

Treatment outcomes

Total number
Total number of HIV- evaluated for
Type of case positive TB patients Treatment Treatment Lost to Not outcomes:
Cured Died
Block 2, Column (a) completed failed 2 follow-up evaluated
(1) (3) (sum of 1 to 5)
(2) (4) (5) (6)

All TB cases 68 24   44  0 0   0 0  68

 TB Laboratories Activities

• Light Microscopy LED Microscopy GeneXpert testing

• Slides Done=168 • Slides Done=1395 Tests Done=142

• Pos=40 • Pos=291
• Neg=126 • Neg=109
• Scanty=2 • Scanty=10
• Invalid=0 • Invalid=0
 HIV achievements in the state
S/N Planned Achievements
1 Site ECHO Installation • ECHO functioning in Wau.

2 Site POCT VL/EID Installation in the state • Viral Testing is functioning.

3 Retention in Care and Treatment • Retention improved through CV and experts Clients.

4 Site Weekly/monthly/quarterly/ performance meeting • Regularly monthly meeting accelerated.

5 Improvement in coordination • Smooth TB/HIV Coordination at the site level

6 IIT Client tracing • About 273 retuned to care

7 MDR Cases to be tracked from the community • MDR 15 patients on treatment

 Implementation challenges and proposed
solutions to resolve
S/N Implementation Challenges proposed solutions

1 Poor coordination among implementing parterres and SMOH Improvement in coordination of implementation of all
on implementation the HIV/TB activities in the state between the SMOH
and the IPs
2 Inadequate staff training and mentorship especially in the rural The government in support of the IPs should scale up
areas staff capacity building( refresher raining and
mentorship) of all staff.
3 Poor motivation of staff, particularly government staff due to IPs are urged to continue providing and improve
current economic challenges in the country incentives of government staff

4 Irregular drugs , test kits and other supplies transportation to Improvement in coordination among the IPs and
the State MOH for timely delivery of HIV/TB supplies to the
State
5 Poor clients retention of clients in treatment due to stigma The government in support of its partners should
intensify massive communities awareness on HIV and
TB through the media, community leaders and
religious leaders.
 What available opportunities Exist in your state to strengthen HIV epidemic response?

1. Commitment of Government staff in services although low salary or incentive.

2. Availability of community volunteers who are working in the community;
home visit, community refill and clients tracking
3. Human Resources at the health facility.
4. Presences of Implementing partners.
5. presences of Association of PLHIV in the state.
6. Radio Talk show which is helping in TB/HIV Awareness.
 What are the threats to implementation

1-In security.
2-Road inaccessibility During raining season.
3- Long distance to health facility.
 Best Practices and Lessons Learned

1. Involvement of PLHIV associations with their Peer community counselors greeted a good impact
on reduction off stigma.
2. Dissemination of HIV preventives information messages by the officers during occasion events.
3. Involvement of chiefs in HIV awareness creation in the community
4. Linkage of clients to expert clients and counselors deduced defaulters and lost to follow up.
5. Availability of air time for the counselors which helps in tracking of clients who are lost to follow
up through phone calls.
 Conclusion and Way forward

• Improvement in coordination of implementation of all the HIV/TB activities in the state between
the SMOH and the IPs.
• The government in support of the IPs should scale up staff capacity building( refresher raining and
mentorship) of all staff.
• IPs are urged to continue providing and improve incentives for government staff.
• Improvement in coordination and timely delivery of HIV/TB supplies to the State.
• The government in support of its partners to intensify massive communities awareness on HIV and
TB through the media, community leaders and religious leaders.
Collective Responses
THANK YOU