Meeting Targets and Maintaining Epidemic Control (EpiC) Project O CTO B ER | 2 0 20

Meeting Targets and Maintaining Epidemic Control

(EpiC): Factsheet

EPIC’S CORE PARTNERS

AND THEIR EXPERTISE

FHI 360: Prevention, care,

and treatment; key
populations; local CSO
capacity strengthening and
transition awards; and
strategic information

Right to Care: Regional

organization based in South
Africa with expertise in Meeting Targets and Maintaining Epidemic Control (EpiC), a
prevention, care, and five-year global project (2019–2024) funded by the U.S.
treatment; scale-up of viral
President’s Emergency Plan for AIDS Relief (PEPFAR) and the
load testing; and lab
optimization U.S. Agency for International Development (USAID), is
dedicated to achieving and maintaining HIV epidemic control.
Palladium: Systems
strengthening, including Currently working in 35 countries in programmatic and technical
policy, sustainable financing,
areas across the cascade, the project provides USAID Missions
governance, and human
resources for health (HRH) with a proven platform and deep technical bench to bring
innovations to country programs and overcome performance
PSI: HIV self-testing, challenges. EpiC is able to work through both strategic technical
voluntary medical male
assistance (TA) and direct service delivery (DSD) to break
circumcision (VMMC),
condom programming, social through barriers to 95-95-95 and promote self-reliant
and behavior change management of national HIV programs by improving HIV case
communication (SBCC), and finding, prevention and treatment programming, and viral load
private sector engagement
suppression. A full menu of EpiC’s technical strategies for
Gobee Group: Human- epidemic control is available here. EpiC also provides TA to help
centered design countries prevent, prepare for, respond to, and bolster health
systems to address COVID-19. (See here for more information
about EpiC’s COVID-19 portfolio.)

EpiC is currently implementing HIV programming in the following countries: Cambodia, India, Indonesia, Central Asia
(Kyrgyzstan, Kazakhstan, Tajikistan), Laos, Myanmar, Nepal, Philippines, Thailand, Vietnam, Botswana, Burkina Faso, Burundi,
Cote d’Ivoire, DRC, Djibouti, Eswatini, Ghana, Kenya, Lesotho, Liberia, Malawi, Mali, Mozambique, Namibia, Nigeria, Senegal,
South Africa, Tanzania, Togo Zimbabwe, Jamaica, Haiti.

This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the U.S. President’s
Emergency Plan for AIDS Relief (PEPFAR). The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID, PEPFAR, or the United States Government.
Meeting Targets and Maintaining Epidemic Control (EpiC) Project

EpiC is led by FHI 360 with core partners Right to Care,

Palladium, Population Services International (PSI), and EPIC’S FOUR MAIN
Gobee Group. The project also draws upon regional OBJECTIVES
resource partners (Africa Capacity Alliance, Enda Santé, 1. Attain and maintain HIV epidemic
Thai Red Cross AIDS Research Center, University of the control among at-risk adult men,
West Indies, VHS-YRG Care) to provide TA, as well as women, and priority populations
global resource partners who bring unique capacities 2. Attain and maintain HIV epidemic
control among key populations
(Aurum Institute; Dimagi; JSI Research and Training
(KPs)
Institute, Inc; Johns Hopkins University Key Populations
3. Improve program management,
Program; MTV; World Vision International). health information systems, HRH,
and financial systems to attain
As one of USAID’s Office of HIV/AIDS’s central PEPFAR and maintain epidemic control
awards, EpiC is designed to accept funding from USAID 4. Support the transition of direct
missions interested in expanding or initiating programs that funding and implementation to
address their epidemic control needs. The EpiC capable local partners in order to
meet PEPFAR’s goal of providing
consortium works in partnership with and strengthens the
70 percent of its funding to local
capacity of governments, CSOs, other PEPFAR
partners by 2020
implementing partners, and the private sector to introduce
innovations. The EpiC team’s approach to TA is guided by
four mutually reinforcing principles: (1) a focus on speed, scale, standards, and sustainability;
(2) customization according to local priorities, financing, epidemiology, and the differentiated
needs of target populations; (3) adaptive management based on results; and (4) transition of TA
and DSD to local and regional partners to enable them to receive direct awards. In addition,
EpiC applies human-centered design thinking to resolve persistent challenges along the HIV
service cascade.

Approaches and Activities by Objective

ATTAIN AND MAINTAIN HIV EPIDEMIC CONTROL AMONG AT-RISK ADULT MEN, WOMEN,
AND PRIORITY POPULATIONS
EpiC provides TA and DSD to surge, scale, and sustain client-centered DSD models along the
entire cascade from prevention through maintained viral suppression to meet the needs of men,
women, and children living with HIV or at high HIV risk. Priorities include (1) rolling out HIV self-
testing and pre-exposure prophylaxis (PrEP) in a way that decentralizes access, promotes self-
care, and focuses demand efforts without creating additional stigma; (2) supporting the
sustainable transition of VMMC services to government and private sector providers; (3)
deploying a total market approach to condom programming and antiretroviral therapy (ART)
services; (4) scaling up index and network testing approaches to close gaps in case-detection;
(5) scaling up treatment literacy for all, including the transformative message that undetectable
= untransmittable (U=U); (6) improving access to same-day initiation of ART and treatment
adherence; (7) promoting transition to preferred first-line ART regimens and improving
management of those with suspected treatment failure; (8) expanding access to differentiated
ART service delivery, including by decentralizing drug distribution through the private sector and

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Meeting Targets and Maintaining Epidemic Control (EpiC) Project

community- and home-based delivery channels and

implementing multimonth dispensing; (9) increasing
EPIC’S RESOURCE PARTNERS AND
THEIR EXPERTISE
demand for and provision and tracking of viral load
testing; and (10) leveraging online platforms to
Regional resource partners provide safe, convenient, client-centered HIV
services, including outreach, linkage to testing, and
• Africa Capacity Alliance: Human and
case management. EpiC also provides tailored
institutional capacity development in East
and Southern Africa solutions for improving pediatric and adolescent
care and treatment outcomes. Across all of these
• Enda Santé: Key population areas, we use financing, costing, and epidemic
programming and CSO capacity modeling tools to improve efficiency and
development in Francophone African
effectiveness of service delivery.
countries

• Thai Red Cross AIDS Research Center: ATTAIN AND MAINTAIN HIV EPIDEMIC CONTROL
Clinical services, implementation AMONG KEY POPULATIONS
research, transgender health EpiC builds on LINKAGES’ successful KP
programming in Asia
programming and invests in new strategies to
• University of the West Indies: CSO address the complex and dynamic challenges that
capacity development and sustainable have kept epidemic control out of reach among men
financing in the Caribbean who have sex with men, sex workers, transgender
• VHS-YRG Care: HIV programming and
people, people who use drugs, people in prisons
CSO capacity development in India and and other closed settings, and their partners. In
Africa addition to improving KPs’ access to new
technologies such as HIV self-testing and PrEP and
Global resource partners
scaling up proven case detection strategies such as
• Aurum Institute: TB/HIV integration and index and network testing, EpiC promotes a wide
viral load testing and suppression range of KP-competent health services. These
include drop-in centers that improve links to and
• Dimagi: Mobile data collection platforms
retention on ART, and approaches for reaching KP
• JSI Research and Training Institute, members in virtual spaces and linking them to offline
Inc: Supply chain management and HRH services. EpiC also empowers and supports KPs
and providers to address violence, stigma, and
• Johns Hopkins University Key
Populations Program: Analyses of
discrimination from police and in health settings.
routinely collected data to answer critical Finally, EpiC assists local KP-led organizations in
research questions expanding their roles as advocates and service
providers across the cascade, as well as in
• MTV: Demand creation and behavior
change communication through
implementing community-led monitoring of HIV
global media services.

• World Vision International: Community IMPROVE PROGRAM MANAGEMENT, HEALTH

mobilization and service provision through INFORMATION SYSTEMS, HRH, AND HIV
collaborations with faith-based FINANCING SOLUTIONS TO ATTAIN AND
organizations
MAINTAIN EPIDEMIC CONTROL
EpiC develops the capacity of national HIV
programs to increase their use of domestic,

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Meeting Targets and Maintaining Epidemic Control (EpiC) Project

sustainable funding sources and capitalize on local technical and management expertise to
achieve and sustain epidemic control. Toward this objective, EpiC is working with in-country
stakeholders to develop a process for government-led transition and a sustainability roadmap
that highlights clear interventions to improve programmatic and financial sustainability;
strengthening unified leadership and management at all levels to control local epidemics;
integrating and leveraging CSO and private sector capabilities as part of the national HIV
program; integrating HIV services into national and local government budgets and purchasing
HIV services through sustainable mechanisms such as health insurance and social contracting;
and institutionalizing HRH, health information systems, and supply chain innovations needed for
maintaining epidemic control.

SUPPORT THE TRANSITION OF DIRECT FUNDING AND IMPLEMENTATION TO CAPABLE

LOCAL PARTNERS IN ORDER TO MEET PEPFAR’S GOAL OF PROVIDING 70 PERCENT OF
ITS FUNDING TO LOCAL PARTNERS BY 2020
In collaboration with USAID missions, EpiC identifies local partners that demonstrate a
readiness to accept direct funding currently or with additional support. Transition partners
receive customized TA to help them meet organizational and technical performance goals
necessary to implement technically sound programming while managing U.S. government
funding. EpiC assigns a capacity-building coach to each transition award partner to provide
intensive, ongoing mentoring and to instill a culture of data use and adaptive management. Over
time, EpiC will develop a local marketplace for TA provision and rely increasingly on regional TA
providers for capacity development. Through the Key Populations Investment Fund (KPIF),
EpiC is strengthening the organizational and technical capacity of local key-population-led
organizations in 18 countries, effectively positioning them to lead the HIV response there.

EpiC is one of two new global HIV awards

issued by USAID in response to the NOFO
initially announced as TMEC (Meeting Targets
and Maintaining Epidemic Control). The other
award, called RISE, is led by Jhpiego with ICAP
at Columbia University (ICAP), Management
Sciences for Health (MSH), ANOVA Health
Institute (ANOVA), BAO Systems, JHU Center
for Public Health and Human Rights (JHU), and
Mann Global Health (MGH). EpiC and RISE
have the same mandate and geographic focus,
and they are both 5-year global cooperative
agreements. A mission can choose to buy in to
one or both awards.

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Meeting Targets and Maintaining Epidemic Control (EpiC) Project

In FY20, EpiC advanced implementation of several priority technical approaches

that are key to accelerating progress toward epidemic control. Many of these
strategies helped insulate HIV programs from disruptions caused by the COVID-
19 pandemic while optimizing performance across the HIV cascade. EpiC is
available to help Missions reinforce and further scale these approaches in FY21.

HOT APPROACHES AT A GLANCE

Going Online
To promote more inclusive, convenient, and client-centered HIV services, FHI 360
has been providing HIV services virtually since 2017 as part of its Going Online
portfolio. EpiC provides TA to countries to implement differentiated online outreach
approaches, including social network outreach (online outreach workers), social influencer outreach,
and social profile outreach (online targeted advertising); introduce and use the Online Reservation
and Case Management App (ORA); transition case management services to virtual channels; and
implement LINK, a routine electronic client feedback system for HIV services. With 35 countries now
implementing Going Online approaches, EpiC has successfully leveraged this infrastructure to
maintain access to HIV services during restrictions on movement and clinic attendance posed by the
COVID-19 pandemic. As summarized here, these approaches have led to increases in HIV case
finding and contributed to treatment retention and PrEP continuation during the pandemic. They will
continue to be important features of HIV service delivery programs going forward.

Decentralized Drug Distribution

Decentralized distribution of ART, PrEP, and other commodities in the community,
including through the private sector, can make services more convenient for patients
while reducing the burden on health systems and producing cost savings for donors,
national governments, and clients. In 2019, EpiC published the technical resource, Decentralized
Distribution of Antiretroviral Therapy through the Private Sector: A Strategic Guide for Scale-up.
Since then, EpiC has provided TA to partners in 10 countries in sub-Saharan Africa to introduce or
scale up three models for providing ART through the private sector: community pharmacy,
automated dispensing, and private hospital models. Prompted by COVID-19, EpiC is also
supporting scale-up of non-facility individual and small group ART access models—such as
community access refill groups, home delivery of ART, and delivery through post—and using GIS
and client interview data to identify underserved areas for placement of additional community ART
pick-up points. These approaches to differentiated service delivery have been critical to maintaining
access to ART and decongesting facilities during COVID-19.

HIV Self-Testing
EpiC is providing TA for the introduction and scale up of HIV self-testing in 16
countries. EpiC offers assisted and unassisted self-testing options and matches
distribution channels (via peers, social networks, online platforms, pharmacies,
index testing, facilities/health workers) with target populations. Likewise, EpiC offers options for
follow-up and tracking that include follow-up by peers and health care workers. The project uses
SMS and online reporting mechanisms with linkage to confirmatory testing and ART initiation for

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those with reactive self-tests and referral for appropriate HIV prevention services, including PrEP, for
those who test negative. In Thailand, case finding from self-testing was 17% among first-time testers
and 11% among re-testers among all populations in Q3 FY20 compared to case finding of just 2%
and 4% from community outreach and facilities, respectively. In DRC, case finding with self-testing
was 23% among all populations in Q3 FY20 compared to 7% and 10% from community outreach
and the enhanced peer outreach approach (EPOA), respectively.

Community-Led Monitoring
Community-led monitoring (CLM) platforms are critical aspects of HIV and KP
programs. CLM is a technique by which CSOs and other community groups gather
quantitative and qualitative data about HIV services that can be used to improve the
quality and accessibility of those services. EpiC supported the rollout of CLM in eight countries in
FY20, helping partners establish systems for obtaining client feedback from multiple sources. These
include the electronic client feedback mechanism LINK; Community Score Cards; and direct
reporting of any adverse events to service providers, peers, or others.

Total Quality Leadership and Accountability

EpiC deploys a TQLA approach to close gaps toward achievement of targets across the
HIV cascade. The TQLA approach—also called “surge TA” —has three core elements:
adaptive leadership, situation room meetings, and performance improvement
monitoring. Together, they strengthen the capacity of program managers and health care workers to
use data for planning, adopting local solutions to program weaknesses, and requiring accountability.
TQLA supports leaders to target resources to sites with greatest needs and enables attainment of
results within reasonable timeframes. FHI 360 has used the TQLA approach to improve the
performance of several HIV programs, including in Nigeria, Zambia, Burundi, Kenya, and Ethiopia.
In Nigeria, the approach was recently deployed in six USAID-supported projects across 10 states,
enabling the programs to surpass targets for client retention on ART and viral suppression.

DHIS2 Standard Tracker Metadata Package

KP clients served by HIV programs need continuous engagement throughout HIV
prevention, care, and treatment services. As such, it is important to track individuals
longitudinally across the continuum of care throughout the duration of program
implementation in order to better understand the needs of clients, tailor effective packages of
services, and optimize program outcomes. Based on EpiC’s experience independently developing
DHIS2 trackers for KP programs in eight countries, we discovered that the majority of the data
elements were similar, yet the structure of data systems across countries differed, which created
challenges when analyzing results or mapping data to external databases. In response, EpiC
developed and advocates for use of a standard tracker for KP programs, including metadata that
define a minimum set of indicators for reporting, performance assessment, client management, and
quality improvement. EpiC provides TA to help countries customize and configure the tracker to local
country contexts while ensuring a certain level of uniformity and data quality assurance across
programs. The metadata package can be easily downloaded and rapidly deployed, saving programs
time, money, and effort.

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Meeting Targets and Maintaining Epidemic Control (EpiC) Project

Illustrative EpiC Technical Assistance Menu

TECHNICAL AREA ILLUSTRATIVE ASSISTANCE OPTIONS

PREVENTION

Pre-exposure prophylaxis EpiC is rolling out PrEP in 11 countries. Activities include PrEP
PrEP scale-up is critical to interrupt transmission in networks provider training, values clarification, and mentoring; PrEP demand
with individuals who are not yet virally suppressed. generation, policy development, and market-based supply solutions
based on local context; and monitoring support and standardization.
Voluntary medical male circumcision EpiC tailors demand creation and differentiated service delivery
VMMC is a highly effective and cost-efficient HIV prevention support; provide logistical support, training, and staff mentoring; and
intervention, recommended in countries with high HIV assist countries in strengthening national guidelines to improve
prevalence and low levels of male circumcision. prevention of adverse events, follow-up of clients, and integration of
other services. In Zimbabwe, EpiC is implementing a demonstration of
results-based incentives for VMMC services and will support the
transition of VMMC services to the national government by 2022.
Condom supply and demand The project builds local capacity to remove barriers to commercial
In spite of substantial past donor investments, condoms entry; push social marketing toward sustainability; hone local partners’
remain underused, and many markets fall short of meeting promotion skills; support development of “total market” plans.
the needs of priority and key populations.
Tuberculosis preventive therapy EpiC is providing TA to scale up TB preventive therapy, including
TB is the leading cause of death for people living with HIV building the capacity of ART providers to integrate TB preventive
(PLHIV). TB preventive therapy is an essential and cost- therapy and planning for drug procurement and supply chain
effective component of HIV care for PLHIV but remains management.
widely underused.

CASE FINDING

HIV index testing In all 35 countries where EpiC is working, the project provides training,
The impact and efficiency of HIV testing services can be tools, and mentoring to implement index testing safely and ethically in
accelerated by targeting testing in networks of people living community and clinical settings to optimize case finding.
with HIV who are not yet virally suppressed.
Enhanced peer outreach approach (EPOA) EpiC includes EPOA as a core component of KP-focused
The impact and efficiency of HIV testing services can be programming, providing TA to local partners to implement the peer-
accelerated by focusing testing in the hard-to-reach networks led, coupon-based referral network approach to reach and test
of KPs. networks of KPs in ways that ensure their privacy.

HIV self-testing EpiC provides TA to programs in 16 countries to integrate assisted or

HIV self-testing expands access to HIV testing services, unassisted HIV self-testing, including determining self-test kit delivery
particularly for those at high risk who may not otherwise options; designing HIV self-testing advertising strategies; training peer
get tested. outreach workers and others to provide support to self-testers; and
establishing mechanisms for linking those.

CARE AND TREATMENT

ART optimization EpiC is supporting all countries in their efforts to develop a

Dolutegravir is a key component of the preferred first-line dolutegravir transition strategy and budget, update national guidelines,
ART regimen in the 2018 WHO Interim Guidelines because forecast commodities, and develop tools. In the 11 countries where
of its superior efficacy, improved tolerability, and higher EpiC has treatment targets, the project also provides training and TA
threshold for resistance as compared to efavirenz-containing on facility-level implementation and monitoring.
regimens.
Decentralized drug distribution In 10 countries, EpiC is providing TA to introduce or scale up a range
Decentralized distribution of ART in the community, including of models for providing ART through the private sector, including
through the private sector, can make services more community pharmacy, automated dispensing, and private hospital
convenient for patients while reducing the burden on health models. EpiC is also supporting scale-up of non-facility-based
systems and producing cost savings. individual and small group ART distribution models (e.g., home
delivery) and using GIS data to identify underserved areas to inform
placement of additional community ART pick-up points.

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Meeting Targets and Maintaining Epidemic Control (EpiC) Project

Illustrative EpiC Technical Assistance Menu

TECHNICAL AREA ILLUSTRATIVE ASSISTANCE OPTIONS

Same-day antiretroviral treatment (SDART) In all countries where EpiC works, the project supports the
SDART reduces the time to treatment initiation and viral collaborative development and implementation of protocols and
suppression, thereby maximizing the health and prevention training for localized SDART models, drawing upon global standards
benefits of treatment. and best practices. In the 11 countries where EpiC has treatment
targets, the project provides TA to local partners on direct
implementation of SDART.
Viral load testing and suppression EpiC builds capacity of staff to promote and expand access to viral
Access to patients’ viral load is essential to optimize care and load testing; support the optimization of laboratory networks; and
maximize the prevention benefits of treatment. create demand for viral load testing. In South Africa, for example,
EpiC achieved and maintained viral load coverage and suppression
rates above 90% in FY20.

CROSS-CUTTING

Differentiated service delivery The project identifies, analyzes, costs, and supports opportunities to
Differentiation is critical to increase options for patients, advance differentiated services, including differentiated prevention,
simplify their care, and free up resources to address multimonth scripting and dispensing for children and adults, and
individuals with greater needs. community and pharmacy dispensing. EpiC rapidly expanded
coverage of multimonth dispensing in 11 countries and scaled up
home- and community-based delivery of ART in five countries in
response to COVID-19, maintaining uninterrupted access to treatment
services despite restrictions posed by the pandemic.
Use of GIS and spatial modeling for effective EpiC combines GIS mapping, program data, and open-source
differentiation and decentralization secondary data (i.e., roads, terrain, population estimates) through
The latest GIS technology allows stakeholders to answer spatial models to determine the best sites to decentralize services
detailed questions about how and where HIV services should based on location, reduced travel time, and available services. EpiC
be differentiated and decentralized. also uses GIS mapping to give community teams guidance on what
areas of the community to prioritize for testing and case finding based
on clustering of HIV positive cases. EpiC is currently deploying this
technology in seven countries.
Going Online EpiC’s Going Online portfolio extends to 35 countries and includes
Online platforms can accelerate progress toward epidemic technical support to implement differentiated online outreach
control by engaging previously unreached individuals approaches strategically and safely, connect people engaged online
according to their preferences, and by leveraging technology- to physical services, provide virtual case management for clients on
related efficiencies. PrEP and ART, and securely assess results.

Key population-specific program approaches In more than 30 countries, EpiC provides TA on the design and
Addressing the differentiated preferences and needs of those implementation of state-of-the-art KP program approaches, as well as
most at risk and most underserved, including young and monitoring and evaluation systems using custom indicators to help
hidden KPs, transgender women and older men who have generate and use data to target KP members most in need of
sex with men, is critical to achieving epidemic control. services.

“Smart” care and prevention cascades EpiC analyzes cascade data by population group and provides cost‒
Increasing achievement along the prevention, care, and benefit analysis of different interventions that can improve cascade
treatment cascade requires weighing the value of outcomes, especially considering uncertain factors such as potential
improvements (in terms of reducing leaks in the cascade and improvements to testing yield, reduced loss to follow-up, reduced loss
improving adherence/follow-up) against the increased cost of during links, etc.
these additional interventions.
Sustainable financing The project is supporting countries to generate evidence for budget
Sustained epidemic control for a national HIV program advocacy and resource allocation decisions; conduct analyses to
requires mobilizing additional domestic resources for HIV identify cost-efficient solutions; work with CSOs to conduct advocacy,
programming, improving efficiency of the HIV response, hold government accountable, and access government funding
integrating HIV into broader health financing mechanisms through social contracting; and support development of HIV financing
and health sector reforms, and leveraging the private sector. strategies and policies (e.g., user fee removal). For example, in the
three Central Asian Republics of Kazakhstan, Tajikistan and the
Kyrgyz Republic, EpiC is currently providing national-level technical
assistance to government partners on social procurement and
contracting and sustainable HIV financing.

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Meeting Targets and Maintaining Epidemic Control (EpiC) Project

Illustrative EpiC Technical Assistance Menu

TECHNICAL AREA ILLUSTRATIVE ASSISTANCE OPTIONS

Motivational counseling EpiC is training frontline providers in advanced interpersonal
A common concern of programs designed to reach, recruit, communication skills to improve the quality and effectiveness of client
and retain clients in the HIV services continuum is their ability counseling sessions related to HIV testing, PrEP, index testing,
to help clients to overcome individual barriers to change. treatment adherence, and viral load testing. The project’s motivational
counseling training package has been rolled out in 15 countries.
Stigma and discrimination EpiC conducts trainings to improve service providers’ capacity to
Stigma and discrimination are among the greatest barriers to assess, prevent, and mitigate stigma and discrimination and their
health-seeking behavior for priority and key populations. effects on use of HIV services. EpiC uses the Health4All training
curriculum, which was developed under LINKAGES and has been
implemented in at least 15 countries.
Violence prevention and response EpiC builds capacity of providers and outreach workers to assess
Integrating HIV and violence prevention and response clients’ risk of violence, including gender-based violence, and respond
services is key to improving service access, as well as to appropriately; develop referral networks, including law enforcement;
protecting health and human rights. provide monitoring support; and ensure programs meet PEPFAR
requirements for detecting and responding to intimate partner violence
and other adverse events in index testing and PrEP services. EpiC’s
violence prevention and response activities currently span 15
countries.
Undetectable = Untransmittable The project is integrating correct information on viral suppression and
Promotion of U=U messaging can provide a pivotal platform onward transmission into communication (tools and training) at
to overcome barriers to HIV testing, adherence, viral load testing, treatment initiation, and through peer navigation support. We
testing, and participation in index testing, while mitigating are also promoting U=U at both the individual and community levels to
stigma and discrimination. accelerate service demand.

Safety and security of implementers In 10 countries, EpiC is operationalizing a safety and security toolkit
Threats to the safety of HIV program implementers—often developed by and used throughout the LINKAGES project; training
HIV program implementers to assess their security risks, identifying
due to stigma, discrimination, and violence against PLHIV
priority security gaps, and implementing security plans. For example,
and KP members—negatively affect all aspects of the HIV EpiC staff are currently providing TA to CSOs implementing HIV
program cycle and limit opportunities for epidemic control. programs in the MENA region to improve their security.

Human-centered design thinking The project applies human-centered design approaches to accelerate
Persistent gaps in access reflect limited capacity to address the development and implementation of service and systems solutions
the differentiated preferences and needs of priority and key to core challenges. For example, in Kyrgyzstan and Tajikistan, EpiC is
populations. Human-centered design thinking can accelerate using human-centered design to inform the design of models for
solutions to close these gaps. community-based delivery of ART and PrEP.

Community-led monitoring EpiC establishes systems for obtaining client feedback from multiple
Systematically gathering input on the quality of HIV services sources, including through the electronic client feedback mechanism
from recipients of those services can lead to changes that LINK, Community Score Cards, and direct reporting of any adverse
improve the client experience and client outcomes. events to service providers, peers, or others. EpiC is currently rolling
out these systems in eight countries.
Total Quality Leadership and Accountability The TQLA approach has been effectively implemented by
(TQLA) FHI 360 in Nigeria, Zambia, Burundi, Kenya, Ethiopia, and elsewhere.
TQLA is an innovative management approach that This adaptive management approach involves strategic site mapping
accelerates performance across the entire prevention, care, and prioritization; differentiated management and resource
and treatment cascade by ensuring appropriate leadership deployment; daily site-level target setting, data collection, and
and accountability for implementation fidelity. TQLA helps reporting on key indicators; daily situation room meetings, granular
leaders target resources to places of greatest need and level data review, and evidence-informed decision-making; targeted
enables attainment of results within a reasonable time frame. and data driven dosing of TA; and client behavior monitoring and
client experience management for improved retention in care.

USAID Missions should contact Kris Mills ([email protected]) or Judy Chen ([email protected]) for more information.
For all other enquiries, please contact Hally Mahler, EpiC Project Director: [email protected].
For more information on EpiC’s technical strategies for epidemic control, click here.