National strategic plan on hiv/aids 2016-2020

Objectives

The 2016–2020 National Strategic Plan seeks a Sierra Leone in which HIV is no longer a public-health threat, contributing to the longer-term objective of ending AIDS as a public-health threat by 2030. Its overarching goal is zero new HIV infections, zero AIDS-related deaths and zero discrimination.[1][2][3]The plan applies a rapid-response, equity-oriented and evidence-informed framework that prioritises people and places with the greatest HIV burden and aims to ensure that no one is left behind.[4][3]

• Achieve the 2020 impact targets of reducing adult and adolescent HIV incidence from 0.04% to 0.02%, reducing infant HIV infections among children born to mothers living with HIV from 13% to below 5%, reducing HIV-related mortality among adults and children, and raising domestic HIV financing to 30%.[2]
• Implement the core continuum-of-care strategy of testing all, treating all and retaining all, supported by combination prevention, treatment as prevention, targeted counselling and information, education and communication.[1]
• Prioritise prevention among adolescents, young people, women and girls, and key affected populations, including sex workers, men who have sex with men, transgender people, people who inject drugs, prisoners, migrant workers and uniformed personnel.[5][6][7]
• Eliminate mother-to-child transmission by supporting planned pregnancies, HIV screening and immediate treatment for pregnant women living with HIV, maternal viral suppression, infant prophylaxis, early infant diagnosis and family-centred care.[8][9][10]
• Provide comprehensive treatment, care and support, including clinical, psychosocial and socioeconomic assessment, antiretroviral therapy, viral-load monitoring, tuberculosis care, nutritional support and social protection for people living with HIV and affected children and caregivers.[11][12][13]
• Address structural barriers through human-rights-based, gender-responsive and participatory action on stigma, discrimination, gender-based, sexual and intimate-partner violence, legal and policy protections, and meaningful involvement of people living with HIV.[3][14][15]
• Strengthen health and community systems, commodity security, access to affordable medicines, and integration of HIV with tuberculosis, sexual and reproductive health, maternal and child health, social protection and chronic-care services.[16][13]

Implementation

Implementation is designed as a government-led, multisectoral and decentralised response, coordinated nationally while linking district, local-council, community and facility-level delivery.[17][18][19]The National HIV/AIDS Secretariat is expected to coordinate partners, strategic direction, resource mobilisation and implementation, while the National AIDS Control Programme within the Ministry of Health and Sanitation supports health programming and service provision.[17][20]The plan is aligned with post-Ebola recovery, the Health Sector Recovery Plan, Sustainable Development Goals, and regional and global HIV initiatives.[2][21]

• Coordinate government ministries, departments and agencies; local councils; civil-society, community-based and faith-based organisations; networks of people living with HIV; private-sector actors; development partners; donors; and United Nations, bilateral and multilateral institutions.[1][22][23]
• Use district-based programming, operational planning, monitoring and adaptive decision-making, supported by decentralised AIDS coordination structures and potential Chiefdom AIDS Committees.[18][24]
• Deliver services through the three-tier primary healthcare system, community systems and a national network of health facilities and community health workers, while using task shifting, community testing, community antiretroviral therapy delivery and technology-supported follow-up to improve access and retention.[4][16][25]
• Target interventions geographically towards high-burden districts and urban centres, and tailor services to the distinct needs of key populations, mobile groups, adolescents, young people and people in humanitarian or emergency settings.[26][16][27]
• Integrate HIV services into routine chronic care, hospitals and primary healthcare facilities, maternal, newborn and child health, sexual and reproductive health, tuberculosis services, laboratory networks, social protection and community or home-based follow-up.[24][16][28]
• Strengthen governance through the National HIV and AIDS Commission and the National AIDS Secretariat, coordinated stakeholder structures, joint planning and action, and the “three ones” principles for shared responsibility, accountability and coordinated resource use.[29][20][1]
• Use a costed strategic plan and monitoring and evaluation plan, with Results Framework targets covering incidence, infant infection, mortality, treatment access, viral suppression, prevention coverage, discrimination, institutional capacity and domestic financing.[1][2][5]
• Support accountability through district-based monitoring and evaluation, community and health-management information systems, the Fast-Track Cities initiative, real-time strategic information, data use for decisions, and participation of people living with HIV and communities in monitoring.[6][16][30]
• Mobilise financing through a minimum annual investment target of 50 million US dollars, domestic funding of at least 12% of annual resource needs, a national HIV budget line, AIDS trust funds, financial-sustainability transition plans and diversified international funding sources.[6][31][32]

Monitoring & Evaluation

The National Strategic Plan links monitoring and evaluation to a results framework with impact, outcome and output targets for HIV incidence, mother-to-child transmission, mortality, treatment, viral suppression, prevention coverage, discrimination, institutional capacity and domestic financing.[2][5][6]Monitoring is intended to generate timely strategic information for planning, resource allocation, implementation, evaluation, accountability and adaptive decision-making at national and sub-national levels.[30][33][34]

• Track 2020 impact targets including adult and adolescent HIV incidence declining from 0.04% to 0.02%, infant HIV infection falling from 13% to below 5%, an 80% reduction in HIV-related mortality, and domestic financing reaching 30% of the response.[2]
• Measure service outcomes including 90% treatment and care access among adults and adolescents who know their status, 90% sustained viral suppression among people on antiretroviral therapy, and 90% access to tailored prevention among key populations.[5][6]
• Monitor prevention of mother-to-child transmission through maternal viral suppression, infant prophylaxis, early infant diagnosis, prevention of unplanned pregnancies and retention of mother-and-baby pairs in care.[8][9][35]
• Use district-based and geographically disaggregated data to target high-burden locations and population groups, drawing on demographic surveys, antenatal-clinic surveillance, key-population studies, Modes of Transmission studies and Spectrum estimates.[21][36][16]
• Strengthen sex-, age-, population- and district-disaggregated epidemiological and programme data, particularly for key populations, adolescents and young people.[26][37]
• Integrate data generation, prompt reporting, analysis and selective dissemination across service providers, local authorities, national policy bodies, development partners and accountability mechanisms.[33][34]
• Align stakeholders’ information systems with the National HIV Monitoring and Evaluation Strategy, harmonise data collection and verification, and build capacity for data analysis, use, joint learning and evidence-based decisions.[30][33]
• Use the Fast-Track Cities initiative as an accountability framework and incorporate HIV reporting into community information systems and health management information systems used by local councils.[2][6][38]
• Track evidence-based decision-making, targeted to reach 70% of HIV-response stakeholders by 2020, and integration of HIV into priority services, staff training and reporting in 10 local councils.[33][38]
• Conduct periodic clinical, psychosocial and socioeconomic assessments, including at least annual reassessment where needed, to establish client baselines and monitor treatment and care progression.[12][13]

The supplied material identifies monitoring gaps in retention after a positive HIV test, timely initiation of antiretroviral therapy, follow-up of HIV-exposed infants and availability of disaggregated data.[18][37]Although it provides extensive targets and strategic-information mechanisms, it does not specify a complete reporting calendar, surveillance protocol, independent evaluation design, data-quality process or detailed allocation of accountability responsibilities.[2][24][30]

Costing & Financing

The financing approach combines greater domestic resource mobilisation, continued international support, investment-oriented prioritisation and efficiency measures.[16][22][23]It seeks predictable and sustainable financing while addressing funding and programme gaps, declining donor support, low absorption of funds and weak allocative efficiency.[26][37][22]

• Target domestic financing to reach 30% of the HIV response by 2020.[2][3]
• Provide a minimum annual investment of 50 million US dollars for the national AIDS response and mobilise domestic funding equivalent to at least 12% of annual resource needs.[6][31]
• Establish financial-sustainability transition plans, a national HIV budget line and AIDS trust funds to support domestic financing.[6][31][32]
• Diversify international resource mobilisation for HIV, Ebola virus disease and tuberculosis to 10 sources by 2020.[6][31]
• Improve value for money through more efficient resource allocation and service delivery, pooled resources, transparent management, tracking of disbursement and utilisation, reduced commodity costs and removal of restrictive intellectual-property and trade barriers.[23][30][34]
• Use government and other domestic financing alongside a broad range of international support, with multi-year operational plans intended to inform costing projections and programming budgets.[28]

Financial sustainability is a material concern: international funding was reported to account for 95% of national HIV-response financing, and the 2011–2015 response reportedly received funding equal to only 30% of projected needs.[26][18]Risks include donor fatigue, economic difficulties, competing priorities, weak political governance, limited allocative efficiency and low fund absorption.[26][37][23]The supplied extracts do not provide a complete costed expenditure framework, activity-level allocations, monetary funding gap, unit costs or economic assumptions.[18][28][30]