Background: With an HIV prevalence of 2% and ART treatment coverage of 26%, Angola''s health system aims to improve efficiency and effectiveness of HIV service delivery towards epidemic control. ICAP at Columbia University implemented a novel strategy called I-Surge, a comprehensive multi-pronged approach to optimize health and human resources in clinics and communities.
Methods: I-surge implementation at two ICAP-supported sites in Angola started in April 2018 based on a “pull-push-hold on” approach to enhance services across the HIV care cascade at health facilities (pull); redesign testing and treatment interventions in communities (push); and target interventions to boost retention (hold on). Efforts included daily monitoring of key data elements; expanded index case testing; deployment of patient navigators to counsel and escort patients between services; revised patient, lab, and pharmacy flows; expanded same-day ART initiation; and active phone follow-up. To assess change, we compared routinely collected aggregate data from Q2: Jan-Mar vs. Q3: Apr-Jun 2018.
Results: Following implementation of the I-Surge strategy the number of people tested for HIV increased 42% from 8,465 in Q2 to 12,045 in Q3, including a 68% increase in the number of children < 15 tested, (463 to 780). There was a 125% increase in linkage to treatment among patients newly identified as HIV positive, from 32% in Q2 to 72% in Q3, and a 62% increase in the total number initiating ART, (402 to 651). The number of viral load tests increased by 85%, from 645 viral load tests to 1,192 conducted in Q3.
Conclusions: The first results of ICAP''s I-Surge strategy in Angola are encouraging. Through immediate identification of missed opportunities to test, treat and retain, I-Surge allows for immediate recognition of gaps in service delivery to achieve 95-95-95 goals. I-Surge contributes by identifying efficiencies across the major components of the health systems in order to provide more effective HIV services including access, coverage and quality of service delivery. ICAP continues to work with the Angolan government to bring I-Surge to scale.

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