1. Enhancing access to community clinical services July 2014

2. LINKAGES - Overarching goal Accelerate the ability of governments, KP organizations and private sector providers to collaboratively plan, deliver and optimize services that reduce HIV transmission among KP and extend life for those who are HIV-positive. Implemented by core partners: FHI 360, IntraHealth, PACT and University of North Carolina (UNC)

3. Key focal areas Increased availability of comprehensive prevention, care and treatment services, increasing coverage across the Continuum of Care for key populations Demand for comprehensive prevention, care and treatment services among key populations enhanced and sustained Strengthened systems for planning, monitoring, evaluating and assuring the quality of programs for key populations

4. Strategic approach

5. Ultimately increasing… Access to better quality, more integrated HIV services closer to home in welcoming settings that protect their privacy Support from trained peers who can help them access HTC and other HIV services, as well as legal aid, psychosocial and nutrition support, and economic opportunities KP-friendly HCWs who understand and address their multi-faceted needs in a non-stigmatizing way Safer communities, with less gender-based and other violence and stronger crisis response systems Meaningful opportunities to have their voices heard in how services are delivered, improved and evaluated Relevant communication that empowers them to be savvy health care consumers and make decisions that lead to better health Protective environments and mitigating impact of discriminatory laws

6. The Cascade Framework

7. The Cascade framework is… Old, but new…building on the continuum of care Improvement on older methods for presenting data & illustrating program performance Simple, easy to communicate with powerful impact Easily adaptable to different programs, strategies and populations Promotes different interventions targeted to different phases of - or gaps in - the cascade Based on a set of available core indicators

8. The Cascade Framework: Patching a Leaky Pipe

9. The cascade

10. HIV cascade - Mozambique Step 2: Drop-off 44% 3,049 lost Step 4: Drop-off 69% 1,035 lost Micek et al 2008

11. Cascade of HIV diagnosis, care and treatment in Vietnam among key populations, Sep-2013 Source: Report on HIV and Drug for UB50, VAAC – Sep, 2013; D28 – Quarter 3, 2013; EPP, 2012

12. Community clinical services are the glue DICs – safe spaces at center of clinical services for KPs Clinical outreach led by non-stigmatizing health care workers and key populations leads A case management approach – training KP community workers to reach and support peers over time to keep them linked to clinical services, sustain retention and bolster ART adherence

13. Improved retention in care Etienne et al 2007

14. Thank you!