South Sudan NFM-3 Global Fund Project Progress Review Meeting 17th to

20th May 2022

warrap State Team members

* Nyang Kiir
*James Ayieny
 Geographic administrative areas ( plus administrative area

• Total population 1.5 million base on census

of 2008
• Warrap State bordering five states and
Sudan at North of the country.
- Unity state at North East
- Northern Bahr el Ghazal at West
- Lake at East South
- Western Bahr el Ghazal West South
- Western Equatoria at the South
Geographic administrative areas

S/No Names Remark

1 Gogrial East

2 Tonj East

3 Gogrial West

4 Tonj North

5 Tonj South

6 Twic
Number of Health facilities (PHCU, PHCC, Hospitals)

S/No County Facility level Remarks

1 Gogrial East 12

2 Tonj East 12

3 Gogrial West 20

4 Tonj North 14

5 Tonj South 12

6 Twic 25
Main implementing partners and areas of support

• AAA
• WPF
• WV
• HPF
• CCM
• Health net OTP
• Cordaid
• NEWPU
• SSNEP
Number of Health facilities (PHCU, PHCC, Hospitals)

• 4 hospitals
• 23 PHCC
• 65 PHCUS
Number of facilities providing ART, HTS, ANC/PMTCT and EID services

• 8 ART sites
- Tonj Civil Hospital
- Marial-Lou Hospital
- Kuajok State Hospital
- Mother Teresa
- Luonyaker PHCC
- Warrap PHCC
- Akon PHCC
- Gogrial PHCC
 Summary of HIV/TB Facilities old and new proposed Sites in WS

Facility County Payam

ART HTS EID/PMTCT
Kuajok Hospital Gogrial W Kuac North
1 1 1 1 1 1 1 1 1 old site
Alek PHCC Gogrial West Alek South
                  New to start
Akon PHCC Gogrial West Akon South
1 1 1 1 1 0 1 1 1 old site
Gogrial PHCC Gogrial West Gogrial
1 1 1 1 1 1 1 1 0 old site
Luanyaker PHCC Gogrial East Pathoun west
0 0 1 1 1 1 0 1 1 old site
Lietnom PHCC Gogrial East Toch East
New to start
Tonj Hospital Tonj South Tonj
1 1 1 1 1 1 1 1 1 old site
Tonj Don Bosco Tonj South Tonj
                  New to start
Mariallou Comboni Tonj North Mariallou
New to start
Mariallou Hospital Tonj North Mariallou
0 0 0 0 0 0 0 0 0 old site
Rumabuth PHCC Tonj North Paliang
                  New to start
Warrap PHCC Tonj North Awul
1 1 1 1 1 1x x x old site
Aliek PHCC Tonj North Aliek
                  New to start
Ngapagok PHCC Tonj East Ananatak
                  New to start
Paweng PHCC Tonj East Paweng
                  New to start
St Mother Theresa Twic Turalei
x x x x x 1 1 0 1 old site
Wunrok PHCC Twic Wunrok
                  New to start
 Updates on performance indicators with focus on the three 95s
2020-2022 HTS/ART CASCADE ANALYSIS
2020 -2022 HTS/ART CASCADE ANALYSIS
16,000

14,192
14,000

12,000

10,000

8,000

6,000

4,000

2,000
1,258 1,384
1,100
671
382
49 46 67 62 25 22
0
2020 2021 2022

Total Tested Total TestedHIV Positiv linked to care On ART

 2020-2022 ANC/PMTCT CASCADE ANALYSIS
2020 2021 2022
35000

31281
30000

25000

20000 19498
Axis Title

15000
11933

10000 8589
8291
6492
5436
5000 3442 3244
2020 2021 2022
217 204 24
0
tatal ANC visit Fisrt Visit No Tested for HIV Tested positive

Axis Title
 2021 -2022 EID Cascade Analysis

Discharged ( tested Neg) 28

Linked to Care 7
Tested positive after 18 months 8
New EID clints 15
Total Old EID Clients 58
0 10 20 30 40 50 60 70
 HIV achievements in the state

- Expansion of new HIV/TB site in the State

- HIV/TB State Health Workers are getting incentives support

- 50 Health workers are been trained in the State, TB/HIV last year and
this year 2022 on LED microscope, HTS, Care & treatment and TB.

- We are also receiving joint supportive supervision from (NMoH, SMOH

partners and Zonal Supervisors)
 Cont….
At least one good example that other states can also benefit

• PLHIV/ TB farm harvest 134 bags of groundnut in 2021

• PLHIV/ TB in Warrap have vegetable garden supported by WPF

• PLHIV/ TB in Warrap bought ten bulls supported by UNOP

• 5 ox plough donated by World Vision to PLHIV/TB

• PLHIV/ TB in Warrap have (150 acres ) supported by WPF

 Implementation challenges in state

• Inadequate training and refresher training for State Health workers

• Irregularities or delay in receiving HIV/TB commodity supply to facilities, especially
HTS kits which affects testing and linkages to care
• High HIV stigma and low awareness about TB/HIV
• Frequent stock out of HIV reporting tools and registers. E.g ART registers
• 2 Genexpet machine installed in Warrap state (Kuajok Hospital , Tonj Civil
Hospial)
• Turn over of staff in ART sites
• Inadequate number of data clerks trained on DHIS2 at the facilities level.
• Poor quality of data entry in DHIS2 (unverified figures entry)
 TB Case Notification
Block 1: All TB cases registered during the quarter New Relapse Previously treated Previous treatment Total
(excluding relapse) history unknown
Pulmonary, bacteriologically confirmed 3692  12  1052  728  5484

Pulmonary, clinically diagnosed  1668 20  340   724 2752

Extrapulmonary, bacteriologically confirmed or clinically diagnosed 187  9  75  218  489

Block 2. All new and relapse cases (bacteriologically confirmed or clinically diagnosed) 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  5  11 17  0  0  11   0 44
Female  1  0 2   3 8  1  1  2  18

Block 3: Laboratory diagnostic activity

Patients with presumptive TB
Patients with presumptive TB undergoing
2420 with positive bacteriological 272
bacteriological examination
examination result

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

   16 16  16 

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  0  1  3  2 2 0  8
Female  0  0 0  2   2  1  3 0   8
 TB Treatment outcome
Number of new bacteriologically confirmed pulmonary TB cases Sputum smear microscopy not Sputum smear microscopy Sputum Conversion Rate
registered in the quarter recorded above2 done at either 2 or 3 months Conversion at:
(a) (b) e x100
2 months 3 months a
(c) (d)

1675  72  20  38  40

Total converted at 2 and 3 months (e):

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 follow-up evaluated
2 outcomes:
registered
during quarter * (1) (3)
(2) (4) (5) (6) (sum of 1 to 5)

New bacteriologically confirmed TB cases  1675 751   883 41  0  0  0  1675

New cases of TB clinically diagnosed (smear-negative,

             
smear not done and extrapulmonary TB)

Relapse              
Treatment after failure              
Treatment after lost to follow-up              
Other previously treated 3              
 TB Treatment outcome
Block 2: TB/HIV activities (same quarter analysed as Block 1)  
No. patients on
No. patients tested for HIV 4 No. patients HIV-positive(a) 4 No. patients on ARV treatment 5
CPT 6
 
All TB cases  442 12   12  12

Block 3: TB treatment outcomes of HIV-positive patients

Treatment outcomes
Not Total number evaluated for
Total number of HIV-positive Treatment Treatmen Lost to evaluate
Type of case TB patients Block 2, Column Cured Died outcomes:
completed t failed 2 follow-up
(a) d
(1) (3) (sum of 1 to 5)
(2) (4) (5) (6)
All TB cases 25  4   2 2  0  0  17  8 

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

Treatment outcomes
Total number of Total number evaluated for
HIV-positive TB Treatment Treatment Lost to Not outcomes:
Type of case Cured Died
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  112 16  95  0  1   0 0  112 

 TB Laboratories Activities

Light Microscopy LED Microscopy GeneXpert testing

• Slides Done=2970 • Slides Tests Done=470

• Positive=138 Done=9261
• Negative=? • Positive=737
• Scanty=? • Negative=?
• Invalid=? • Scanty=?
• Invalid=?
 Conclusion and way forward

• NMOH and HIV/TB partners to provide training to HIV/TB staffs in the States to
upgrade their knowledge.

• Warehouse team to always response to States commodity/tools requests on time,

especially HTS kits that run out of stock quickly

• Partners to provide some money for improving HIV/TB awareness to reduce stigma
associated with HIV intervention.

• NMoH to print HIV/AIDS guideline to all ART sites

Thank you for attention.