 Good morning everyone. First thank you for the opportunity to present some of the work that we're currently doing in that's currently ongoing in Mozambique. Today I will talk about reaching the 90-90-90 target and the role of community antiretroviral therapy groups or CAGs in Mozambique. So the UNA 90-90-90 target as Dorogest first already discussed was adopted in 2014. The aim of this target is that by 2020 90 percent of people living with HIV should know their status. 90 percent of those patients who know their status are retained on art and then 90 percent of those patients who are on art have a suppressed viral load. So today we will focus on the MSF project that's currently ongoing in TET Mozambique. In TET the HIV prevalence is about 7 percent. The majority of the population is living in rural areas and the Mozambican health system can be described as quite weak. This includes large human resource shortages as well as a limited infrastructure. MSF is currently providing support in 10 facilities, 10 art providing facilities within two districts, Shanghara and Morara, in both in rural areas. So as is the case in many countries in the region in Mozambique many of the many barriers have been identified for accessing ART treatment. So this includes a distance from this facility associated transport costs and a lack of general knowledge about HIV. Additionally in Mozambique one month ARV refills are provided for treatment. So that means that each patient must traditionally attend the facility once per month to pick up their drugs. So to reduce patient burden self-forming groups in TET started in 2008. So the idea behind this group is that one representative for the group attends the facility picks up the ARV drugs for the rest of the group and then comes back to the community and distributes them to the rest of the group. The next month it rotates through to another member of the group who then is the representative. These groups also are seen as a way to provide peer support as well as create an openness that comes with being in a group. So so far what we've seen in Mozambique is that and as well in other sites is that they've reduced patient and facility burden. So the evidence is that the appointment that the number there's a decrease in facility visits and there's also a high retention in care among patients in GAGS. So the in recent analysis done in TET for instance they found that 97 almost 98 percent retention in care 24 months after eligibility for a GAG among GAG patients compared to 82 percent among individual care patients. So GAGS haven't then been rolled out nationally as well as regionally in the in the in surrounding countries. So what we decided to do was take the recent adoption of the 1990-90 target as a nice opportunity to explore what role the GAGS could have in meeting this target framing it through then the HIV care continuum and the activities that are going on in the project. So first we will take a look at community HIV testing and the associated linkage to care. We'll frame that through the idea that of testing context of GAG members. So this is one aspect of what goes on in HIV community HIV testing in Mozambique and then also to look at peer support and facilitated linkage to care that goes on to strategies that are used in community HIV testing. The second aspect that we will focus on is viral suppression. So the uptake and as well as adherence among GAG members and among non-GAG members. So to explore these areas we retrospectively analyzed routinely collected community-based HIV testing data from the first three and a half years of implementation. So from July 2012 to December 2015 included in the routinely collected information was some basic information about the contact information about how how we reach these patients. We additionally retrospectively analyzed virological outcomes from patients receiving ART for more than six months from December 2013 to December 2015. So the first two years of routine viral load implementation in Mozambique. So community testing was introduced in July 2012 in in Cengada and Marada districts. This was in response to low observed linkage to care. In the first phase so in the first couple of years of community testing the primary strategy was using an index case testing strategy. So we tested contacts of the GAG members. In the second phase it was a more general it expanded to more general population testing. Testing was traditionally done by lay by trained lay counselors. Additionally there was a small small number of tests done by trained GAG focal point members. So in the end almost 26,000 people have been tested in the program. That's more than 10% of the population there and with an HIV positivity of 4%. For regarding facilitated linkage and peer support I will get to that in a few moments. So first it's important to note that in the initial although it's not shown here in the initial implementation of community testing in the first year we saw quite a high rate of HIV positivity. So in the first couple of quarters 31, 13% and then it plateaued after one year of implementation and we see about 3 to 5% HIV positivity across the board. So here we can see community testing by contact method. So what's important it's broken down by if it was an immediate GAG family member so a mother, sibling, a spouse by other GAG contact. So if it was a friend or a neighbor of a GAG contact and then by non-GAG contact. So if it was through community leaders and other types of contact with the community. What we can see clearly there's two points that jump out right away. Of course adults have a higher HIV positivity than children across the board and within each group. Additionally we see that immediate GAG family members have a significantly higher HIV positivity than other GAG contacts and non-GAG contacts. Neither one of these is too surprising in context. What's important is that that relationship holds up for both adults and children. So we can see that perhaps that we're capturing through the immediate GAG families many children that were missed in the PMTCT part of the program in the facility but we were able to test them in the community. Excuse me. What's also quite important to note about this slide though is although the HIV positivity was higher in the immediate GAG family members the total number of positive people that we found was much higher in the non-GAG contacts and as well as other GAG contacts because there were so many more of them that were able to be reached. So when we look at linkage-to-care by contact method we can see actually there's a high linkage-to-care overall 77% and there's no significant differences by contact method. So people who tested positive in the community in Shangara were immediately offered membership into a GAG regardless of so from the beginning of the this strategy this was implemented so everyone had this opportunity to reap the benefits of the peer support of the GAG membership. In the first phase of the community testing so when it was done primarily through contacts of GAG members there was more informal facilitated linkage-to-care so because we tested through GAG members there was this follow-up also by the GAG members to ensure that patients were linking to care. In the second phase it was more formalized follow-up or facilitated linkage-to-care so this means that the counselors that tested them were then following up for patients who did not immediately link to care. So although the linkage is not significantly different across the different contact methods we do we can say that in the second phase we needed many more resources health facility resources and the health system to ensure this the same linkage-to-care. So now we move to viral load so routine viral load testing is not available widely in Mozambique it's just excuse me it's only been available in Shangara and Marata districts since the end of 2013 so what we have seen in the first two years of implementation is that among GAG members the coverage has been much higher than among non-GAG patients however almost 40 percent of patients overall have a viral load above 1000 as Dodo previously mentioned in his slide with no differences in viral load by GAG or non-GAG members. So the conclusions are index case testing through GAGs is a simple way to identify a high-risk population both for adults and for children although the saturation can be reached quite quickly through testing through GAG contacts. Regardless of contact method high linkage-to-care was observed with with the strategies of peer support and facilitated linkage care there's also a possible reduction in stigma due to the long term GAG presence in this area. Regarding the third 90 we conclude that GAGs facilitated improved viral load coverage. The high failure rates though among the GAG and the non-GAG patients in Mozambique especially when compared to other sites are very are quite wearing and actually they indicate the importance of high viral load uptake in order to ensure that all the patients have access to enhanced adherence counseling as well as to second line switch. So further work is necessary to maximize the benefit of differentiated models of care, differentiated testing and art delivery models across the 90-90-90 target. So before I finish up and take any questions I would just like to acknowledge the patients of Shanghara in Marata, the Ministry of Health in Mozambique as well as the the wonderful team MSF team in Mozambique and in TET.