INTRODUCTION: Achieving optimal HIV outcomes, as measured by global 90-90-90 targets, that is awareness of HIV-positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub-Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90-90-90 progress by age, 15-49 (as a comparison) and 50+ years, with further analyses among 50+ (55-59, 60-64, 65+ vs. 50-54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). METHODS: Using data from nationally representative Population-based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90-90-90 targets. Country-specific Poisson regression models examined 90-90-90 variation among OPLWH age strata. RESULTS: Analyses included 24,826 HIV-positive individuals (15-49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15-49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15-49, women were more likely to achieve 90-90-90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country-specific 90-90-90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. CONCLUSIONS: While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV-positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA.

Water, sanitation, and hygiene (WASH) services in healthcare facilities are essential to ensure quality health care and to facilitate infection, prevention, and control practices. They are critical to responding to outbreaks and preventing healthcare-associated infections and, therefore, critical to global health security. Many healthcare facilities in low- and middle-income settings have limited WASH services. One tool to address this issue is the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) Water and Sanitation for Health Facility Improvement Tool, or "WASH FIT." WASH FIT is a continuous improvement tool based on key WHO environmental health and infection, prevention, and control standards. While using WASH FIT, internal teams regularly perform self-assessments at their facilities, using up to 65 WASH indicators to develop and implement an improvement plan. The Ministry of Health and Social Protection (MSPS) in Togo, with support from WHO and the US Centers for Disease Control and Prevention (CDC), piloted this tool in 3 healthcare facilities. The pilot included facility assessments at 3 time points and in-depth interviews and document review 7 months after initiating WASH FIT. Facilities made improvements without significant external financial or material support. On average, pilot facilities improved from 18% of total indicators meeting standards at baseline to 44% after 7 months. Examples included improved drinking water supply, medical waste segregation, and increased soap at handwashing stations. Participants reported improvements in staff and patient satisfaction, hand hygiene, and occupational safety. Findings suggest that WASH FIT, coupled with training and supervision, may help facilities improve WASH services and practices, thus contributing to global health security. Based on these findings, the Togolese MSPS plans to scale up nationwide. Les services d'eau, d'assainissement, et d'hygiene (WASH) dans les etablissements de sante sont essentiels pour assurer des soins de qualite et faciliter les pratiques de prevention et controle des infections. Ils sont essentiels pour repondre aux epidemies et prevenir les infections associees aux soins de sante, et donc a la securite sanitaire mondiale. De nombreux pays a revenu faible ou intermediaire ont des services WASH limites dans les etablissements de soins. Un outil recemment publie pour remedier cette situation est l'outil WASH FIT [Water and Sanitation for Health Facility Improvement Tool] de l'Organisation mondiale de la Sante (OMS) et le Fonds des Nations Unies (UNICEF) pour l'amelioration de l'eau et l'assainissement dans les formations sanitaires. WASH FIT est un outil d'amelioration continue base sur les normes de l'OMS en matiere de sante environnementale et de prevention et controle des infections. Lors de l'utilisation de WASH FIT, les equipes internes effectuent regulierement des auto-evaluations dans leurs installations en utilisant jusqu'a 65 indicateurs pour elaborer et mettre en oeuvre leur plan d'amelioration. Le ministere de la Sante et de la Protection Sociale (MSPS) du Togo, avec le soutien de l'OMS et les Centres pour le controle et la prevention des maladies (CDC), a fait un pilotage de cet outil dans 3 centres de sante. Ce pilotage comprenait 3 evaluations dans chaque formation sanitaire, des interviews approfondies, et une revue documentaire, 7 mois apres l'initiation du WASH FIT. Les formations sanitaires ont realise des progres, sans aide financiere ou materielle exterieure. En moyenne, les formations sanitaires sont passees de 18% des indicateurs atteignant les standards au depart, a 44% apres 7 mois. Les exemples incluent l'approvisionnement en eau potable, le tri des dechets medicaux, et le savon aux points de lavage des mains. Les participants ont signale des ameliorations dans la satisfaction du personnel et des patients, l'hygiene des mains, et la securite au travail. Les resultats indiquent que WASH FIT, associe a la formation et a la supervision, pourrait etre un outil pour aider les formations sanitaires a ameliorer les services et pratiques WASH, contribuant ainsi a la securite sanitaire mondiale. Sur la base de ces resultats, le MSPS prevoit une extension a l'echelle nationale.