INTEGRATED ACTIVITY FLAG: This activity also relates to activities in Condoms and Other Prevention (#7920), Basic Health Care and Support (# 7278), CT (#7279), TB/HIV (#7281), ARV Services (#7277) and OVC (#7282) provided to the Eastern Cape Department of Health (ECDOH) and Department of Social Development (DOSD). Peer educators and advocates contribute to promotion of counseling and testing, reduction of stigma, and care and support. Empowerment of, and respect for women and girls is incorporated into prevention activities.

SUMMARY: Africare's Injongo Yethu Project will continue to work through several foci of influence in the Whittlesea community to disseminate information and influence behavior change to prevent new HIV infections and to encourage testing. While intensifying the project's reach into communities in the Hewu Hospital catchment area of the Lukhanji Health Local Service Area (LSA), the project will extend prevention activities in the catchment areas of the feeder clinics of Frontier Hospital in nearby Queenstown. Major emphasis is on community mobilization/participation while minor emphasis is given to linkages with other sectors and initiatives and IEC.

BACKGROUND: This is an ongoing activity, expanding the number of peer educators (PEs) and expanding the geographic reach to include more villages in the Hewu catchment area and to extend activities into the Lukhanji LSA. Prevention activities are supported and encouraged by the ECDOH. The House of Traditional Leaders supports the project, and is an important behavior change agent in the community. Lukhanji Local Municipality expresses support for the integration of ward councilors in community mobilization efforts. Efforts to empower young women are included in the in-school youth peer education/life skills activities, out-of-school youth peer education and livelihood activities supporting young women to be materially independent of older men. Shaping how young men see and behave toward women is included in the out-of-school youth peer education activities, the traditional initiation schools, faith-based youth activities, and in-school youth (intermediate phase). Middle-aged men are reached through faith-based organizations (FBOs) and traditional leaders, and in FY 2007, through taverns and ward councilors. Appropriate activities that focus on these target groups have been moved this year to "Other Prevention".

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Strengthen the Quality and Intensity of Existing Community-based Activities Human capacity development will remain a key activity, building on the training of traditional leaders and healers, faith leaders and out-of-school youth. In-school youth will continue to be developed, along with their coaches and teachers. Rural youth with little education will need continued support to internalize messages with regard to gender and behavior change and to better develop facilitation, counseling, and activity management skills. Funds will be used to recruit additional Peer Education and Advocate Supervisors to support community-based peer education and advocacy in new communities. A School Life Skills Officer position will be converted to a fulltime position to provide more support of the program and to meet the teacher's life skills capacity development and support needs. Additional training in peer education and behavior change approaches will be provided to the Supervisors to enhance their ability to provide technical guidance in communities. Community-based PEs and advocates from all participating groups will be provided with in-service education on interpersonal communication for behavior change. Practical skills for youth development and life skills will also be provided to the out-of-school youth PEs. Teachers from participating schools (20 current and 20 new) will continue to receive professional development in life skills education for grades 4-7 and support of PEs. Further training and mentorship for traditional initiation (circumcision) surgeons/nurses will integrate HIV prevention, gender awareness and behavior change education for young males during initiation into manhood (traditional practice). Linked with the care and support components, the Service Corps Volunteers and community-based caregivers will have their HIV prevention communication skills further developed to improve the frequency, intensity and quality of their communications in the clinics and in the homes of clients. Summer and Spring Youth Camps (2) for existing PEs (120 youth) will focus on personal empowerment and build their capacity to promote abstinence and delayed sexual

debut for in- and out-of-school youth in collaboration with church Sunday Schools.

ACTIVITY 2: Reach the Community with Consistent AB Messages Funding will support quarterly HIV prevention-focused awareness events for each target group. These events are not intended to raise awareness about HIV, but rather to stimulate discussion of intergenerational sex, transactional sex, stigma, discrimination, denial and other related issues, to reduce high-risk behavior and to create a supportive environment for HIV testing. The forums for these events include youth debates, drama, and sensitization meetings to highlight these issues. Through these open forums, Africare aims to stimulate discussion on issues and guide the community to identify HIV risk and appropriate steps to reduce such risks. The project will facilitate the dissemination of relevant IEC materials and enlist the support of PEPFAR partners such as Soul City to adapt materials.

In addition, Africare will continue to work with faith-leaders to disseminate information about HIV and AIDS with a focus on promoting risk reduction through AB messages. In FY 2007, Africare will expand the number of pastors in their program from 40 to 60 and expand the geographical reach. Through this activity alone, Africare expects to reach approximately 24,000 people.

ACTIVITY 3: Expand to New Community Groups and New Localities within this Site The project will hire a Community Leadership Officer to support intensive activity with tavern owners and to initiate activity with the ward councilors, who will be trained in HIV and AIDS, covering issues around prevention such as reducing intergenerational sex, supporting youth programs, and will link with care, support and OVC activities to enlist elected official and local committee support for local forums, health services and social services. Additionally, in collaboration with the law enforcement agents, the project will strengthen and expand the gender- and child-based violence working group by supporting quarterly meetings/activities to promote case identification, effective support and intervention (including PEP) and prevention. For in-school youth peer education, new schools in Hewu (10) and in the Queenstown area (10) will be added to the existing group of schools. Churches in Queenstown areas of Ezibeleni and Mlungisi will be engaged and trained for prevention as well as stigma reduction and care and support.

ACTIVITY 4: Vocational Skills Training and Microfinance Building on the initial garden development carried out partially with leveraged funding in FY 2006, appropriate vocational skills and financing will be initiated to ensure that youth, especially young women, are economically empowered, avoid intergenerational/transactional sex and avoid conflict with the law. The project will conduct a vocational skills training needs assessment for youth, engage the services of training institutions to provide vocational and skills training, and support learnerships and apprenticeships for youth. Selected initiatives will be supported with limited financing, and will link youth groups with government and local sources of funding.

By focusing on prevention among young people, Africare contributes to the PEPFAR goal of preventing 7 million new HIV infections.

INTEGRATED ACTIVITY FLAG:

Africare's Condoms and Other Prevention activities are linked to AB (# 7280), Basic Health Care and Support (# 7278), CT (# 7279), ARV Services (# 7277), TB/HIV (# 7281) and OVC support (# 7282) activities described in the COP. Peer educators and advocates contribute to the promotion of counseling and testing, reduction of stigma, and care and support. Empowerment of, and respect for women and girls is incorporated into prevention activities.

SUMMARY:

In the Hewu Hospital catchment area (in Whittlesea, Eastern Cape), part of Africare's Injongo Yethu Project approach is working through several foci of influence in the community to disseminate information and influence behavior change to prevent new HIV infections and to encourage testing. Activities will address target groups such as those patronizing taverns and using them for access to transactional sex (clients of sex workers), and prisoners will be reached with messages emphasizing correct and consistent condom use and getting tested for HIV. Traditional healers will extend further into villages in the Hewu area and strengthen their activities in Ilinge, outside of Queenstown to promote voluntary counseling and testing (VCT), prevent transmission during medical procedures, and provide messages on correct and consistent condom use, along with being faithful and partner reduction messages during their cultural dancing. Activities carried out by traditional healers aim to reduce stigma. Major emphasis will be on community mobilization/participation with minor emphasis on information, education and communication (IEC) and training. Target populations include men, women, prisoners and partner clients of sex workers.

BACKGROUND:

This is an ongoing activity, extending from the Abstinence and Being Faithful (AB) messages initiated with these groups and bringing tavern owners more formally into the partnership of the project. Traditional healers have been very active in combining messages into their cultural dancing, and have begun to refer clients for VCT. All trained traditional healers have medical waste sharps disposal boxes. Two local associations of tavern owners have initiated activities through the local community policing forum and express interest in being trained to implement activities in their establishments. While there is not a formal sex worker trade in this community, informal sex for transaction does occur and is frequently initiated at taverns. Monthly discussion sessions have been carried out in the male prison around HIV transmission and AB prevention. The local minimum security prisons have small populations (about 70 inmates) with short sentences and will return to their communities in a short time. Prisoners have expressed the need for prevention work, including condoms and condom information.

ACTIVITIES AND EXPECTED RESULTS:

Largely through consistent and frequent messages using video and print materials and backed by trained tavern owners, correct and consistent condom use along with reducing the number of concurrent sexual partners will be encouraged. Backing of the taverns owners will be important. In addition to affecting behavior while in prison, it is anticipated that significant information coupled with discussion while in prison will positively influence behavior after release into the community.

ACTIVITY 1:

Tavern owners from the Whittlesea and Romanslaagte Community Policing Forums will be trained first in HIV disease, transmission and prevention, as well as oriented to IEC materials that can be used in their establishments. Included in their program will be an orientation to the local HIV services for testing and care (including treatment). Project support will also be used to provide videos and Xhosa print materials on condom use and reducing the number of partners. VCRs and televisions will be made available on a rotational basis where they are not available on premises. Discussions once per quarter in each establishment facilitated by project volunteers will reinforce messages in addition to the informal discussions that will be generated by the videos and supported by the tavern

owners.

ACTIVITY 2:

Prisoners in the Sada prison for men and the Queenstown prison for women will continue to be reached with monthly discussion sessions. Videos will be used to trigger discussion and Xhosa print material on condom use, partner reduction and AB messages will be provided. Where condoms are not institutionally available, they will be provided, given permission from the authorities.

ACTIVITY 3:

Traditional healers trained in the Hewu and Ilinge areas will be refreshed, updated and supported in their ongoing activities. Reinforcement of messages around limiting sexual networks through partner reduction and condom use will be provided. Additional practice to build confidence in answering questions will be structured to promote independence from project staff.

ACTIVITY 4:

Violence reduction is addressed through several activities in the community. Traditional caretakers/educators (Ikankhatha) who educate male youth during traditional circumcision and initiation "school" are beginning to include emphasis on traditional norms and values that mandate respect and caring for women and children. This is to counter anecdotes of bullying behavior of young men toward women (even their mothers) when they come out of the school. Traditional leaders will include similar discussions with adult men with regard to violent behavior toward women and children. Peer Educators for out-of-school youth will continue to receive capacity building to lead youth discussions around gender issues and relationships. In-school youth (intermediate phase) will be introduced to issues of gender, how we see the other sex, bullying, and consideration for others. Pastors and church leaders discuss with respect for each other with couples. Youth both in- and out-of-school will be made aware of sexual abuse and what to do if it happens.

By focusing on prevention among people at risk, Africare contributes to the PEPFAR goal of preventing 7 million new HIV infections.

INTEGRATED ACTIVITY FLAG:

This activity relates to Africare's activities AB (# 7280), Other Prevention (#7920), CT (#7279), ARV Services (#7277), TB/HIV (#7281) and OVC support (#7282). This partner may benefit from the Partnership for Supply Chain Management ARV Drugs activity (#7935), which will explore current pain and symptom management practices, drug availability and cost, and provide recommendations.

SUMMARY:

Africare's Injongo Yethu Project will continue to support home-based care managed by the Eastern Cape Department of Health (ECDOH) clinics, expand the number of clinics supported in the Lukhanji Local Service Area, and begin support in the Glen Grey Hospital catchment area. Facilitators of support groups will be developed and nutrition support through clinic and home-based gardens will be expanded. Documentation and planning of care and support will be supported by the development of an electronic database of clients. Major emphasis is on local organization development, with training, supportive supervision and nutrition support as supporting minor emphasis areas. Palliative care services target all HIV-infected clients and their families, adults and children. Training largely targets South African-based volunteers and public sector nurses.

BACKGROUND:

This is an ongoing activity, building on the deployment of Service Corps Volunteers (SCV) to assist clinic nurses with the supervision of home-based care, health talks and counseling in the clinics. Traditional healers have begun to refer clients for care and treatment, with some providing support to clients on treatment. Pastors and church leaders who were trained in HIV-related care have begun pastoral support to clients. Training of people living with HIV (PLHIV) as support group facilitators began in FY 2006. With leveraged funding, a large demonstration garden at Hewu Hospital and six clinic-based gardens were developed in conjunction with training community-based caregivers and SCVs in permaculture and nutrition. Several PLHIV and families at each of eight clinics have begun to grow a combination of high-nutrient vegetables, along with appetizing and micronutrient-rich herbs.

ACTIVITIES AND EXPECTED RESULTS:

Activities will focus on improving the quality of home-based care (HBC) and enhancing facility-based management of palliative care. Strengthening pre-ART and ART support care based in the clinics will help to support down referral from hospitals and health centers.

ACTIVITY 1: Improved Quality of Clinic and Home-based Care

Quality-focused care plans for HBC visits to be piloted with three clinics. These activities will be linked with Columbia University's work with the Eastern Cape on new forms for care. Care plans will be informed by simple HIV client management tools for use by clinic nurses to plan care throughout the client's disease. Home-based care supervision training modules for nurses and for SCVs will be developed. All SCVs will receive enhanced training in HBC supervision. Training in palliative care will include: evidence-based preventive care interventions which include the following: OI screening and prophylaxis (including cotrimoxazole, TB screening/management), counseling and testing for clients and family members, safe water and personal hygiene strategies to reduce diarrheal disease, HIV prevention counseling, provision of condoms, referral for family planning services for HIV-infected women, appropriate child survival interventions for HIV-infected children and nutrition counseling, clinical measurement, nutrition monitoring and targeted support based on WHO criteria for severely malnourished PLHIV. The package of services to be delivered includes basic pain and symptom management and referral for facility-based support for adherence to OI medications (including cotrimoxazole prophylaxis and TB treatment) and antiretroviral therapy (ART) if needed.

A social worker capable of training in basic counseling will be recruited to train clinical staff, volunteers and pastors in basic counseling skills. This will link closely with the psychosocial training under the OVC component. The provincially supported course

implemented by the University of Fort Hare will be adapted with psychosocial support materials. Nurses and volunteers will be trained as they become available for training.

Building on the initial training of PLHIV for support group facilitation, the project will refine support group facilitation training, guidance for PLHIV co-facilitators and orientation for nurses as a support resource; a) a guide for leading groups, b) a modular curriculum for facilitators, and c) information packs for use in groups. Effort will be made for the equitable access of services by males and females (key legislative area).

To better link the community, five pilot HIV community response teams will be established to monitor processes, provide feedback to the clinic and promote understanding of HIV.

ACTIVITY 2: Develop a Culture of Managing Patients and Services using Data and Information

In collaboration with Columbia University, Africare will develop and implement a simple electronic database as a continuity register of HIV-infected clients, linked with the antiretroviral treatment component. A database development service provider will be engaged to adapt software that will be open source and compatible with the local health information system, to populate the register, provide documentation on the data entry process, data element and indicator definitions, and to train data entry, health and program management staff. Funds will support software development, training and follow-up needed to effect sound implementation. Computers will be provided for Hewu Hospital, Sada Community Health Clinic and Glen Grey Hospital. Nurses will also be trained in the use of data for HIV management and the project will facilitate routine data review. HIV Service Review Guides will be drafted and piloted. It is expected that analyzed data will inform improved quality of the program.

ACTIVITY 3: Provide Direct Training for ECDOH and Africare Staff in Basic HIV and AIDS, CT, PMTCT and ART support

Training organized by the ECDOH has been extremely limited in quantity and frequency, hindering the basic development and certification of professional and volunteer staff. Funds will support recruitment of a trainer already accredited in several needed areas of palliative care. FY 2007 funds will support the establishment of Africare as an accredited training provider for the above areas. Training for Africare's volunteers can then be completed and ECDOH volunteers and professional staff will have an additional source of training made available to accommodate turnover and existing gaps.

ACTIVITY 4: Nutritional support through gardens

To promote quality, economical nutrition, through non-USG funding, the team will work with Lukhanji DOH to develop a local low-literacy cookbook (in Xhosa) and home economics guide. Clinic nurses and SCVs will be trained on the use of the guide. Cooking demonstrations will be established at clinics and selected churches on using nutritious foods, especially the foods and herbs from the permaculture gardens. Funding will support referral for nutritional support and monitoring as well as training clinic teams and as budget allows, outfitting modest kitchens, such as adding a table, stove or sink to existing clinic kitchens.

Africare's palliative care activities contribute to PEPFAR's goals of 10 million people in care by increasing access and quality of care.

INTEGRATED ACTIVITY FLAG:

Africare's TB/HIV activities are integral to Basic Health Care & Support (# 7278), CT (#7279), and ARV Services (#7277). They are also linked to AB (#7280) and Other Prevention activities (#7920).

SUMMARY:

Africare's Injongo Yethu Project will continue to encourage identification of HIV infection among TB clients, and TB disease detection and management among HIV clients. Major emphasis is on local organization development of clinics in the Hewu Hospital catchment area in the Eastern Cape and the feeder clinics for Frontier Hospital and Glen Grey Hospital. Emphasis of project interventions is also on training, monitoring and evaluation support through information technology development (the ARV and HIV electronic register) and developing supportive supervision.

BACKGROUND:

This is an ongoing activity that has received some support for training of nurses in TB and HIV care and an orientation of Service Corps Volunteers on the frequency of HIV infection among TB clients. Testing of TB clients has increased, but in many clinics is poorly documented in the counseling and testing program (better documented in the TB program records). Implementation of TB prophylaxis guidelines for HIV-infected clients in the Eastern Cape has been put on hold by the Eastern Cape Department of Health (ECDOH). Health workers express frustration and difficulty in diagnosing TB in HIV-infected patients who are sputum negative.

ACTIVITIES AND EXPECTED RESULTS:

Activities will focus on providing tools and mechanisms to improve the quality of home- and facility-based management of TB screening and management in HIV-infected clients, and HIV screening and management for clients on TB treatment. Tools for monitoring and supportive supervision will also be provided.

ACTIVITY 1: Improve HIV Testing Rates of TB Clients

The project will support development of a standard client HIV education flip chart for TB clients similar to the CDC-supported antenatal care (ANC) counseling guide that achieved much success in Botswana. Nurses from 10 clinics will be recruited to field-test the flip chart and the counseling routine and note any effect on HIV testing among TB clients. Nurses will be encouraged to offer counseling both at the initiation of TB therapy and after the two-month intensive treatment phase to clients who had declined testing at initiation.

South African Government DOTS supporters from selected clinics will be provided with additional basic HIV and AIDS training, particularly for those not recently trained or provided with an update and refresher course. The flip chart piloted by clinics will be made available to DOTS supporters from the same clinics in order to further encourage HIV testing among the TB clients.

ACTIVITY 2: Improve TB Screening Among HIV Clients

A simple TB screening tool that is piloted by Catholic Relief Services (CRS) with support from CDC and FY 2006 PEPFAR funding will be used for further field testing in Lukhanji or Emalahleni Local Service Area. Selection will be based on the response from the TB and HIV coordinators of the LSA. The project will support the implementation of this screening too if protocols are disseminated by the ECDOH for skin testing in preparation for prophylaxis.

ACTIVITY 3: Training and Capacity Building

To ensure effective integration of TB and HIV care, doctors and nurses from Hewu Hospital, Sada CHC, Frontier Hospital and Glen Grey Hospital will be prioritized for updated training on TB and HIV co-management, using recent WHO materials. Training for doctors

will be open to 20 local general practitioners.

Routine technical information packets of information from e-newsletters, tools and guides from PEPFAR partners, publications from USG cooperating agencies, such as WHO and the AIDS Vaccine Bulletin will be collated and distributed to the doctors, HIV service managers and nurses in ARV clinics. The project will subscribe to newsletters and training materials from various membership organizations on behalf of the health care providers at the three hospitals. .

ACTIVITY 4: Strengthen Organizational and Supervisory Support for TB and HIV Integration

The project will support the Chris Hani District HIV, AIDS, STI, TB (HAST) committee to create objectives and a standing agenda item for monitoring progress toward integration of TB and HIV services.

Sections of the Clinic Supervisor's Handbook will be updated to facilitate the capacity of general clinic supervisors to support integration of the two program services at primary health care clinic level.

ACTIVITY 5: Ensure and Monitor Cotrimoxazole Therapy Implementation

Cotrimoxazole therapy is widely given to HIV clients, but the effects are not routinely monitored. To ensure that all appropriate clients benefit from cotrimoxazole, relevant data elements will be included in the HIV patient electronic register and therapy will be included in the algorithms as will the proposed HIV client care plans.

ACTIVITY 6: Effective Monitoring of TB and HIV-infected Patients

The flow of information and documentation of information between services to HIV-infected and TB patients will be assessed for bottlenecks and potential for losing follow-up of clients, to ensure that all TB and HIV-infected patients are effectively monitored in terms of their co-morbidity. Africare will collaborate with another PEPFAR partner, QAP to capitalize on, and to reinforce, principles and processes of quality assurance that will allow facility teams to uncover their local constraints and to plan solutions.

ACTIVITY 7: Support to TB Clients as Potential or Diagnosed HIV Clients

TB clients will be informed of, and welcomed to the new HIV support groups at the clinics. It is understood that some TB clients are not ready to be tested for HIV and might find support to do so in the group.

Africare's TB and HIV support contributes to PEPFAR's goal of 10 million people receiving care.

INTEGRATED ACTIVITY FLAG:

Africare's OVC activities are linked to AB (# 7280), Other Prevention (#7920), Basic Health Care & Support (#7278), TB/HIV (#7281), CT (#7279) and ARV Services (#7277) and support the activities the project provides to the Eastern Cape Department of Health (ECDOH) and the Department of Education. For example, identifying orphans and their needs will link closely to palliative care by the community caregivers. Livelihood activities link with others under prevention and palliative care.

SUMMARY:

Africare's Injongo Yethu Project will establish the structures and processes that will facilitate service delivery and support to orphans and vulnerable children (OVC) in Lukhanji and Emalahleni Local Service Areas in the Eastern Cape. Child Forums, Kids Clubs, counseling, health care, social services coordination and livelihood will be linked together and to other Injongo Yethu Project activities to create an integral support system. Major emphasis is on community mobilization, with additional emphasis on human resource, training and local organizational development. Target populations include OVC and their caregivers.

BACKGROUND:

The OVC program was started in FY 2006, and will build on existing community caregiver services, the Service Corps Volunteers and Africare's programs with youth and faith-based organizations.

ACTIVITIES AND EXPECTED RESULTS:

Africare's activities in support of orphans and vulnerable children will be continued during this period, emphasizing the development of sound public sector and community responses to OVC needs.

ACTIVITY 1: Strengthen Communities to Meet the Needs of OVC Affected by HIV and AIDS

Fifteen new Service Corps Volunteers (SCVs) will be recruited to support OVC community-based activities. To support the identification and tracking of support to OVC, Africare will support the Eastern Cape Department of Social Development (DoSD) in designing and developing an OVC registration system and other tools for identifying vulnerable households. SCVs, health sector community care-givers and the newly established Child Care Forum (CCF) members will be trained to identify OVC and vulnerable households, and ongoing household needs assessments will be initiated and made routine.

A community stakeholders' meeting will be convened to sensitize community leaders, development partners and local leaders on the approach of the DoSD and Africare's support and role in the process as a catalyst. Child Care Forums will be developed for 15 wards to provide a venue and mechanism for coordinating resources to meet the children's needs. Small grants will be provided to the CCFs to enable them to meet and coordinate activities for OVC. A memorandum of understanding will be signed with each CCF, each will be assessed for its development and resource needs and each forum will meet quarterly. Africare support will be provided through a Service Corps Volunteer in establishing patterns of OVC needs identification, work planning and policy development, and the development of an OVC community service plan.

Kids' Clubs will be established with Africare support, designed in conjunction with the DoSD and their district committee for HIV and OVC. Workshops will be held to jointly establish roles, functions, and the service complement of Child Forums and Kids' Clubs. Under guidance from the DoSD district office (Chris Hani), support will first focus on the wards in the Whittlesea/Hewu area, followed by Queenstown, then Emalahleni. Child Care Forums, Kids Clubs, and community caregivers will link OVC and child heads of households to social services for necessary support.

ACTIVITY 2: Community-based Responses in Support of OVC and Their Households

Africare will provide technical assistance to community-based organization (CBO) members of Child Forums in grant writing, financial management and monitoring and evaluation. A limited number of grants will be awarded Africare FY 2007 PEPFAR funds. Grants will focus on enabling CBOs to provide care and support to OVC in their communities.

Both service CBOs and public sector health volunteers will be provided with tools and training to monitor health status and to promote child utilization of well-child health services and to be cared for when sick.

OVC households will be linked to ongoing and expanding food garden projects, soup kitchens and locally available food parcels distributed by the DoSD, churches and CBOs.

A local legal aid service will be engaged to train child forums and volunteers in basic legal aid support for OVC and families, such as wills, succession planning, identity documents, deferment of school fees, etc. The project will facilitate the development of a referral system between the community, DOSD and legal aid for common legal needs.

The South African Depression and Anxiety Group (SADAG) will be subcontracted to provide specific support in developing community-oriented psychosocial support training. They will initiate caregiver support groups, train the support group leaders, and produce information, education and communication (IEC) materials, such as their successful "talking books" for facilitating discussion and engaging children and youth. They will also establish a toll-free call line for support.

ACTIVITY 3: Direct Assistance to OVC

Africare will facilitate establishing effective referral patterns and access to social services and various benefits. SCVs and peer educator supervisors will be trained to assist Child Care Forums and train child headed households on home management, services and entitlements. To foster school compliance with the provincial no-fee policy in disadvantaged areas, minor repairs and rehabilitation or other school-wide benefits will be undertaken in exchange for waiving fees for OVC. Enrollment by OVC in school and routine attendance will be monitored. Africare will capacitate the community volunteers and child care forums to ensure that OVC in need of shelter get referred.

Monthly monitoring of access and utilization of a standardized package of services will be established.

Children and youth attending Kids' Clubs will be trained in Life Skills. Kids' Clubs leaders will be trained in HIV and AIDS and care and support of OVC.

Africare will provide small grants to Kids' Clubs to organize recreational activities. Africare will seek leveraged matching funds. Peer Educators (40) and Peer Counselors (40) will be trained to support children and youth attending Kids' Clubs and in the community.

Children heading households and older OVC will be targeted for training in vocational and livelihood skills through vocational training centers and training organizations. Local organizations will be trained to support the development of income generating activities (IGA), and OVC and caregivers will be assisted in securing funding for IGA activities.

ACTIVITY 4: Access to Healthcare

Home-based caregivers based at clinics will ensure that OVC under 2-year olds are weighed, immunized, and those that are HIV-exposed are screened for infections, receive their follow-up HIV test, and access care and treatment, when required. Older children encountered in the home will also be linked to clinic care and treatment services as needed. Schools and Kid's Clubs will be alert to children and youth, who need referrals for healthcare and HIV treatment, linking them through the structures above to ensure that clinic or hospital level care is provided.

Africare's activities focused on orphans and vulnerable children contribute to PEPFAR's goals of 10 million people in care, including OVC.

INTEGRATED ACTIVITY FLAG:

Africare's support to voluntary counseling and testing (VCT) services are linked to prevention through helping those who test negative to remain HIV-negative, and through helping those who test HIV-positive to receive care that will reduce their viral load and to prevent transmission to others. VCT also serve as entry points to Basic Health Care and Support (#7278) and to ARV Services (#7277). Africare's CT activities are also linked to activities described in AB (#7280), Condoms and Other Prevention (#7920), TB/HIV (# 7281) and support for OVC (#7282).

SUMMARY:

Africare's VCT activities will include linking testing to community events, increasing the participation of people living with HIV (PLHIV) in the counseling process, and supporting clinics to integrate VCT into all services and ensure quality of counseling and testing. Major emphasis will be on community mobilization and participation. Additional emphasis will be placed on strengthening quality and short-term human resource support and training. The aim is to increase testing in communities among adults and secondary school students.

BACKGROUND:

VCT in the Lukhanji Local Service Area (Eastern Cape) has been supported by Africare in terms of encouragement of testing in community events and volunteer pre-test counseling. A perception of limited time has been expressed as interfering with integrating counseling and testing throughout clinic services, particularly in Sada Community Health Centre. Accredited training for counseling and testing has been very limited in the district, hampering preparation of volunteers to support the nurses.

ACTIVITIES AND EXPECTED RESULTS:

Four activities will focus on ensuring greater participation of PLHIV; increasing community mobilization; and strengthening existing counseling and testing services.

ACTIVITY 1: Develop PLHIV for Counseling Support

PLHIV will be trained as both support group co-facilitators and VCT counselors. On a voluntary basis, they will be able to support both clinic and community-based testing activities, adding particular value to post-test counseling and referral to support groups and services.

ACTIVITY 2: Mobile VCT Services

Mobile VCT services will be initiated to ensure that VCT services are provided to the whole community, in particular the villages not in the immediate vicinity of the local clinic. Mobile services will be designed with the Eastern Cape Department of Health (ECDOH) clinic teams to augment their reach. Where practical, clinic nurses will join the mobile team to perform the test. Where required, a nurse recruited by the project to support VCT will provide testing. Service Corps Volunteers (SCV) from the clinics and community caregivers who are trained can support pre- and post-test counseling and logistics. In order to address community concerns about being tested by someone they know, SCVs can exchange sites and the Africare nurse will test. Mobile testing will take place monthly, rotating sites. A compensation plan for volunteer community caregivers supporting testing will be developed with the Lukhanji health team. To ensure maximum uptake, the mobile VCT team will work with the project's peer educators and drama group to provide entertainment in the form of "street theater" (skits, songs, poems, monologues and dances) that include, but are not limited to, HIV and AIDS themes. These preparatory sessions will help to reduce fear and tension while addressing myths, misconceptions and promoting behavior change.

ACTIVITY 3: VCT Training

Training on VCT will include both initial and refresher training. Refresher training will be conducted at least once three months for nurses and volunteers already trained in

counseling and testing. Project support will include hiring an accredited nurse trainer, training workshops, and supporting training sessions with onsite follow-up. Training of SCVs and community caregivers from among the 18 clinics in the Whittlesea community will strengthen the clinic's ability to provide more facility-based testing and to conduct outreach. Community-based organizations providing home-based care will also benefit from the training of their caregivers, as needed.

ACTIVITY 4: Optimize Clinic Flow for Integrated VCT

Africare will review clinic flow, clinic efficiency and integration of services at three selected sites to increase the amount of time allocated to VCT services. Findings from the review will be analyzed in a workshop with the clinic teams to identify options for increasing access to VCT by family planning clients, TB clients and general clinic attendees. Support will be provided to teams piloting their changes.

By focusing on promoting counseling and testing through community structures, Africare contributes to the PEPFAR goals of 10 million people in prevention and 7 million infections averted.

INTEGRATED ACTIVITY FLAG:

Africare's treatment activities are linked closely to Basic Health Care & Support (#7278), Counseling and Testing (#7279), AB (#7280), Other Prevention (#7920), TB/HIV (#7281) and OVC (#7282) support activities.

SUMMARY:

Africare's Injongo Yethu Project (AIYP) will continue to support increased quality of, and access to antiretroviral therapy (ART) for adults and pediatrics, providing support for an electronic patient register, improvement of treatment readiness and high-quality patient management. Hewu Hospital, Frontier Hospital, Glen Grey Hospital and their referral clinics in the Lukhanji and Emalahleni local service areas of Eastern Cape will be assisted. Major emphasis is on building local organization capacity with minor emphasis on training, strategic information and human resources. Human capacity development is focused on doctors, nurses, local traditional healers and data management personnel.

BACKGROUND:

This is an ongoing activity supporting treatment readiness and follow-up at Hewu Hospital and Sada Community Health Center, and service support to Frontier Hospital. The referral rate from Hewu Hospital to Frontier Hospital for initiation of antiretroviral treatment (ART) has increased. Challenges have included inadequate recording systems, incomplete reporting, absence of a treatment readiness program in Hewu, and limited documentation of client care and progress. Hewu Hospital has not yet been accredited, but is imminent. Glen Grey Hospital recently became accredited and already has patients on ART. The treatment support is linked to community-based activities that address HIV and AIDS, care and treatment awareness and reduce stigma. Traditional healers and faith leaders provide spiritual support. An electronic patient register for ART clients will be linked to an HIV client register piloted, described in the Basic Health Care and Support section of the COP.

ACTIVITIES AND EXPECTED RESULTS:

Support for treatment emphasizes the management of patient care and services within public sector facilities in Eastern Cape. Tools and onsite support will put mechanisms in place that will facilitate treatment availability, quality, and service management.

ACTIVITY 1: Support Hewu Hospital in Establishing ARV Service

With support from the Eastern Cape Department of Health (ECDOH), the Africare team will design a supportive strategic and operational planning process for the Hewu Hospital Wellness Centre and ARV service that will assist the hospital in identifying the resources required to provide ARV services, including staffing, drugs, guides and tools, equipment and furnishings. Support will be provided for the completion of the wellness centre establishment as needed in term of filing systems, data management staff and equipment, communication systems and temporary staff.

ACTIVITY 2: Development of an Electronic Patient Register

With another PEPFAR partner in the Eastern Cape, Columbia University, the project will engage a software manager to develop and implement an electronic patient register and record for adult and pediatric patients on ARVs. Funding will support the adaptation of an open-source, tested software and ensure that it includes all essential elements of information required locally and can link easily with the existing health and hospital information systems. Training and implementation support will be provided initially to Hewu Hospital, Frontier Hospital and Glen Grey and potentially to Sada Community Health Center. Both Glen Grey Hospital and Hewu Hospital will need computer equipment and temporary staff (data capturer). Training will be provided for data capturers, health workers and service managers to us the information for client ART case management.

ACTIVITY 3: Strengthen the Process of Treatment Readiness Patient Education

Support will be provided to identify and implement local best practices identified the

Eastern Cape. ARV readiness workshops will be conducted to improve quality of care at Frontier, Hewu and Glen Grey hospitals and referral sites (approximately 15 clinics). A model ARV readiness patient education program will be adapted for these supported facilities.

ACTIVITY 4: Continuing Professional Development

Access to continuing education on HIV disease management, ARV initiation and support, and drug supply management will be facilitated, using existing training providers and programs. Continuing education seminars for doctors, nurses and pharmacists will improve competence in evidence-based HIV and ARV management through onsite mentoring of health workers. In-service training for nurses to support ART started in FY 2006 will continue. Data and case management review meetings will be supported bi-monthly.

Through an institutional collaborating partner and/or identified mentors, medical and surgical inpatient doctors in Glen Grey, Frontier and Hewu Hospitals will be mentored in identifying and appropriately managing HIV patients in the general wards.

Training on pediatric HIV management will be implemented through onsite clinical mentoring for neonatal HIV management and management of pediatric cases, and follow-up to promote early identification of infants and children needing ARVs. In addition, general practitioners working in these facilities part-time will be trained basic pediatric ARV care.

Integration of TB and HIV care will be supported with training on TB and HIV co-management.

ACTIVITY 5: Pilot for Utilizing Traditional Healers for Treatment Support

Traditional healers have expressed interest in becoming an integral part of client referral for treatment and support of the client when on ARVs. A pilot group of traditional healers will be trained as ART aides that will assist patients to adhere to treatment.

ACTIVITY 6: Addressing Barriers to Optimal ARV Services Utilization at Frontier and Hewu Hospitals

With data that will be available from the ARV software, case and service statistics reviews will be conducted 6-monthly, using client data (defaulter rates, treatment adherence rates, common ART side effects experienced, reasons for discontinuation, and CD4 counts at ART initiation) to monitor access to and utilization of services, as well as patient outcomes.

A transport voucher system will be developed to support patients who decline ART because they are unable to afford the cost of transport to Frontier Hospital. This system will be developed and implemented for adult patients from Hewu while awaiting accreditation, and for pediatric clients until plans to decentralize pediatric care to Hewu are implemented. FY 2007 funds will support the cost of transport and management of the documentation system.

By supporting ARV service delivery programs, Africare will contribute to the realization of the PEPFAR 2-7-10 goal of treating two million people with ART. These activities will also support efforts to meet the treatment objectives outlined in the USG Five-Year Strategy for South Africa.