INTEGRATED ACTIVITY FLAG: This activity is in support of the National Department of Health (NDOH) and is linked to other activities in support of NDOH, including those in the PMTCT (#7369), AB (#7966), TB/HIV (#7365), CT (#7366) and SI (#7364) program areas. These activities provide overall HIV and AIDS programmatic support to NDOH and supplement its ongoing program. In addition, NDOH relies on CDC to implement activities that address NDOH's emerging priorities, providing financial and technical support more quickly than the systems of NDOH allow. PMTCT-specific activities are represented on the NDOH operational plan, and contribute to the overall implementation of the national PMTCT program.

SUMMARY: The aim of the "In Support of the NDOH PMTCT" project is to provide technical assistance to the NDOH and provincial health departments to ensure expansion and strengthening of PMTCT services in all nine provinces. The major emphasis area is training. Minor emphasis areas include development of network/linkages/referral systems, human resources, local organization capacity development, quality assurance and supportive supervision, and strategic information.

BACKGROUND: The goal of the National PMTCT program is to reduce mother-to-child transmission of HIV by improving access to HIV counseling and testing in antenatal clinics, improving family planning services to HIV-infected women, and implementing clinical guidelines to reduce transmission during childbirth and labor. In addition, the National program is responsible for ensuring follow-up of infants born to HIV-infected mothers and ensuring that these infants are identified early and referred to treatment if necessary. The purpose of this project is to provide technical assistance to NDOH by funding two program assistants to work within the NDOH on all aspects of the program. The technical assistance focuses particularly on capacity building of healthcare workers and community healthcare workers, development and implementation of provincial PMTCT-specific operational plans, strengthening national and provincial reporting systems, coordinating the national PMTCT steering committee meeting, developing a monitoring and evaluation system for early infant diagnosis and strengthening service delivery by implementing systems strengthening activities.

ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Capacity Building In FY 2004 and FY 2005, PEPFAR and the NDOH finalized the PMTCT and Infant Feeding Curricula and PEPFAR funding produced a trainers' guide, participants' guide and course directors' guide. In FY 2006, course directors and trainers were updated on the finalized curriculum and provincial training coordinators were assisted in developing provincial training plans to implement the curriculum at the provincial level. FY 2007 funding will be used to ensure that training for healthcare workers continues to expand throughout the provinces. Funding will be used to work with provincial training coordinators and ensure a minimum of two healthcare workers per health facility will be newly trained or re-trained to ensure improved PMTCT service delivery.

Since community healthcare workers are often the first point of contact for pregnant women at the health facility and are responsible for providing HIV counseling at antenatal care, FY 2006 funding was used to develop a training package and job-aids targeting community healthcare workers. FY 2007 funding will target NGOs and rollout the community health worker curriculum through training, supervising and monitoring a core group of course directors and trainers from NGOs for each of the nine provinces, and through assisting in development and implementation of provincial community health worker training plans.

In addition, the NDOH recently announced an important policy shift in ARV prophylaxis from monotherapy to dual therapy. PEPFAR funds will assist the NDOH and provincial DOH to implement this change. This may include training and technical assistance depending on requests from the SAG.

In ensuring that all healthcare workers offering antenatal care, postnatal and child health services receive training, these activities will contribute to the PEPFAR goal of averting 7

million new infections, as healthcare workers will be trained to integrate PMTCT into routine service, and more pregnant women will receive PMTCT services.

ACTIVITY 2: Monitoring Early Infant Diagnosis FY 2006 funding supported formative work aimed at identifying psychosocial issues and implementation challenges related to early infant diagnosis. As a follow-on to this activity, FY 2007 funding will be used to create a full-fledged monitoring and evaluation system for early infant diagnosis, as no national system currently exists in this area. The system will include monitoring and evaluation training on the national protocol implementation, implementation itself and client adherence and follow-up. The activity is a logical follow-on from the formative/descriptive work conducted in FY 2006, and the results obtained from the formative work will serve as the basis for formulating monitoring and evaluation tools (both quantitative and qualitative, exploring both quality of care and service provision and client adherence and psycho-social impact) that can be used for early infant testing rollout.

Expected results include development of a draft monitoring and evaluation package to be tested in a number of facilities as the early infant testing training and protocol are progressively rolled out. The draft package will also include an assessment of the feasibility of implementing the package in different types of health facilities and how it can be adapted to facilities already offering the service. In addition, while the monitoring and evaluation package will be thorough and comprehensive, certain components may not be realistic for certain clinical settings. Therefore, part of the package will explore different levels of monitoring and evaluation (gold, silver, bronze standard) depending on the clinical environment. This will ensure exploration of quality of care issues in greater depth.

This activity will contribute to PEPFAR goals by facilitating a process where HIV-infected infants can be identified early and referred to antiretroviral therapy facilities for monitoring and ensuring that they receive treatment at the appropriate time. In addition, the focus on quality of care will ensure sustainable implementation of early infant diagnosis.

ACTIVITY 3: Technical Assistance Technical assistance to NDOH will be conducted by two locally employed staff. Although both will engage with NDOH regularly, one locally employed staff person will work at the National program and be engaged in the day-to-day activities of the national PMTCT program. Specific technical assistance to the national PMTCT program will relate to capacity building for all cadres of healthcare workers, monitoring and evaluation, the development of protocols and guidelines, addressing challenges in implementation and integration of PMTCT into routine Maternal Child and Women's Health services and general day-to-day management of the national program. Funding will be used to assist the NDOH and provinical departments of health in the rollout of the New Strategic Plan (NSP) for HIV and AIDS, and the accelerated prevention strategy. Funding will ensure that the new PMTCT policy is disseminated throughout the country and that health care workers are trained in accordance with the NSP.

This program will contribute to 2-7-10 goals by ensuring implementation of quality PMTCT services and by preventing vertical transmission.

Added February 2008: There is no change to this COP entry as these additional small amount of funds will be used to support activities at the request of the NDOH.

INTEGRATED ACTIVITY FLAG:

This activity is one of six activities in support of the National Department of Health (NDOH); additional activities include PMTCT (# 7369), TB/HIV (# 7365), ARV Services (# 7368), SI (# 7364) and CT (# 7366). Together, these activities provide overall HIV and AIDS programmatic support to NDOH and supplement their ongoing programs. In addition, the NDOH relies on CDC to implement activities that address NDOH emerging priorities, providing financial and technical support more quickly than the systems of NDOH allow.

SUMMARY:

PEPFAR funds support a local hire to work with the NDOH on HIV prevention among youth. This position works closely with NDOH in the design and delivery of their youth interventions. The major emphasis will be on local organization capacity development with minor emphases on, development of policy guidelines, and training. The target populations will include host country government workers, and implementing organizations.

BACKGROUND:

Through the NDOH Cooperative Agreement, four non-governmental organizations (NGOs) will be supported to carry out AB prevention activities for youth. The funds requested under this COP entry "In-Support of the NDOH" will continue to support a youth specialist that provides technical assistance to the NDOH on youth activities including the provision of technical oversight to the four NGOs. The "In-support of the NDOH" funds are also allotted to small-scale activities at the request of the NDOH for AB prevention activities.

ACTIVITIES AND EXPECTED RESULTS:

Three activities will be carried out in this Program Area.

ACTIVITY 1:

Providing technical assistance and oversight to the NDOH activities with youth, including coordinating life skills training offered through schools in collaboration with NGOs.

Plus Up Funding will be used to support the development of guidelines, training materials, etc. and to provide TA to the youth program on the implementation of specific activities within the National Strategic Plan and accelerated prevention strategy. Specifically, the USG will assist to update the National Youth and Adolescent Health Policy Guidelines. Lastly, health care providers will also be trained on improving youth-friendly services and funding will support the printing of those materials. Lastly, Plus-Up funds will be used to support a meeting led by the NDOH for FBOs and NGOs who carry out AB messages to ensure that their strategies are harmonized and are done in a collaborative manner.

ACTIVITY 2:

Providing coordination and oversight for Rutanang peer education trainings (particularly addressing stigma and discrimination) offered for the NDOH, the South African Department of Education (DOE), and other South African Government partners in collaboration with Harvard University.

ACTIVITY 3:

Building capacity of local organizations through training on promotion of AB messages. This will be done in collaboration with the NDOH and DOE and in line with their priorities.

The provision of technical assistance to the NDOH for AB prevention activities will continue to support PEPFAR's goal of preventing 7 million new infections worldwide. These activities also support the HIV prevention goals outlined in the USG Five-Year Strategy for South Africa.

Since the majority of the funds will be used to support a technical advisor for the NDOH for youth-focused prevention activities, the PEPFAR indicators do not reflect the activities supported in this COP entry. Small amounts of funds will be allotted for activities at the request of the NDOH, primarily focused on training. However, the actual training activities have not been fully discussed at this time so no targets have been set.

INTEGRATED ACTIVITY FLAG: This activity is in support of the National Department of Health (NDOH). CDC carries out additional activities in support of NDOH, including in the PMTCT (#7369), AB (#7966), TB/HIV (#7365), CT (#7366) and SI (#7364) program areas. Together, these activities provide HIV and AIDS programmatic support to NDOH and supplement its ongoing program.

BACKGROUND: The ETR.Net is the software application conceived, developed, and managed by the NDOH National TB Control Program (NTCP) and reflects program-defined needs and inputs. This has been developed by WamTechnology CC, a South African private information technology firm. Funding for this activity supports a CDC direct hire for programmatic management and oversight and a locally employed staff (LES) coordinator for TB/HIV surveillance technical assistance.

ACTIVITES AND EXPECTED RESULTS:

ACTIVITY 1: TB/HIV Surveillance. All TB patients are recommended to receive provider-initiated, diagnostic HIV testing and counseling. Implementation of these recommendations entails the addition of HIV testing and follow-up data elements to the national TB recording and reporting system. An assessment of the TB/HIV forms in ETR.Net in early 2006 demonstrated that healthcare workers widely accept the importance of these data and that the availability of standard tools and forms helped drive routine offer of these services.WamTechnology works with CDC South Africa and the NTCP to develop software and provide support for the ETR.Net. The ETR.Net was successfully deployed by the NTCP to monitor key TB indicators in all nine provinces of South Africa. This software has been modified to track HIV testing and care services among TB patients. The TB/HIV module has been field tested in one district in North West province and the Cape Metropolitan area. Expected results include strengthening of TB/HIV recording and reporting system to include patient-level data collection on TB/HIV (TB patients counseled and tested for HIV, started on cotrimoxazole (CTX), referred for HIV care and starting antiretroviral treatment (ART)). This will in turn be used to bolster referral systems between services leading to more comprehensive care for TB/HIV patients.The ETR.Net is one tool in a package that USG supports and includes the following components:

(a) Needs Assessment to prepare for TB/HIV training.

(b) TB/HIV Surveillance Training Course (4 days).

(c) TB/HIV Surveillance Training Roll-out (one-day sessions).

(d) Follow-up evaluation of HIV testing of TB patients.

The M&E package will be combined with another CDC-GAP training package, How to

Incorporate HIV Diagnostic Counseling and Testing into TB Clinics, to ensure increased

delivery of routine HIV testing in TB patients. Settings offering TB services are a logical point-of-entry for expanded HIV care and treatment services thereby contributing to Emergency Plan 2-7-10 objectives.

ACTIVITY 2: TB/HIV integration - Screening. With support from the NDOH, funds will expand the model for TB/HIV integration in Eastern Cape Province to include rural and areas hardest to reach. Replication of TB/HIV integration activities using the existing model implemented in this province through AMREF can expedite this implementation and assist South Africa with the expansion of screening and referral methods for TB/HIV integration.

ACTIVITY3: Improving MDR and XDR-TB reporting and surveillance systems. With support from the NDOH, funds will be used to respond to technical assistance requests from the SA National Health Laboratory Systems (NHLS). NHLS currently maintains a large data warehouse (DW) that is used to extract laboratory data from existing NHLS laboratory information systems (LIMS). This system requires strengthening and NHLS is actively working to improve the capacity and utility associated with this system. The currently proposed funds would be used to provide TA to assist in development of systems that

would improve the management and reporting of MDR and XDR-TB cases, data mining activities, and surveillance analysis from the NHLS DW.

ACTIVITY 4: Surveillance system of MDR/XDR. In collaboration and with support from the NDOH, funds will be used to develop an electronic surveillance system for MDR/XDR TB surveillance data collection (patient and laboratory data sources), reporting, and analysis and to ensure timely surveillance of MDR/XDR cases in South Africa.

ACTIVITY 5: TBHIV integration - Treatment and Management. In collaboration with the NDOH, implement field-based DOT program in 2 districts with high default rates. Efforts would include treatment monitoring in addition to patient tracking and management using Community health care workers. Project would be evaluated and compared to other DOT models.

ACTIVITY 6: TBHIV Strategic Plan. Funds will be used to support the development of a TB/HIV strategic plan for South Africa PEPFAR Partners. The purpose of the plan will be to develop a forward plan for TBHIV activities within the SA PEPFAR TBHIV portfolio, linking activities to Gates/WHO/OGAC TBHIV plan as well as SA NDOH TB Strategic plan.

INTEGRATED ACTIVITY FLAG:

This activity is one of five activities in support of the National Department of Health (NDOH). Additional activities include PMTCT (#7369), Strategic Information (#7960), ABl (#7966) and ARV Services (#7368). Taken as a whole, these activities provide overall HIV and AIDS programmatic support to the NDOH and supplement their ongoing program. Counseling and Testing (CT) specific activities are represented in the NDOH operational plan, and contribute to the overall implementation of the national CT program.

SUMMARY:

The aim of this project is to provide technical assistance to the NDOH and provincial health departments to ensure expansion and strengthening of CT services in all nine provinces. Target populations for these activities include host country government, healthcare workers and community healthcare workers. PEPFAR funds will be used to employ two full time CT technical advisors to be placed at NDOH to assist with the coordination of CT activities, enhance capacity of NDOH CT staff by providing support for the NDOH annual CT technical meeting, and to support the piloting of routine testing in five public facilities sites per province. At the request of NDOH, CDC will also use PEPFAR funds to support the African Medical and Research Foundation (AMREF) to address the need to strengthen voluntary counseling and testing (VCT) services in partnership with the Eastern Cape Department of Health. CDC also will also increase the number of youth who will know their status for HIV and AIDS through CT in youth-friendly settings.

BACKGROUND:

The goal of the National CT program is to ensure the universal access to HIV counseling and testing. The purpose of this project is to provide technical assistance to NDOH by funding two CT technical advisors to work within the NDOH on all aspects of the program. Responsibilities of the technical advisors include focusing particularly on development of national guidelines on routine testing and the training of healthcare providers. The technical advisors will also monitor the piloting of routine testing in all provinces. They will also assist in the development and implementation of quality assurance guidelines around HIV testing.

CDC will work with youth-friendly clinics and AMREF in increasing access to counseling and testing.

The goal for this new project will be to increase the number of youth who know their status for HIV and AIDS through CT in youth-friendly settings. South African CT Activity Managers will assist with the assessment of where the new sites will be and with introduction to provincial health departments when needed.

The project will also support capacity building of healthcare workers and community healthcare workers, development and implementation of provincial CT specific operational plans, strengthening of national and provincial reporting systems, coordination of the national CT steering committee meeting, development of a monitoring and evaluation system for early infant diagnosis and strengthening service delivery through the implementation of systems strengthening activities.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Technical Assistance to NDOH

Technical assistance to NDOH will be conducted by two technical advisors. Although both will engage with NDOH regularly, one of the advisors, who will be a locally employed staff person, will work at the National program. Specific technical assistance to the national CT program will be around capacity building for all cadres of healthcare workers, monitoring and evaluation, the development of protocols and guidelines, and the piloting of routine testing in all nine provinces.

The responsibility of the technical advisors will include support for the provision of quality HIV testing which will require: the development and implementation of quality assurance

guidelines on HIV testing; standardization of national quality assurance guidelines; and supervision of quality training for all CT coordinators, laboratory technicians and nurses who conduct HIV testing.

Support will also be provided for the accreditation of non-medical voluntary counseling and testing (VCT) facilities according to the NDOH requirements as well as the revision of all current training materials relating to CT.

In addition, PEPFAR funds will support skills enhancement of current NDOH and provincial staff by providing support for the national CT technical meeting and attendance of NDOH CT staff at the International HIV and AIDS meeting.

ACTIVITY 2: AMREF Support

The African Medical and Research Foundation aims to address the need to strengthen VCT services in the Eastern Cape in partnership with the provincial Department of Health. The project is comprised of a series of coordinated interventions which aim to achieve two main outcomes: (1) to assess and build the capacity of the selected VCT sites in the Eastern Cape (Amatole, Chris Hani and Ukhahlamba districts), and (2) to strengthen the integration and coordination of HIV and TB services in selected facilities in the same areas. The target population includes health professionals working in VCT and TB services, lay counselors, directly observed treatment short course (DOTS) supporters, traditional leaders and local communities. AMREF will emphasize the strengthening of VCT services and coordination of VCT and TB services to enable increased access to and quality of VCT services.

ACTIVITY 3: Increasing the Number of Youth Who Know Their HIV Status

The goal for this project will be to increase the number of youth who will know their status for HIV and AIDS through CT in youth-friendly settings. The ACTS-like (Assess, Counsel, Test, Support) model will be used with a focus on youth in underserved areas of South Africa. Underserved may relate to the lack of youth-friendly CT sites, or areas with high prevalence among a large youth population that are not seeking to know their status. South Africa CT Activity Managers will assist with the assessment of where the new sites will be and with introduction to provincial health departments when needed.

The first phase of implementation will include consultation with CDC South Africa to assess suitable locations and determine the feasibility and readiness for new sites. The next phase would include an update or revision of the curriculum/training materials and training of appropriate local staff. The third phase includes CT with youth. Data collection will include standard PEPFAR indicators in addition to using the brief questionnaire used in the Khayelitsha pilot that provided information on the changes in behavior by youth post CT.

For this activity, consulting time will be required from a project manager, a part-time health educator and a part-time psychologist who will assess potential sites, prepare materials, train and mentor counselors.

This program will contribute to 2-7-10 goals by ensuring the implementation of quality CT services and increasing access to CT services.

These targets will be moved to the new partner. The remaining funds are largely paying for staff salaries. Only indirect targets apply.

INTEGRATED ACTIVITY FLAG:

This activity is one of six that CDC funds in support of the National Department of Health (NDOH). Together, these activities provide overall HIV and AIDS programmatic support to the NDOH. Additional activities include PMTCT (#7369), TB/HIV (#7365), Abstinence and Be Faithful (#7966), Strategic Information (#7364) and Counseling and Testing (#7366).

SUMMARY:

PEPFAR funding is set aside to support the National Department of Health (NDOH) in the implementation of the Comprehensive Plan for HIV and AIDS Care, Management and Treatment, by providing financial and technical assistance to ensure greater access to antiretroviral treatment. In addition, FY 2007 funds will be used to continue work started in FY 2006 to strengthen the capacity of treatment programs to screen for and manage TB, and ensure TB/HIV integration as per South African policies and guidelines. The major emphasis area is human resources.

BACKGROUND:

This is an ongoing activity in support of the National Department of Health, and has received PEPFAR funding since FY 2005. The activities are implemented by CDC staff supporting the National Department of Health, and will, when necessary, involve contracting out services.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: CDC staff member costs

Staff and travel costs for a locally hired CDC staff member to provide support to the National Department of Health (including the nine provincial health departments) when required in the implementation of the Comprehensive Plan. This includes regular provincial consultations with PEPFAR partners working within a specific province to ensure coordination and integration with the South African Government (SAG).

ACTIVITY 2: Screening algorithm

The USG will support integrated TB/HIV activities in sites providing antiretroviral treatment (ART) by implementing a simple screening algorithm for TB screening, diagnosis, referral and care developed in FY 2006 in two Catholic Relief Services sites, and by expanding this to new sites and partners in FY 2007 to improve TB/HIV collaborative activities.

ACTIVITY 3: Meetings with stakeholders

At least six meetings will be held with external stakeholders, including those supported by PEPFAR. All stakeholders will be involved with providing ARV services, and these meetings will ensure proper coordination with the South African Government, and share lessons in implementing antiretroviral treatment programs.

ACTIVITY 4: Communication materials

FY 2007 funds will be used to develop and distribute communication and marketing materials to the nine provincial management teams and PEPFAR partners relating to ART. This includes the distribution of technical materials to strengthen the five priority areas for FY 2007: human capacity development; pediatric HIV care and treatment; scaling up HIV counseling and testing; TB/HIV integration; and implementing a down referral system that allows for HIV care and treatment at the primary healthcare level.

These activities contribute to the implementation of the 2-7-10 PEPFAR goals by strengthening the capacity of the National Department of Health and the nine provincial health departments to implement the Comprehensive Plan, and ensure improved access to treatment.

INTEGRATED ACTIVITY FLAG: This activity is one of five activities in support of the National Department of Health (NDOH). This activity also relates to PMTCT (#7369), CT (#7366), AB (#7966) and ARV Services (#7368). SUMMARY: PEPFAR funds will support the NDOH to implement M&E activities in HIV and AIDS programs. The major emphasis areas are the development of health management information systems, with minor emphasis on improving information technology and communication infrastructure, M&E and reporting, targeted evaluation, and proposed staff for Strategic Information (SI). Target populations include South African policy makers, members of the National AIDS Control Program, and other NDOH staff. Activities described in this COP entry are those that have been requested by the national or provincial Departments of Health for SI. BACKGROUND: The NDOH currently lacks trained M&E personnel for specialized information gathering and management tasks. Data on disease surveillance and HIV and AIDS service uptake are often not up to standard and/or not transmitted in a timely manner, negatively impacting the NDOH's ability to effectively analyze epidemiological trends. CDC has provided technical support for M&E since 2003, including developing standard indicators, developing policies and guidelines and training tools. Funds will be used to expand the NDOH's M&E activities, especially its human capacity development at the national and provincial levels. ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Training Funds will be used to conduct orientation sessions on M&E for HIV and AIDS program staff. The sessions will new (and existing) M&E officers, and will inform staff of the importance of M&E in measuring the effects of the HIV epidemic. Staff will be trained to use the District Health Information System (DHIS), an electronic database that tracks disease and health indicators, and trained to use sophisticated M&E techniques for program planning. HIV and AIDS program staff will be trained in data management techniques. ACTIVITY 2: Staff There are four SI positions included as part of this COP entry. 1) An M&E Advisor, who is seconded to the NDOH HIV and AIDS Directorate, will continue to provide technical assistance to the NDOH and provincial health departments to support data use and analysis efforts at the NDOH. 2) An M&E Advisor based at the CDC office will continue to work closely with the NDOH, in addition to working with PEPFAR partners, on activities including management information systems, data issues, and activities with the Western Cape Department of Health (WCDOH). 3) A Management Information Systems (MIS) specialist will soon be hired with FY 2006 funds and will continue to work in FY 2007. In November 2005, the USG convened a meeting of PEPFAR partners and the South African Government (SAG) to discuss health management information systems with a specific focus on those used by partners working in antiretroviral services. It became apparent that USG, in collaboration with the SAG, needed to work closely to collaborate on implementing these systems and to improve communication standards among systems. In FY 2006, the MIS specialist will conduct an assessment of USG-supported MIS. In FY 2007, the assessment results will lead to an improved investment strategy in MIS and work towards aligning systems. The position will provide support to partners, especially those working in the public sector, and will provide technical assistance to the NDOH on MIS. The position will also be available to provide technical assistance in MIS to other SAG departments. 4) A Data Analyst will be hired with FY 2007 funds to improve the data analysis of PEPFAR data and assist in providing feedback to partners and the SAG about PEPFAR activities. The USG is currently in discussions with the provincial departments of health to improve collaboration and communication about PEPFAR-funded activities. This position will assist in facilitating these activities in the future. ACTIVITY 3: GIS PEPFAR funds will support the development of a geographic information system (GIS) program in the NDOH. Funds will be used to purchase software and to train at least two additional M&E officers at the national level on how to use GIS for HIV and AIDS programs. ACTIVITY 4: Western Cape Department of Health The following activities have been requested by the WCDOH with FY 2007 funds.

1) Respondent Driven Sampling (RDS) Surveys. With FY 2006 funds, CDC, in collaboration with the WCDOH and the Medical Research Council (MRC), is conducting an RDS survey to gather behavioral and epidemiological surveillance data on older men who have multiple younger female sex partners, which has been identified as a high risk group contributing to HIV transmission. The RDS survey is conducted in Khayelitsha township in the Western Cape. RDS has often been used to sample most at risk populations that are often hidden (e.g., men who have sex with men, sex workers, and injection drug users). The RDS methodology is based on the premise that these populations are linked through networks and not easily reachable though population-based surveys. RDS has never been used for this population and CDC along with the MRC and the WCDOH have decided to use this methodology to gather in-depth information about this population. The results of the survey will identify risk behaviors, perceptions of social norms, and estimate the HIV prevalence in this high risk population. If this data-gathering methodology proves successful, the WCDOH will conduct similar surveys in this population for routine behavioral and HIV surveillance on a yearly basis. The information gathered will guide the development and evaluation of HIV prevention activities, especially those targeting male norms and behaviors. With FY 2007 funds, the WCDOH has requested assistance to use RDS surveys in other higher risk populations. Some of the sub-populations to be examined include men who have multiple sex partners in rural areas and women who are the casual girlfriends of older men. 2) Evaluation of the peer education programs in the Western Cape secondary schools to look at their effect on knowledge, attitudes, and behavior change. 3) Evaluation of the nutrition supplements given in HIV programs, and strengthening nutrition support for HIV-infected patients. The NDOH provides nutritional support to HIV-infected persons. However, there is no standardized counseling or standardized method to capture data. The nutrition supplementation and the HIV clinical care data sets are not linked; and therefore, an opportunity to monitor the effect of the nutrition intervention is being lost. With FY 2007 funds, CDC and MRC will work with the WCDOH to train their nutritionists and dieticians, and to strengthen their information systems to effectively gather information and evaluate the impact of nutritional supplements on clinical outcomes. This should increase the efficiency of the program by optimizing the protocol for nutrition supplements. Improving the NDOH's ability to collect, process and utilize SI will directly contribute to improvements in HIV and AIDS service delivery by having the information available for decision making purposes. These improvements, in turn, will have a positive impact on South Africa's ability to prevent new infections, care for patients living with HIV, and provide treatment for those with AIDS, in support of PEPFAR's goals. These efforts also support the USG Five-Year Strategy for South Africa by building capacity within the South African Government. 4) Evaluation of a ‘Prevention with Positives' intervention within a clinical setting that provides ART within the Western Cape public sector.