This entry is not part of the Nelson Mandela School of Medicine. This entry has been moved to University of KwaZulu Natal, Mechanism 5680, Activity number 10997.

Targets

Target Target Value Not Applicable Indirect Number of service outlets
Indirect number of women provided with a complete package of
PMTCT services Indirect number of women provided ARV prophylaxis for PMTCT
Indirect number of people trained for PMTCT services
Number of infants born to HIV positive mothers that receive a
complete course of cotramoxizole (from 6 weeks - 1 year) Indirect number of infants born to HIV positive mothers that receive
a complete course of contramoxizole (from 6 weeks - 1 year) Number of mother-baby pairs followed up over 12 month period
Indirect number of mother-baby pairs followed up over 12 month
period Indirect number of pregnant women who received HIV counseling
and testing fo PMTCT and received their results Number of service outlets providing the minimum package of
PMTCT services according to national and international standards Number of pregnant women who received HIV counseling and
testing for PMTCT and received their test results Number of HIV-infected pregnant women who received
antiretroviral prophylaxis for PMTCT in a PMTCT setting Number of health workers trained in the provision of PMTCT
services according to national and international standards Table 3.3.01:

INTEGRATED ACTIVITY FLAG:

The Nelson Mandela School of Medicine carries out integrated activities described in Basic Health Care and Support (#7424), CT (#7425), Other Prevention (#7423) and support to OVC (#7426).

SUMMARY:

The University of KwaZulu-Natal Nelson Mandela School of Medicine (NMSM) uses PEPFAR funds to work closely with the KwaZulu-Natal and Ethekwini Traditional Health Practitioner Councils to tease-out, refine and outline culturally appropriate and effective behavior change messages focused on preventing the spread of HIV through abstinence and being faithful in relationships. The major emphasis area is information, education and communication, with minor emphasis given to community mobilization and participation, the development of network/linkage/referral systems, human resources, quality assurance and supportive supervision, and strategic information. The target population will include public and private sector traditional health practitioners (THPs) (members of the KwaZulu-Natal and Ethekwini Traditional Health Practitioner Councils).

BACKGROUND:

The University of KwaZulu-Natal has an ongoing collaboration with associations of traditional health practitioners in urban, peri-urban and rural areas of Ethekwini District, KwaZulu-Natal province. THPs are influential in KwaZulu-Natal, and are a largely untapped resource in HIV prevention and mitigation on the community level. THPs ascribe to and uphold traditional African cultural values, including conservative attitudes toward sexual practices and abstinence that make them natural partners in this effort. These values are a set of social and community norms that support delaying sex until marriage and that denounce coerced sexual activity (key legislative issue) among unmarried individuals. This THP cultural perspective has not been reinforced, nor has it been included in public abstinence and being faithful (AB) campaigns in KwaZulu-Natal. Given the position the THPs hold in their social networks, working with the THPs holds great promise for enhancing the uptake of a culturally appropriate version of the AB message. These activities began in August 2005 with the arrival of FY 2005 PEPFAR funding. NMSM is implementing the project in collaboration with the KwaZulu-Natal and Ethekwini Traditional Health Practitioner Councils.

ACTIVITIES AND EXPECTED RESULTS:

It is widely acknowledged among health professionals in KwaZulu-Natal that the Abstinence, Be Faithful and correct and consistent use of Condoms (ABC) messages are not having enough effect in this local cultural context. This project trains and mobilizes THPs in KwaZulu-Natal so that they will be effective promoters of HIV prevention messages and strategies, including AB-focused behavior change messages.

1. NMSM is adapting Abstinence/Be Faithful messages to the cultural and healing contexts in KwaZulu-Natal to inform and communicate effective behavior change messages.

2. NMSM is developing prevention messages together with the THPs and incorporating these messages into training workshops on an ongoing basis.

3. Development of new prevention message formats for posters, pamphlets, instructional medical comic books, and medical animations for training and for distribution to the THPs to use with their patients.

These messages are developed in Zulu and English, though they will be distributed primarily in Zulu. This project has also been developing dramatic presentations that are used in the training workshops to deliver prevention messages. These have been designed by the senior THPs on the project team and are embedded in Zulu cultural practice. The prevention messages are all being developed jointly with the THP team members so that they are culturally embedded and effective. Discussions with senior traditional healers on the PEPFAR-funded team indicate they have a variety of interesting, potentially effective suggestions for ways to deliver modified and improved prevention

messages to the community that go beyond the confines of the traditional healer practice sites.

The following activities will take place:

1. Ongoing assessment workshops (usually one day) with the THPs on the program to assess the effectiveness of the prevention messages and prevention message material for use in their practice.

2. Ongoing assessments of the level of absorption and understanding (amongst the THPs) of the basic scientific information underlying the rationale of the need for prevention activities, particularly in the value of abstinence in preventing infection.

3. Ongoing investigation and assessment of the value of partner reduction and faithfulness to one partner, and assessment of the effectiveness of faithfulness if the other partner is not also being faithful (particularly relevant in marriage situations).

4. Meeting with indunas and amakhosi: these are headman and chiefs of the tribal areas. Traditional healers meet with these leaders who command some authority in their communities, and work together to speak to their constituents about prevention. Target communities include townships and urban areas.

5. Engaging parents: Modern mothers have often lost the knowledge of the traditional ways of protecting their daughters and helping them to be abstinent. Traditional healers trained during this program visit women's clubs and work with mothers to reintroduce these practices.

Expected results include:

1. Recruiting traditional healers who come through the training program and demonstrate particular effectiveness as communicators of prevention messages.

2. Further development, implementation and refinement of Zulu-culture-specific messages of AB that work with the patients, as well as their families and associates, who visit traditional healers, including dissemination through other culturally-specific community venues. Delivery of these messages will also occur through innovative multi-media medical education tools.

3. THPs will visit homes in their communities spreading prevention messages.

4. Remove the misperception by Zulus that Westernized healthcare messages that include what biomedical people think of as the essential and critical facts are inaccurate, deceptive and misleading.

5. Clarification in the minds of the general populace in the Zulu communities of the real source of HIV and the real causes for AIDS as well as real and effective methods of prevention.

6. Increase uptake of HIV and AIDS prevention messages from the healers, working with gender equity and behavioral norms of men and women (key legislative issue).

7. Assessing the effectiveness of these prevention messages.

Formally integrating traditional healers into the public healthcare system is a stated objective of the National Department of Health, and the prevention objectives in the South African Strategic Plan for HIV and AIDS. By expanding access to culturally and scientifically appropriate prevention messages, the Nelson Mandela School of Medicine will directly contribute to the PEPFAR goal of preventing 7 million new infections. These activities also support the prevention objectives outlined in the USG Five-Year Strategy for South Africa.

INTEGRATED ACTIVITY FLAG:

The Nelson Mandela School of Medicine carries out integrated activities described in AB (#7422), Palliative Care (#7424), CT (#7425), Other Prevention (#7423) and support to OVC (#7426).

SUMMARY:

The Nelson Mandela School of Medicine (NMSM) is using PEPFAR funds to support the development and implementation of innovative prevention messages specifically adapted to the cultural practices of traditional healers (isangomas and izinyangas) in KwaZulu-Natal. The major emphasis area for this program is information, education and communication, with minor emphasis placed on community mobilization and participation, human resources, policy and guidelines, quality assurance and supportive supervision, and strategic information. The target population includes traditional health practitioners (THPs) in the private and public sector who are members of the KwaZulu-Natal and Ethekwini Traditional Health Practitioner Councils.

BACKGROUND:

The University of KwaZulu-Natal has an ongoing collaboration with associations of traditional healers in Ethekwini District, and the larger KwaZulu-Natal province. Traditional Healers are extremely influential in KwaZulu-Natal, and are a resource in HIV and AIDS prevention and mitigation on the community level. They are also generally considered to hold conservative attitudes towards sexual practices and abstinence that make them natural partners in HIV prevention efforts. This project provides THPs with the necessary tools and training to act as effective HIV prevention agents. The message of Abstinence, Be Faithful, and Condoms (ABC) has not been entirely successful in the Zulu cultural context. These issues are continuously explored with the THPs in our program and we are constantly developing more effective ways of communicating prevention messages that resonate in the Zulu cultural context. Project training, prevention message delivery and follow-up with the THPs emphasize a clear understanding of the facts of viral transmission in sexual practices and the necessity of barrier methods to prevent viral transmission during sex. THPs work with their patients and the community to change cultural practices (non-sexual) that can contribute to viral transmission, such as blood-letting, scarification (use of razor blades to make incisions for rubbing herbs directly into the bloodstream), and skin puncturing using porcupine quills that are frequently used in an African type of acupuncture. Prevention messages delivered in training courses and follow-up work with THPs emphasize the biomedical facts of viral transmission and the vital necessity of safety precautions to prevent viral transmission in these cultural practices. In FY 2005, with the arrival of PEPFAR funding, NMSM trained 221 traditional healers to deliver HIV prevention messages to their clients and communities. NMSM will implement the project in collaboration with the KwaZulu-Natal and Ethekwini Traditional Healer Councils.

ACTIVITIES AND EXPECTED RESULTS:

1. Although NMSM is already engaging South African Government healthcare workers in biomedical facilities, PEPFAR funds will allow for additional individuals to work full-time on increasing collaboration and communication with government health workers. NMSM considers it a vital aspect of their work since it seeks to integrate traditional healers into the public healthcare system. 2. NMSM will build on English and Zulu language prevention messages developed with the traditional healers by the KwaZulu-Natal Provincial Department of Health. This project will also promote the understanding of infectious disease in the traditional healer culture. Engagement with THPs through this project both in training workshops and follow-up work have made it clear that the majority of THPs were previously uncertain about what HIV is, that there is a "virus" that is transmitted, how this virus is transmitted both sexually and through cultural healing practices, and how to prevent this transmission. Similarly most THPs were unclear about what the virus does inside the body, how the activity of the virus leads eventually to AIDS, and what steps could be taken to slow this progression. It was also unclear to most THPs what the relationship was between HIV transmission and other sexually transmitted infection (STI) transmission, and why it was so important to treat and clear up other STI pathologies. In KwaZulu-Natal, HIV and AIDS

are a heterosexual pandemic, and largely a behavior-driven epidemic.

The following activities will be achieved:

1. NMSM will work to increase uptake of HIV and AIDS prevention messages from the healers by both genders (increasing gender equity in HIV and AIDS programs, key legislative issue), specifically looking into novel ways to instill behavior change ideas into the community. 2. Community mobilization/participation will be used to enhance the capacity of traditional healers to deliver prevention messages as they work with their patients and their families. A small number of medical school faculty, support staff and traditional healers will receive salaries in order to facilitate this project. Specifically, they will be responsible for monitoring and evaluation and training. 3. Monitoring and evaluation activities will measure the effectiveness of these interventions. Supervision and monitoring will be achieved through regular site visits. Data from these activities will contribute to the development of policies and guidelines for working with traditional healers. 4. Local organization capacity development will expand the capacity of the School of Medicine, the Ethekwini and KwaZulu-Natal Traditional Health Practitioner Councils. Through regular staff site visits, quality assurance and supportive supervision of the development and implementation of prevention messages will be carried out.

Expected Results: - The development of new, innovative prevention messages in English and Zulu, including messages to change cultural practices (non-sexual) that can contribute to viral transmission. - The development of better understanding of cultural perceptions, leading to better prevention messages. - Train THPs and Improve their prevention message delivery capacity as they work with their patients and the patient families. - Increased condom usage among sexually active community members who are not amenable to abstinence/be faithful prevention messages (male norms and behaviors, key legislative issue). - Assessment of the effectiveness of Other Prevention approaches within the Zulu cultural context in Ethekwini.

By expanding culturally and scientifically appropriate prevention messages to communities that receive much of their healthcare from traditional healers, the Nelson Mandela School of Medicine will directly contribute to the realization of PEPFAR's goal of preventing 7 million new infections. These activities will also support efforts to meet the prevention objectives outlined in the USG Five-Year Strategy for South Africa.

INTEGRATED ACTIVITY FLAG:

The Nelson Mandela School of Medicine carries out integrated activities described in AB (#7422), Basic Health Care and Support (#7424), CT (#7425), Other Prevention (#7423), and support to OVC (#7426).

SUMMARY:

The Nelson Mandela School of Medicine (NMSM) is using PEPFAR funds to support the implementation and refinement of common clinical guidelines for HIV and AIDS management by traditional healers, including: the standardization of HIV clinical staging for traditional healers; collaborative introduction of Patient Record Keeping, Monthly Data Sheets, and Data Transfer to the Medical School; and provision of basic medical supplies to trained healers. The main emphasis area is first in training, with minor emphasis placed on human resources, logistics, policy and guidelines, quality assurance and supportive supervision, and strategic information. The target population includes Traditional Health Practitioners (THPs) in the private and public sector who are members of the KwaZulu-Natal and Ethekwini Traditional Health Practitioner Councils.

BACKGROUND:

The University of KwaZulu-Natal has an ongoing collaboration with associations of traditional healers in rural areas of Ethekwini District. Traditional healers are extremely influential in KwaZulu-Natal, and are a largely untapped resource in HIV and AIDS prevention and mitigation on the community level. These activities began in August 2005 with the arrival of FY 2005 PEPFAR funding. NMSM is implementing the project in collaboration with the KwaZulu-Natal and Ethekwini Traditional Healer Councils.

ACTIVITIES AND EXPECTED RESULTS:

The principal focus of this project will be training and equipping traditional healers to better deal with the HIV and AIDS epidemic in KwaZulu-Natal.

ACTIVITY 1: Training

Training will be provided through workshops run by the project training team (including senior traditional healers). Trained THPs will be provided with a customized version of the home-based care medical kit currently used by the KwaZulu-Natal Department of Health (DOH), modified to include the elements of the Adult Preventive Care Package endorsed by the CDC (micronutrients and vitamins). Training includes the refinement and implementation of common clinical guidelines for HIV and AIDS patient management by traditional healers, including the standardization of HIV clinical staging, the introduction of patient record keeping, monthly data sheets, and transfer of these data to the Medical School.

ACTIVITY 2: Referrals

NMSM is working closely with South African Government colleagues to establish viable bi-directional referral pathways (including referral forms); formalizing and enhancing what is currently happening.

ACTIVITY 3: Monitoring and Evaluation

NMSM will also ensure that traditional healers have adequate stocks of appropriate medical supplies, through collaboration with the provincial Department of Health. Regular site visits will be conducted to monitor the implementation of these guidelines and data management protocols.

ACTIVITY 4: Gender Issues

In all of these activity areas NMSM is working with the Traditional Healers to ensure gender equity in basic care (key legislative issue). This includes information on healthy modifications of behavioral norms for men (key legislative issue) and women. NMSM will

support THP service outlets that will provide palliative care through these activities (assuming each THP practice site constitutes a service location).

Expected Results: 1. Refine and implement Standardized Clinical Guidelines for HIV and AIDS management for traditional healers. 2. Develop Standardized Therapeutic Protocol for HIV and AIDS patient management by traditional healers. 3. Improve collaboration and referral between biomedical and traditional healers. 4. Improve record keeping by traditional healers and availability of the anonymous data to public health authorities. 5. Provide adequate basic care package to trained traditional healers. 6. Assess the usefulness of working with traditional healers to enhance their capacity to provide palliative care to HIV-infected patients. 7. Human resources: Through this activity, traditional healers will be trained, equipped, and empowered. A small number of medical school staff, traditional healer representatives, and support staff receive salaries from the project for monitoring and evaluation and training.

Logistics: Includes managing the care package supply, re-supply, and medical waste removal with the trained traditional healers and government colleagues. This overlaps with commodity procurement since NMSM funds will purchase the care packages. Through regular site visits quality assurance and supportive supervision will be conducted on the use of adapted clinical guidelines and HIV staging, care packages and record keeping systems.

Through monitoring and evaluation record keeping systems, policy and guidelines for working with traditional healers will be developed. By providing new tools and materials to traditional healers working with HIV and AIDS patients, this project will expand basic care and support services in KwaZulu-Natal, contributing to the PEPFAR goal of providing care and services to ten million HIV-affected individuals. These activities will also support efforts to meet the care and treatment objectives outlined in the USG Five-Year Strategy for South Africa.

INTEGRATED ACTIVITY FLAG: The Nelson Mandela School of Medicine carries out integrated activities described in AB (#7422), Basic Health Care & Support (#7424), CT (#7425), Other Prevention (#7423) and OVC (#7426).

SUMMARY: The Nelson Mandela School of Medicine will introduce additional training modules to explore developmental disability prevalence and interventions for orphans and vulnerable children (OVC) seeing Traditional Health Practitioners (THPs), either directly as patients or as family members of patients. The primary emphasis area will be training, with minor emphases in information, education and communication and needs assessment. The target populations are OVC, their caregivers and traditional healers.

BACKGROUND: It is estimated that 6 to 11 percent of South African children under 15 years of age are orphaned due to loss of one or both parents due to HIV and AIDS. These children are particularly vulnerable to neglect within households, marginalization within communities, and are less likely to receive adequate, education, growth and nutrition, regular healthcare and social services. Many of these children may be infected with HIV themselves. This emphasizes the need to address the biopsychosocial problems facing this group of children in addition to access to antiretroviral drugs. Traditional healers may facilitate preventive care in these households and children.

ACTIVITIES AND EXPECTED RESULTS: The traditional healer and the biomedical collaboration will facilitate the following specific activities:

1. Provide support for voluntary counseling and testing (VCT) of OVC, families and child caregivers, including HIV prevention and treatment education.

2. Provide psychosocial support to OVC, their caregivers and families by introducing coping strategies, mental health assistance, counseling and referral for problems that can be dealt with on the biomedical side.

3. Steps 1 and 2 will be included in one-day training modules for THPs (entire FY 2006 cohort) on a ten-question screen for pediatric developmental disabilities as well as for HIV that lay counselors can also use. This will be introduced and adapted to THP practice. OVC are especially at risk for developmental disabilities, delayed school entry, etc. Field evaluation will follow to validate negative or positive screens of OVC. Workers from the Department of Community Health at the Nelson Mandela School of Medicine (NMSM) will apply an inter-rater reliability test for sample THP groups.

4. Stigma and Discrimination:

a. Pilot workshop with smaller group of THPs from FY 2006 cohort to explore assistance and biomedical-traditional healing collaboration on managing stigma and discrimination problems for OVC. Advise on treatment availability and confidentiality.

b. Will explore joint strategies with THPs on disclosure of child's status and daily drug regimens.

5. Integrating child health and wellbeing into home-based care (HBC) for the sick. This will be done in collaboration with our current HBC training modules. THPs visiting patients and patient families can do rapid checks on kids when visiting homes or dealing with parents and determine if OVC are receiving government grants. This will be added to our monitoring and evaluation practices.

6. Improving utilization of public sector services - such as social welfare and health, including facilitating access to antiretrovirals. Ensure that all THPs in the program are fully aware of social security grants available and special facilities for kids, people in communities who receive special training to engage children in early education activities, before pre-school. The same is true for care dependency grants, foster care grants, disability grants. This training and collaboration will form part of training sessions

discussed in item 3 above. THPs could help direct children and their caregivers to social workers at community level instead of patients only meeting a social worker at the tertiary level and having to be referred back to the community level social worker (a common situation currently). Training and interaction with THPs will include discussion of advocacy on behalf of children on issues of guardianship, school attendance, legal issues.

7. Follow up sessions with THPs on these issues during the course of the year to explore implementation successes and failures and needs for modification of training.

The following parameters will be monitored to measure the impact of traditional healer involvement in improving the health and wellbeing of OVC:

1. Numbers of OVC and households in the care of traditional healers;

2. Description of the psychosocial context and needs of OVC and their extended families;

3. Changes in utilization public sector services;

4. Changes in school attendance;

5. Access to social and welfare grants;

6. Access to preventative and curative healthcare services, including antiretrovirals, immunization, growth and nutrition monitoring.

This project contributes PEPFAR's goal of providing care to 10 million people, including OVC by caring for OVC and their primary caregivers. It also contributes to the USG Five-Year Strategy by providing care for OVC through local communities and improving their capacity to deliver quality care for OVC in their communities.

INTEGRATED ACTIVITY FLAG:

The Nelson Mandela School of Medicine carries out integrated activities described in AB (#7422), Basic Health Care and Support (#7424), Condoms and Other Prevention (#7423) and support to OVC (#7426).

SUMMARY:

The Nelson Mandela School of Medicine (NMSM) is using PEPFAR funds to support the implementation and refinement of common clinical guidelines for HIV and AIDS management by traditional healers, including: (1) the standardization of HIV clinical staging for traditional healers; (2) collaborative introduction of patient record keeping, monthly data sheets and data transfer to the Medical School; and (3) provision of basic medical supplies to trained healers. The main emphasis area is first in training, with minor emphasis placed on human resources, logistics, policy and guidelines, quality assurance and supportive supervision, and strategic information. The target population includes Traditional Health Practitioners (THPs) in the private and public sector who are members of the KwaZulu-Natal and Ethekwini Traditional Health Practitioner Councils.

BACKGROUND:

The University of KwaZulu-Natal has an ongoing collaboration with associations of traditional healers in rural areas of Ethekwini District. Traditional healers are extremely influential in KwaZulu-Natal, and are a largely untapped resource in HIV and AIDS prevention and mitigation on the community level. These activities began in August 2005 with the arrival of FY 2005 PEPFAR funding. NMSM is implementing the project in collaboration with the KwaZulu-Natal and Ethekwini Traditional Healer Councils.

ACTIVITIES AND EXPECTED RESULTS:

The principal focus of this project will be on training and equipping traditional healers to better deal with the HIV and AIDS epidemic in KwaZulu-Natal.

ACTIVITY 1: Training

Training will be provided through workshops run by the project training team (including senior traditional healers). Trained THPs will be provided with a customized version of the home-based care medical kit currently used by the KwaZulu-Natal Department of Health (DOH), modified to include the elements of the Adult Preventive Care Package endorsed by the CDC (micronutrients and vitamins). Training includes the refinement and implementation of common clinical guidelines for HIV and AIDS patient management by traditional healers, including the standardization of HIV clinical staging, the introduction of patient record keeping, monthly data sheets, and transfer of these data to the Medical School.

ACTIVITY 2: Referrals

NMSM is working closely with South African Government colleagues to establish viable bi-directional referral pathways (including referral forms); formalizing and enhancing what is currently happening.

ACTIVITY 3: Monitoring and Evaluation

NMSM will also ensure that traditional healers have adequate stocks of appropriate medical supplies, through collaboration with the provincial Department of Health. Regular site visits will be conducted to monitor the implementation of these guidelines and data management protocols.

ACTIVITY 4: Gender Issues

In all of these activity areas NMSM is working with the Traditional Healers to ensure gender equity in basic care (key legislative issue). This includes information on healthy modifications of behavioral norms for men and women. NMSM will support THP service

outlets that will provide palliative care through these activities (assuming each THP practice site constitutes a service location).

Expected results of these activites include: 1. Refine and implement standardized clinical guidelines for HIV and AIDS management for traditional healers. 2. Develop a standardized therapeutic protocol for HIV and AIDS patient management by traditional healers. 3. Improve collaboration and referral between biomedical and traditional healers. 4. Improve record keeping by traditional healers and availability of the anonymous data to public health authorities. 5. Provide adequate basic care package to trained traditional healers. 6. Assess the usefulness of working with traditional healers to enhance their capacity to provide palliative care to HIV-infected patients. 7. Train, equip and empower traditional healers.

This activity will also focus on logistics, which includes managing the care package supply, re-supply, and medical waste removal with the trained traditional healers and government colleagues. This overlaps with commodity procurement since NMSM funds will purchase the care packages. Through regular site visits quality assurance and supportive supervision will be conducted on the use of adapted clinical guidelines and HIV staging, care packages and record keeping systems. A small number of medical school staff, traditional healer representatives, and support staff receive salaries from the project for monitoring and evaluation and training.

Through monitoring and evaluation record keeping systems, policy and guidelines for working with traditional healers will be developed. By providing new tools and materials to traditional healers working with HIV and AIDS patients, this project will expand basic care and support services in KwaZulu-Natal, contributing to the PEPFAR goal of providing care and services to 10 million HIV-affected individuals. These activities will also support efforts to meet the care and treatment objectives outlined in the USG Five-Year Strategy for South Africa.