INTEGRATED ACTIVITY FLAG

This Abstinence and Be Faithful activity is related to Mpilonhle activities in the program areas of Condoms and Other Prevention (#8241), OVC (#8246) and CT (#8247).

SUMMARY:

Mpilonhle's AB prevention activities include school-based provision of (1) health screening, (2) health education and (3) computer-assisted learning, delivered through mobile clinic and computer laboratory facilities to 12 secondary schools in rural KwaZulu-Natal. Emphasis areas are: Information, Education and Communication, Infrastructure, Community mobilization, and Training. Targeted populations are secondary school students and in-school orphans and vulnerable children (OVC).

BACKGROUND:

This is a new activity to be implemented by a new non-governmental organization (NGO) named Mpilonhle with broad support from district and provincial SAG leadership. It will be implemented in Umkhanyakude District, the poorest and most rural district in KwaZulu-Natal, and one with highest HIV prevalence. It involves school-based activities in rural secondary schools that suffer from physical remoteness, poor health conditions, scarcity of health services and generally inadequate resources. Partners include the Department of Education, the South African Democratic Teachers' Union, District Health Services and district and municipal leadership.

These activities will be provided through mobile facilities. Each mobile facility will consist of a mobile clinic and computer laboratory, staffed by one primary care nurse, four health counselors, one health educator, and one computer educator. Each mobile facility will visit a participating secondary school one week per month for eight months per year. This allows each mobile facility to serve four secondary schools per school year. The project will have three mobile facilities, allowing us to serve 12 secondary schools in total. Each participating secondary school has an average of 800 students, and will be offered the first three activities described above. Six of the 12 schools have been pre-selected. The remaining six schools and will be determined in deliberation with the Mayors of Umkhanyakude District, Mtubatuba Municipality, and Hlabisa Municipality, and with local officers of the Department of Education.

This activity addresses gender issues through (1) the provision of AB education to large numbers of adolescent males and females encouraging males to respect females, abandon gender stereotypes, and by discouraging multiple sex partners, (2) computer education which promotes female educational attainment, self-confidence and self-reliance, and employability, which in turn reduce vulnerability to HIV, and in particular to coercive, cross-generational and transactional sex, (3) health education that promotes safer behavior and gender-sensitive attitudes among men and yield benefits to women to make informed choices with regard to their sexual health.

ACTIVITIES AND EXPECTED RESULTS:

Mpilonhle will conduct three activities in this Program Area.

ACTIVITY 1: Schools-Based Health Screening

A health counselor will provide students with an annual individualized health screening that includes voluntary counseling and testing (VCT) and individualized AB counseling. Through this activity, young people will be screened for TB, STIs and other common health problems. Those who are HIV-infected will be referred for CD4 Count and further management at the nearest health sites. Condom-related services will be limited to providing basic, medically accurate information and referrals to community-based condom sources. Main messages will focus on abstinence and delay of sexual debut for young people. Young people need to be reached before they begin having sex. The counseling and testing (CT) will be entry to prevention program especially to sexually active individuals. School principals, local Department of Education officials, district and municipal mayors and focus groups of teachers and students have expressed the community

acceptability of schools-based CT.

ACTIVITY 2: Schools-Based Health Education

A health educator will provide students with four 90-minute small-group HIV, health and life skills education sessions per year that will discuss the basic facts about HIV, CT, STIs, TB, ART, PMTCT; a balanced ABC approach to HIV prevention; reducing stigma and discrimination against PLHIV; and promoting respect between men and women. An age-appropriate curriculum on these topics will be developed by the Educational Development Center (EDC) and the South African Democratic Teacher's Union (SADTU), drawing on material developed by the EDC and SADTU, and the World Health Organization (WHO) summarized in the WHO publication "Teachers' Exercise Book for HIV Prevention". This curriculum emphasizes the traditional three-part public health theory of improving Knowledge, Attitudes and Practice (KAP) skill-building methods in topics such as risk reduction, decision-making, and social responsibility, as a way of preventing HIV infection, providing support to those infected and affected by HIV, fighting stigma and discrimination, and dealing effectively with the challenges of everyday life. The skill-based HIV education will provide focused messages about the benefits of abstinence until marriage and other safe behaviors. Activities will develop their self-esteem to build their resilience, assist them to make informed choices and develop communication skills.

ACTIVITY 3: Schools-Based Computer-Assisted Learning

A computer educator will provide students in participating schools with four 90-minute small-group computer education sessions per year that will provide training on how to use computers, basic software, and the internet; and computer-assisted learning for improved school performance, HIV prevention, and general health promotion. The computer-based health education lessons are packaged to address the life skills needs of youth and are consistent to the SAG guidelines. The AB messages are internationally recognized, appropriately researched messages. This activity is expected to improve student learning, raise graduation rates, and augment employability. This in turn increases female socio-economic status, and reduces their vulnerability to coercive, cross-generational, and transactional sex.

Sustainability will be achieved through 1) political commitment from district and municipal governments, and the local Department of Education who will help in scale-up and fund-raising in support of such scale-up; 2) the relatively low-tech and easily replicable nature of many core program features; 3) minimal dependence on scarce health professional such as doctors and nurses; 4) the ability of rugged mobile facilities to reduce the need for additional investments in fixed physical infrastructure; 5) the possibility of adapting the service delivery model to workplaces as well as schools; 6) the multi-dimensionality of program activities, which includes HIV and AIDS, general health, and education related activities, and which broadens the scope of donors interested in funding continuation and scale-up of activities.

Building human capacity in remote rural areas will occur by maximizing the capacities and skills of relatively abundant lay health workers to enable them to perform critical yet scarce services such as CT, health screening and personalized risk assessment, and health education, shifting the burden of these activities away from relatively scarce professional health workers like nurses and doctors. The organization will build the technical expertise and capacities of lay health workers through rigorous training and regular refresher courses, and through the technological support provided by the Information Technology components of the program.

These activities will contribute to PEPFAR goals of preventing 7 million new infections.

INTEGRATED ACTIVITY FLAG:

The Condoms and Other Prevention (C/OP) activity is related to Mpilonhle activities in the program areas of AB (#8238), CT (#8247), Basic Health Care and Support (#8243) and OVC (#8246).

SUMMARY:

Mpilonhle activities consists of community-based health screenings, which will be conducted by health counselors at 24 community-based (non-school) sites, and will consist of a core of HIV preventive services including individualized voluntary counseling and testing (VCT); personalized abstinence, Be Faithful and correct and consistent Condom use (ABC) counseling, and condom provision to sexually active youth and adults; and group HIV and health education sessions. These services will be delivered through mobile clinic and mobile computer laboratory facilities to 24 community (non-school) sites in rural KwaZulu-Natal. Emphasis areas are: information, education and communication, infrastructure, training, and community mobilization. Targeted populations are adults in the general population.

BACKGROUND:

This is a new activity to be implemented by a new non-governmental organization (NGO) named Mpilonhle with broad support from district and provincial South African government leadership. It will be implemented in Umkhanyakude District, the poorest and most rural district in KwaZulu-Natal province, and one with highest HIV prevalence. Mpilonhle will implement C/OP activities in communities surrounding 12 rural secondary schools that have scarcity of health services and generally inadequate resources, also in areas where individuals with risky behaviors congregate. Partners consist of the Department of Education, the South African Democratic Teachers' Union, District Health Services, and district and municipal leadership.

This activity addresses gender issues through the provision of ABC education and services to large numbers of females in the general population; computer education which promotes female educational attainment and employability, which in turn reduce their vulnerability to HIV, and in particular to coercive, cross-generational and transactional sex; health education that promotes safer behavior and gender-sensitive attitudes among men and yield benefits to women who become their sexual partners. This activity will also promote consistent use of condoms and behavior change through the reduction of sexual partners.

ACTIVITIES AND EXPECTED RESULTS:

Mpilonhle will conduct one activity in the program area. This activity, mobile community-based health screenings, will be conducted by HIV and AIDS counselors at 24 community-based sites outside of schools. Each mobile facility consists of a paired-up mobile clinic and mobile computer laboratory, staffed by one primary care nurse, four health counselors, one health educator, and one computer educator. Each mobile facility will rotate across eight community sites, allowing three mobile facilities to serve 24 sites in total. These 24 community sites will be determined in deliberation with the Mayors of Umkhanyakude District, Mtubatuba Municipality, and Hlabisa Municipality.

The C/OP activity will consist of correct and consistent condom use programs which support the provision of accurate information about condom use to reduce risks for HIV infection and support access for those most at risk populations.

Provision and promotion of information on correct and consistent condom use will be coupled with information about abstinence and behavior change; the importance of HIV counseling and testing (CT), knowing ones HIV status, partner reduction and mutual faithfulness as risk reduction methods. The ABC approach will promote the feeling of dignity and self-worth among the beneficiaries of the services.

The HIV preventive services including individualized CT, personalized ABC, behavior change, HIV and AIDS counseling; referrals to other community-based services for

prevention of mother-to-child transmission (PMTCT), antiretroviral treatment (ART), tuberculosis (TB) and psychosocial support; referrals to a social worker for assistance with accessing government grants and support for orphans and vulnerable children (OVC) or people living with HIV (PLHIV); general health screening and referral for care and other services as required; group computer training; and group HIV and health education sessions.

Group-based HIV and health education will follow a curriculum on these topics to be developed by the Educational Development Center (EDC) and the South African Democratic Teacher's Union (SADTU), drawing on material developed by the EDC in collaboration with SADTU, and the World Health Organization. This curriculum emphasizes the traditional three-part public health theory of improving Knowledge, Attitudes and Practice (KAP) skill-building methods in topics such as risk reduction, decision making, and social responsibility, as a way of preventing HIV infection, providing support to those infected and affected by HIV, fighting stigma and discrimination, and dealing effectively with the challenges of everyday life. PLHIV will be involved in education to fight stigma and discrimination against PLHIV. Issues involving cross-generational sex within their communities will be explored. Sessions will also explore cultural practices that could lead to HIV infection.

Group-based computer education will provide training on how to use computers, basic software, and the internet; and computer-assisted learning for HIV prevention, and general health promotion. This activity is expected to improve knowledge and augment employability. This in turn increases self-confidence, self-reliance and self-sufficiency of women and their socio-economic status, thus reduces their vulnerability to coercive, cross-generational, and transactional sex.

Sustainability of activities is facilitated by political commitment from district and municipal governments, and the local Department of Education to scale-up and to fund-raise in support of such scale-up; the relatively low-tech and easily replicable nature of many core program features, minimal dependence on scarce health professional such as doctors and nurses; the ability of rugged mobile facilities to reduce the need for additional investments in fixed physical infrastructure; declining prices over time for the program's information technology (IT) requirements, the possibility of adapting the service delivery model to workplaces as well as schools, the multi-dimensionality of program activities, which includes HIV and AIDS, general health, and education related activities, and which broadens the scope of donors interested in funding continuation and scale-up of activities.

Building human capacity in remote rural areas contributes to future sustainability of the program. Mpilonhle will respond to this challenge by maximizing the capacities and skills of relatively abundant lay health workers through rigorous training and regular refresher courses to enable them to perform critical yet currently scarce services such as VCT, health screening and personalized risk assessment, and health education, shifting the burden of these activities away from relatively scarce professional health workers like nurses and doctors.

This activity will contribute to PEPFAR 2-7-10 goals of preventing 7 million new HIV infections, and providing care and support to PLHIV.

INTEGRATED ACTIVITY FLAG:

This activity is related to Mpilonhle activities in AB Prevention (#8238), Other Prevention (#8241), Care for OVC (#8246), and Counseling and Testing (#8247). 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:

Mpilonhle will provide elements of HIV-related clinical care and social care through two activities: provision of HIV-related screening, care and prevention, and; school and community-based HIV and AIDS education. These activities will be delivered through mobile clinics deployed to secondary schools and community (non-school) sites in rural KwaZulu-Natal. Emphasis areas are: Human resources, Information, Education and Communication, Infrastructure, and Community Mobilization for HIV awareness and reduction of stigma and discrimination. Targeted populations are PLHIV among secondary school students and PLHIV in the surrounding communities.

BACKGROUND:

This is a new activity to be implemented by a new NGO named Mpilonhle with broad support from District and province-level South African Government leadership. It will be implemented in Umkhanyakude District, the poorest and most rural district in KwaZulu-Natal province, the South African province with the highest HIV prevalence of 39.1%. Implementation will take place in representative rural secondary schools and non-school sites that suffer from physical remoteness, poor health conditions, and inadequate resources. Partners consist of the Department of Education, PLHIV, the South African Democratic Teachers' Union, District Health Services, and District and Municipal leadership.

Gender issues will be addressed in the provision of basic HIV screening and care and prevention messaging to large numbers of male and female adolescent and adult PLHIV (key legislative area), support for disclosure of HIV status and reduction of gender-based violence (key legislative area), involvement of male adolescents and adults in the program (key legislative area), mobilization of community leaders for promoting community efforts against stigma and discrimination, and for raising awareness regarding HIV prevention, care and treatment.

ACTIVITIES AND EXPECTED RESULTS:

These activities will be provided through mobile clinics that visit schools to address the needs of PLHIV in the secondary school population and that visit non-school sites to address the needs of adult PLHIV in the general population. Each mobile clinic is staffed by one primary care nurse, four health counselors, and one health educator. Each mobile clinic will visit a participating secondary school one week per month for eight months per year.

ACTIVITY 1: Screening and provision of basic HIV-related clinical and social care and HIV prevention messaging at schools and in communities

The first component includes HIV and AIDS counselors offering one-on-one health screening, messaging and referrals for preventive care services at secondary schools via a mobile clinic. This will include screening and treating for symptoms indicative of Opportunistic Infections (OI) and other HIV-related illnesses (including TB); individualized counseling on HIV prevention and behavioral change; provision of counseling and testing (CT); provision of counseling in nutrition and personal hygiene; psychosocial support for students (including support for disclosure of status); and referral to essential HIV and AIDS services such as PMTCT, ART, symptoms and pain (including screening and referral to TB services). The partners and focus groups of teachers and students have expressed the community acceptability of schools-based CT and HIV prevention and care services. Effort will be made to ensure equitable access to care services for both males and females. The second social care component includes screening of HIV-related social problems and

referrals to a staff social worker for assistance with accessing government grants and legal services for; PLHIV and their families.

ACTIVITY 2: Group HIV and AIDS education sessions

An HIV and AIDS educator will conduct group education sessions at secondary schools and in surrounding communities that will discuss the basic facts about HIV prevention and care targeted. Topics include the importance of HIV prevention (AB for adolescents and ABC for adults); CT; prevention and care of OIs (including TB and provision of cotrimoxazole prophylaxis), ART adherence; accessing PMTCT services; nutrition counseling; and the importance of personal hygiene and utilizing safe water to reduce diarrheal disease. IEC materials will also be provided. Mpilonhle will work with community leaders and PLHIV to reduce stigma and discrimination against PLHIV and raise community awareness to mobilize for essential HIV prevention, care and treatment services. Efforts will be made to engage male community members and promote respect between men and women in communities. Support will be provided for disclosure of HIV status and strategies to reduce disclosure-related gender-based violence will be encouraged. An age-appropriate curriculum will be developed by the Educational Development Center (EDC) and the South African Democratic Teacher's Union (SADTU), drawing on material developed by the EDC in collaboration with SADTU, and the World Health Organization. This curriculum emphasizes the traditional three-part public health theory of improving Knowledge, Attitudes, and Practice, skill-building methods in topics such as risk reduction, being faithful, decision making, and social responsibility, as a way of preventing HIV infection, providing care to those infected and affected by HIV, respect for women, fighting stigma and discrimination, and dealing effectively with the challenges of everyday life. Group health education provides supportive social care in the form of efforts to reduce stigma and efforts to increase community awareness of care, prevention, and treatment.

Sustainability of activities is facilitated by political commitment from District and Municipal governments, and the local Department of Education to scaling-up and to fund-raising in support of such scaling-up; the relatively low-tech and easily replicable nature of many core program features; minimal dependence on scarce health professional such as doctors and nurses; the ability of rugged mobile facilities to reduce the need for additional investments in fixed physical infrastructure; declining prices over time for the program's information technology requirements; the possibility of adapting the service delivery model to workplaces as well as schools; the multi-dimensionality of program activities, which includes HIV and AIDS, general health, and education related activities, and which broadens the scope of donors interested in funding continuation and scale-up of activities.

Building human capacity in remote rural areas is a critical issue. Mpilonhle responds to this challenge by maximizing the capacities and skills of relatively abundant lay health workers through rigorous training and regular refresher courses to enable them to perform critical yet currently scarce services such as the promotion of elements of the preventive care package and provision of screening for OIs and basic pain and symptoms and health education thus shifting the burden of these activities away from relatively scares professional health workers.

These activities will contribute to PEPFAR goals of providing palliative care to 10 million HIV-infected individuals and their families.

INTEGRATED ACTIVITY FLAG:

This OVC activity is related to Mpilonhle activities in the program areas of AB Prevention (# 8238), Condoms and Other Prevention (#8241), and Counseling and Testing (#8247).

SUMMARY:

The Mpilonhle program will provide Orphans and Vulnerable Children (OVC) with support to access education, economic support, psychosocial support, legal assistance. Mpilonhle will reach the OVC through the implementation of three schools-based activities (1) health screening, (2) health education and (3) computer-assisted learning. These services will be delivered through mobile clinic and computer laboratory facilities to Orphans and Vulnerable Children (OVC) in 12 secondary schools in rural KwaZulu-Natal, South Africa.

Gender issues will be addressed in the provision of care and support to in-school OVC with special emphasis on the girl child. The emphasis areas for this program are Human Resources in the form of salaries for health counselors, health educators, and computer educators, Information, Education and Communication in the form of resources for health education and computer education, Infrastructure in the form of deployment of mobile clinics and computer laboratories and Development of Network/Linkages/Referral Systems through the referral of OVC to the staff social worker. Targeted populations are OVC among secondary school students.

BACKGROUND:

This is a new activity to be implemented by a local NGO, Mpilonhle, with support from the South African Government leadership at the district and provincial level in KwaZulu-Natal. Activities will be implemented in the Umkhanyekude District, the poorest and most rural district in KwaZulu-Natal province, with one of highest HIV prevalence. Mpilonhle will implement activities in 12 rural secondary schools have generally inadequate resources in Umkhanyekude District. Approximately 33% of secondary school students have lost at least one parent. Partners consist of the Department of Education, the South African Democratic Teachers' Union, District Health Services, and District and Municipal leadership.

These activities will be provided through mobile facilities. Each mobile facility consists of a paired-up mobile clinic and mobile computer lab, staffed by 1 primary care nurse, 4 health counselors, 1 health educator, and 1 computer educator. Each mobile facility will visit a participating secondary school one week per month for eight months per year. This allows each mobile facility to serve 4 secondary schools per school year. The project will have three mobile facilities, allowing them to serve 12 secondary schools in total. Six of the 12 schools have been pre-selected. The remaining six schools and the 24 community sites will be determined with the Mayors of Umkhanyakude District, Mtubatuba Municipality, and Hlabisa Municipality and with local officers of the DOE.

ACTIVITIES AND EXPECTED RESULTS:

Mpilonhle will conduct three schools-based activities.

ACTIVITY 1: Health screening

A health counselor will provide students with an annual individualized health screening that includes VCT; individualized AB-counseling for HIV prevention and behavior change; counseling or referral to further services for PMTCT, ART, TB and psycho-social support; and referral to a staff social worker for assistance with accessing government grants and assistance with legal matters. School principals, local Department of Education officials, District and Municipal mayors, and focus groups of teachers and students have expressed the community acceptability of schools-based VCT. This activity provides support for OVC in the form of improving access to health care.

ACTIVITY 2: Health education

A Mpilonhle health educator will provide students with four 90 minute small-group HIV, health and life-skills education sessions per year that will discuss the basic facts about HIV, VCT, STIs, TB, ART, PMTCT; reducing stigma and discrimination against PLHIV; and promoting respect between men and women. An age-appropriate curriculum on these topics will be developed by the Educational Development Center (EDC) and the South African Democratic Teacher's Union (SADTU), drawing on material developed by the EDC in collaboration with SADTU, and the World Health Organization (WHO). This curriculum emphasizes the traditional three-part public health theory of improving Knowledge, Attitudes, and Practice (KAP), skill-building methods in topics such as risk reduction, being faithful, decision making, and social responsibility, as a way of preventing HIV infection, providing support to those infected and affected by HIV, respect for women, fighting stigma and discrimination, and dealing effectively with the challenges of everyday life. Group health education provides supportive social care in the form of efforts to reduce stigma and efforts to increase community awareness of care, prevention, and treatment. This activity will provide support to OVC in the form of psychosocial support and HIV prevention messages.

ACTIVITY 3: Computer-assisted learning

An Mpilonhle computer educator will provide students in participating schools with four 90 minute small-group computer education sessions per year that will provide training on how to use computers, basic software, and the internet; and computer-assisted learning for improved school performance, HIV prevention, and general health promotion. This activity is expected to improve student learning, raise graduation rates, self-confidence and employability. This in turn increases self-reliance, self-confidence and self-sufficiency and the socio-economic status of the females, thus reduces their vulnerability to coercive, cross-generational, and transactional sex. This activity will improve educational development of OVC through computer-assisted learning and will encourage OVC to stay in school and complete their education. In addition, having computer skills will improve the market skills and employability of OVC that head households.

Sustainability of activities is facilitated by building human capacity in remote rural areas.

Mpilonhle maximize the capacities and skills of relatively abundant lay health workers to enable them to perform critical yet currently scarce services such as VCT, health screening and personalized risk assessment, and health education, shifting the burden of these activities away from relatively scares professional health workers like nurses and doctors. Mpilonhle will build the technical expertise and capacities of lay health workers through rigorous training and regular refresher courses. Sustainability is also facilitated by political commitment from District and Municipal governments and the local Department of Education to scale-up and fund-raise for this activity.

The Mpilonhle OVC activities outlined above contribute to PEPFAR 2-7-10 goals of providing care and support to 10 million people, including OVC, in the form of supporting access to health services, psychosocial support and increasing access to with economic opportunities.

INTEGRATED ACTIVITY FLAG:

This activity is related to Mpilonhle activities in the program areas of AB (#8238), Condoms and Other Prevention (#8241), Care for OVC (#8246) and Basic Health Care and Support (#8243).

SUMMARY:

Mpilonhle's voluntary counseling and testing (VCT) activities include (1) schools-based health screening, and (2) community-based health screening. These services will be delivered through mobile clinics and mobile computer laboratory facilities to 12 secondary schools and 24 community (non-school) sites at Umkhanyakude District in rural KwaZulu-Natal province.

Emphasis areas are: human resources in the form of salaries for health counselors performing VCT; infrastructure in the form of mobile clinics and electronic medical record systems; strategic information in the form of data collection on rates of acceptance of pre-test counseling, testing, results, and post-test counseling, data on HIV status, and data on sexual behavior; and development of network /linkages/referral systems through the referral. Targeted populations are secondary school students and adults in the general population.

BACKGROUND:

This is a new activity that will be implemented by the prime partner, a new non-governmental organization (NGO) named Mpilonhle. The program has broad support from district and provincial South African government leadership. The whole infrastructure will be established using the PEPFAR funds to purchase mobile vans, equipment and operational costs to run the program. Mpilonhle will implement activities in Umkhanyakude District, the poorest and most rural district in KwaZulu-Natal province, and one with high HIV prevalence. The activity will consist of activities in 12 representative rural secondary schools that suffer from physical remoteness, poor health conditions, and generally inadequate resources, and in 24 community (non-school) sites. Partners include the Department of Education, the South African Democratic Teachers' Union, District Health Services, and district and municipal leadership.

ACTIVITIES AND EXPECTED RESULTS:

Mpilonhle will conduct five activities in this Program Area.

ACTIVITY 1: Schools-based Health Screening

A health counselor will provide secondary school students with an annual individualized health screening that includes VCT, screening and referral for common health problems, counseling or referral to further services for PMTCT, ART, TB and psychosocial support, and referral to a social worker for assistance with accessing government grants and support for people living with HIV (PLHIV). School principals, local Department of Education officials, district and municipal mayors and focus groups of teachers and students have expressed the community's acceptance of schools-based VCT.

ACTIVITY 2: Community-Based Health Screenings

This will be conducted by health counselors at 24 community-based sites outside of schools. Community-based health screenings will consist of a core of HIV preventive services including individualized VCT; personalized ABC counseling, and condom provision to sexually active individuals; referrals to other community-based services for PMTCT, ART, TB and psychosocial support; referrals to a social worker for assistance with accessing government grants and support for OVC or PLHIV; general health screening and referral for care and other services as required; basic computer training to community members; and group HIV and health education sessions.

ACTIVITY 3: Mobile Facilities

These counseling activities will be provided through mobile facilities. Each mobile facility will consist of a paired-up mobile clinic and mobile computer laboratory, staffed by one primary care nurse, four health counselors, one health educator, and one computer educator. Each mobile facility will visit a participating secondary school one week per month for eight months per year. This will allow each mobile facility to serve four secondary schools per school year. The project will have three mobile facilities, allowing Mpilonhle to serve 12 secondary schools in total. Each participating secondary school has an average of 800 students, and will offer the first three activities described above. Six of the 12 schools have been pre-selected.

ACTIVITY 4: Voluntary Counseling and Testing

VCT will be conducted using the parallel testing algorithm, with the results available along with post-test counseling during the same screening session. A blood sample will be drawn by the nurse and sent for ELISA testing at a reference laboratory for discordant results. Health counselors will be trained in SAG-approved VCT training programs and will use SAG-approved HIV and AIDS VCT protocols. Health screening will use an Electronic Medical Record (EMR) system implemented on handheld computers programmed with health screening guidelines, algorithms, and series of questions that must be followed by the counselors. These will save individual screening results into a medical record. EMRs facilitate collection of timely, high quality and easily analyzable data. EMRs also contribute to quality control by minimizing missing data, and enforcing and monitoring conformity to protocols and guidelines. The data collected by the EMR system will include indicators of acceptance of pre-test counseling, testing, results, post-test counseling, data on HIV status, and on sexual behavior.

Persons who are HIV-infected will be referred to the program nurse for further evaluation, including CD4 testing which will be done at Department of Health laboratories. Persons who meet initial screening criteria for antiretroviral treatment (ART) will be referred to the Hlabisa Health sub-district ART program at one of the DOH clinics. Persons screened for TB will also be referred to district clinics.

ACTIVITY 5: Human Capacity Development

Sustainability of activities is facilitated by building human capacity in remote rural areas. Mpilonhle will maximize the capacities and skills of relatively abundant lay health workers to enable them to perform critical yet currently scarce services such as HIV counseling, health screening and personalized risk assessment, and health education. This skills development in lay health workers will shift the burden of these activities away from relatively scarce professional health workers like nurses and doctors. Mpilonhle will build the technical expertise and capacities of lay health workers through rigorous training and regular refresher courses and through the technological support provided by the information technology components of the program. Sustainability is also facilitated by political commitment from district and municipal governments, and the local Department of Education to scaling-up and to fund-raising in support of such scaling-up.

These activities will contribute to PEPFAR 2-7-10 goals of promoting counseling and testing for HIV among secondary school students and adults in the general population.