SUMMARY:

Africare's Injongo Yethu Project will continue to work through several foci of influence throughout Lukhanji

communities to disseminate information and influence behavior change to prevent new HIV infections and

to encourage testing. In FY 2008, an additional focus on interactive, prevention skills programs (especially

focused on youth and men) will be employed to sustaining messages throughout the community. Further

expansion will be made to catchment areas of other approved care and support sites. Major emphasis is on

human capacity development, local organization capacity building, and gender. Gender activities will focus

on addressing male norms and behaviors, reducing violence and coercion, and increasing women's access

to productive resources. The target populations for this activity include the general population above the age

of ten, teachers and religious leaders.

BACKGROUND:

This is an ongoing activity, expanding the number of peer educators (PEs) and expanding the geographic

reach to include more villages throughout the Lukhanji Local Service Area and into initiate activity in a new

LSA. Prevention activities are supported and encouraged by the ECDOH. The House of Traditional Leaders

supports the project, and is an important behavior change agent in the community. Lukhanji Local

Municipality expresses support for the integration of ward councilors in community mobilization efforts.

Efforts to empower young women are included in the in-school youth peer education/life skills activities, out-

of-school youth peer education and livelihood activities supporting young women to be materially

independent of older men. Shaping how young men see and behave toward women is included in the out-of

-school youth peer education activities, the traditional initiation schools, faith-based youth activities, and in-

school youth.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Strengthen the Quality and Intensity of Existing Community-based Activities

In FY 2008, human capacity development will remain a key activity, building on the training of traditional

leaders and healers, community leaders and in and out-of-school youth. Africare will continue to provide

further training and mentorship for traditional initiation (circumcision) surgeons/nurses on how to integrate

HIV prevention, gender awareness and behavior change education for young males during initiation into

manhood (traditional practice). In-school youth will continue to be developed, along with their coaches and

teachers. Rural youth with little education will be given continued support to internalize messages with

regard to gender and behavior change and to better develop facilitation, counseling, and activity

management skills. Practical skills for youth development and life skills will also be provided to the out-of-

school youth peer educators. Summer and spring youth camps for existing PEs will continue to focus on

personal empowerment and build their capacity to promote abstinence and delayed sexual debut for in- and

out-of-school youth in collaboration with church Sunday Schools. In FY 2008, program depth and quality will

be enhanced for youth to provide skills needed to prevent cross-generational sex and substance abuse

through modular life skills programs. Partnering with Soul Buddyz for youngsters will provide a sustainable,

long-term program and partnership with Girl Guides or similar programs will be explored to give girls the

skills and perspective to focus on their futures.

Funds will be used to recruit additional peer education and advocate supervisors to support community-

based peer education and advocacy in new communities. Additional training in peer education and behavior

change approaches will be provided to the supervisors to enhance their ability to provide technical guidance

in communities. Community-based PEs and advocates from all participating groups will be provided with in-

service education on interpersonal communication for behavior change.

Teachers from participating schools (20 current and 20 new) will continue to receive professional

development in life skills education for grades 4-7 and support of PEs. Linked with the care and support

components, the Service Corps Volunteers and community-based caregivers will have their HIV prevention

communication skills further developed to improve the frequency, intensity and quality of their

communications in the clinics and in the homes of clients.

Training of the various community groups will be done using the Harvard School of Public Health

curriculum. The curriculum is flexible based on assessment of skills, norms and attitudes of each group.

ACTIVITY 2: Reach the Community with Consistent Abstinence and Be Faithful Messages

Funding will support quarterly HIV prevention-focused educational events for each target group. These

events are intended to stimulate discussion of intergenerational sex, transactional sex, stigma,

discrimination, denial and other related issues, to reduce high-risk behavior and to create a supportive

environment for HIV testing. The forums for these events include youth debates, drama, and sensitization

meetings to highlight these issues. Through these open forums, Africare aims to stimulate discussion on

issues and guide the community to identify HIV risk and appropriate steps to reduce such risks. The project

will facilitate the dissemination of relevant IEC materials and enlist the support of PEPFAR partners such as

Soul City to adapt materials. In addition, Africare will continue to work with faith-based leaders to

disseminate information about HIV and AIDS with a focus on promoting risk reduction through AB

messages. In FY 2008, Africare will continue to expand the number of pastors in the program, creating a

supportive environment for testing by fostering care and support of families affected by HIV in addition to

prevention. Pastors link with palliative care activities in providing pastoral care for PLHIV in need of spiritual

counseling.

ACTIVITY 3: Expand to New Community Groups and New Localities within this Site

In collaboration with the law enforcement agents, the project will continue to strengthen and expand the

gender- and child-based violence task working group by supporting quarterly meetings/activities to promote

case identification, effective support and intervention (including PEP) and prevention. For in-school youth

peer education, new schools in the Queenstown area (10) will be added to the existing group of schools.

Additional groups of youth and faith-based organizations in Queenstown areas of Ezibeleni, Mlungisi, Ilinge

and Lesseyton will be engaged and trained for prevention as well as stigma reduction and care and support.

Chiefs' wives will be engaged through the Chris Hani District AIDS Council to reach girls and female youth.

Activity Narrative: As the new care and support sites are finalized, community entry with key stakeholders will begin. FY 2008

will also include jointly developing an adult male-focused strategy (with the House of Traditional Leaders,

Department of Health and male involvement programs) to engage men in reducing sexual partners,

reducing cross-generational sex and increasing utilization of services.

ACTIVITY 4: Vocational Skills Training and Microfinance

Appropriate vocational skills will be linked to youth prevention activities especially for young women in order

to ensure that they are economically empowered, and can avoid intergenerational/transactional sex and

avoid conflict with the law. Training institutions will provide vocational and skills training, and support

learnerships and apprenticeships for youth. FY 2008 COP activities will limit micro-financing to linking

individuals and groups to other financing resources through government small-medium enterprises funding

programs. Support to local information technology centers in collaboration with Microsoft will aim to ensure

that rural women, youth, and community-based organizations have access to information about HIV and

AIDS, entitlements and income-generation funding resources, along with the means to write and send

applications and reports.

SUMMARY:

In addition to interventions promoting abstinence and being faithful, the Africare's Injongo Yethu Project

approach is working through several community constituencies to promote other preventive behaviors.

Activities will address target groups such as those frequenting taverns and using them for access to those

engaged in transactional sex, and prisoners will be reached with messages emphasizing correct and

consistent condom use and getting tested for HIV, as well as partner reduction in preparation for their

release. Traditional healers will strengthen their activities across Lukhanji to promote counseling and testing

(CT), prevent transmission during medical procedures, and provide messages on correct and consistent

condom use, along with being faithful and partner reduction messages during their cultural dancing.

Activities carried out by traditional healers also aim to reduce stigma. A follow-up survey on the effects of

the community interventions will be considered for FY 2008. Emphasis will be on human capacity

development through training and gender. Target populations include men, women, incarcerated

populations and persons engaged in transactional sex.

BACKGROUND:

This is an ongoing activity, extending from the Abstinence and Being Faithful (AB) messages initiated with

these groups. Traditional healers have been very active in combining messages into their cultural dancing,

and have begun to refer clients for counseling and testing (CT). Two local associations of tavern owners

have been trained and plan to encourage discussion as well as to share IEC materials in their

establishments and keep condoms available. While there is not a formal sex worker trade in this community,

informal transactional sex does occur and is frequently initiated at taverns. Monthly discussion sessions

have been carried out in the male prison around HIV transmission and AB prevention. The local minimum

security prisons have small populations (about 70 inmates) with short-term sentences and will return to their

communities in a short time. Prisoners have expressed the need for prevention work, including condoms

and condom information.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Prevention Messaging in Taverns

Largely through consistent and frequent messages using video and print materials and backed by trained

tavern owners, correct and consistent condom use, along with reducing the number of concurrent sexual

partners, will be encouraged. Tavern owners from the Whittlesea and Romanslaagte Community Policing

Forums will continue to be coached in using IEC materials that can be used in their establishments.

Included in their program will be an orientation to the local HIV services for testing and care (including

treatment). Project support will also be used to provide videos and Xhosa print materials on condom use

and reducing the number of partners. To reduce cross-generational sex, specific messages targeting the

behavior of older men will be included. Gender issues, particularly prevention of violence against women

and children will be addressed. VCRs and televisions will be made available on a rotational basis where

they are not available on premises. Discussions once per quarter in each establishment facilitated by

project volunteers will reinforce messages in addition to the informal discussions that will be generated by

the videos and supported by the tavern owners.

ACTIVITY 2: Prevention Activities with Prisoners

Prisoners in the Sada prison for men and the Queenstown prison for women will continue to be reached

with monthly discussion sessions. Videos will be used to trigger discussions and Xhosa print material on

condom use, partner reduction and AB messages will be provided. Where condoms are not institutionally

available, they will be provided, given permission from the authorities. In addition to affecting behavior while

in prison, it is anticipated that significant information coupled with discussion while in prison will positively

influence behavior after release into the community, including gender-based violence, gender relationships

and at-risk social behaviors.

ACTIVITY 3: Prevention Activities with Traditional Healers

Traditional healers trained in the Hewu and Ilinge areas will be refreshed, updated and supported in their

ongoing activities. Traditional healers in new project areas will be trained. Reinforcement of messages

around limiting sexual networks through partner reduction and consistent condom use will be provided.

Increased focus will be added on cross-generational sex and gender-based violence. Additional practice to

build confidence in answering questions will be continued to be provided to promote independence from

project staff. Information level messages from a wide variety of spheres of influence in the community has

indeed been an initial focus (diffuse). While traditional healers continue to include sharing their advice on

being faithful and condom use during the weekend dances (with clients and trainees), it is the role modeling

and interpersonal skills development that will help traditional leaders to be more effective in prevention. A

focus this year is on designing local interventions for effecting changes on male behavior in particular, and

deploying approaches to youth that support protective choices.

ACTIVITY 4: Male Norms and Behavior

Violence reduction is addressed through several activities in the community. Traditional caretakers/

educators (amakankhatha) who educate male youth during traditional circumcision and initiation "school"

are beginning to include emphasis on traditional norms and values that mandate respect and caring for

women and children. This is to counter anecdotes of bullying behavior of young men toward women (even

their mothers) when they come out of the school. Traditional leaders will include similar discussions with

adult men with regard to violent behavior toward women and children. Peer Educators for out-of-school

youth will continue to receive capacity building to lead youth discussions around gender issues and

relationships. In-school youth (intermediate phase) will be introduced to issues of gender, how the other sex

is seen, bullying, and consideration for others. Pastors and church leaders discuss mutual respect with

couples. Youth both in- and out-of-school will be made aware of sexual abuse, prevention, and what to do if

it happens. FY 2008 will include a continuation of the above activities, along with expansion into new

communities.

Activity Narrative: By focusing on prevention among people at risk, Africare contributes to the PEPFAR goal of preventing 7

million new HIV infections.

SUMMARY:

Africare's Injongo Yethu Project will continue to support home-based care, expand the number of clinics

supported in the Lukhanji Local Service Area, and begin support in at least one other Local Service area.

Facilitators of support groups will be developed and nutrition support through clinic and home-based

gardens will be expanded. Documentation and planning of care and support will be supported by the

development of an electronic database of clients. Palliative care services target all HIV-infected clients and

their families, adults and children. Training largely targets South African-based volunteers and public sector

nurses. FY 2008 will include a strengthened focus on holistic chronic care for all HIV-infected clients (from

time of diagnosis) through empowering support groups in support and education and developing continuity

of care interventions in clinics. This is part of the basic package of care for PLHIV.

BACKGROUND:

This is an ongoing activity, building on the deployment of Service Corps Volunteers (SCV) to assist clinic

nurses with the supervision of home-based care, health talks and counseling in the clinics. Traditional

healers have begun to refer clients for care and treatment, with some providing support to clients on

treatment. Pastors and church leaders who were trained in HIV-related care have begun pastoral support to

clients. Training of PLHIV as support group facilitators began in FY 2006. With non-USG leveraged funding,

demonstration gardens and training in permaculture provided the basis for home- and community-based

improved food security and nutrition by making nutrient-dense produce more readily available. A constraint

to expansion has been funding for seeds, compost and implements from local government resources. Still,

several PLHIV and families at each of eight clinics have begun to grow a combination of high-nutrient

vegetables, along with appetizing and micronutrient-rich herbs. In FY 2007, support groups were formed

and trained on basic support group management and PLHIV personal empowerment (acceptance of status,

etc) in several communities and will provide a basis for continuity and accessibility to care. Continuity of

care from the time of testing is being strengthened as a program enrolment and baseline process is being

piloted in 3 clinics along with a format for care plans. Collaboration with Columbia University (ICAP) and the

Health Systems Information Program (HISP) has led to the development of an electronic patient database

that will be ready for deployment when the final Eastern Cape province Treatment Record has final changes

made.

ACTIVITIES AND EXPECTED RESULTS:

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

Quality-focused care plans for HBC visits that were piloted with three clinics will be adapted and rolled out

to additional clinics. Care plan formats and client enrolment records piloted will also be adapted and rolled

out for use by clinic nurses to plan care throughout the client's disease. Home-based care supervision

training modules will be presented to nurses, building on last year's work with the SCVs. Training in

palliative care will include: evidence-based preventive care interventions which include the following: OI

screening and prophylaxis (including cotrimoxazole, TB screening/management), counseling and testing for

clients and family members, safe water and personal hygiene strategies to reduce diarrheal disease, HIV

prevention counseling, provision of condoms, referral for family planning services for HIV-infected women,

appropriate child survival interventions for HIV-infected children and nutrition counseling, clinical

measurement, nutrition monitoring and targeted support based on WHO criteria for severely malnourished

PLHIV. The package of services to be delivered includes basic pain and symptom management and referral

for facility-based support for adherence to OI medications (including cotrimoxazole prophylaxis and TB

treatment) and antiretroviral therapy (ART) if needed. Prevention with positives interventions will be an

important part of this comprehensive care strategy. Through healthy living and reduction of risk behaviors,

these prevention with positives interventions can substantially improve quality of life and reduce rates of HIV

transmission. The goal of these interventions is to prevent the spread of HIV to sex partners and infants

born to HIV-infected mothers and protect the health of infected individuals. A social worker will train in basic

counseling for clinical staff, volunteers and pastors. This will link closely with the psychosocial training under

the OVC component. The provincially supported course implemented by the University of Fort Hare will be

adapted with psychosocial support materials. Nurses and volunteers will be trained as they become

available for training. Building on the initial training of PLHIV for support group facilitation, the project will

refine support group facilitation training, guidance for PLHIV co-facilitators and orientation for nurses as a

support resource; a) a guide for leading groups, b) a modular curriculum for facilitators, and c) information

packs for use in groups. Effort will be made for the equitable access of services by males and females.

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

In collaboration with Columbia University, Africare has been developing a simple electronic database as a

continuity register of HIV-infected clients, linked with the antiretroviral treatment component. A database

development service provider (HISP) has been engaged to adapt software that will be open source and

compatible with the local health information system, to populate the register, provide documentation on the

data entry process, data element and indicator definitions, and to train data entry, health and program

management staff. Funds will support software development, training and follow-up needed to effect sound

implementation. Implementation, including training in software management as well as using data to

manage patients and services will continue through FY 2008. HIV Service Review Guides will be drafted

and piloted. It is expected that analyzed data will inform improved quality of the program.

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

ART support

Training organized by the ECDOH has been extremely limited in quantity and frequency, hindering the basic

development and certification of professional and volunteer staff. FY 2008 funds will support the

establishment of Africare as an accredited training provider for the above areas. Training for Africare's

volunteers can then be completed and ECDOH volunteers and professional staff will have an additional

source of training made available to accommodate turnover and existing gaps.

ACTIVITY 4: Nutritional support through gardens

Activity Narrative: To promote quality, economical nutrition, through non-USG funding, the team will work with Lukhanji DOH

to develop a local low-literacy cookbook (in Xhosa) and home economics guide. Clinic nurses and SCVs will

be trained on the use of the guide. Cooking demonstrations will be established at clinics and selected

churches on using nutritious foods, especially the foods and herbs from the permaculture gardens. Funding

will support referral for nutritional support and monitoring as well as training clinic teams and as budget

allows, outfitting modest kitchens, such as adding a table, stove or sink to existing clinic kitchens.

ACTIVITY 5: This initiative is to be managed and carried out by South Africa Partners, with technical input

from JRI Health. The aim of this project is to promote early recruitment and retention of PLHIV into Care

and Support programs. The lost to follow-up rate from the time of HIV diagnosis to commencement of

ART|V therapy is 70%. PEPFAR partners will be trained on implementing a basic package of care services

to PLHIV and their family from the time they are diagnosed HIV positive. This package will be implemented

within support groups at community level. Expert patients will be trained on empowering their peers to

better health seeking behaviors. The goal of the National palliative care program is to ensure the universal

access to palliative to all PLHIV and family members especially those who do not qualify for ARV therapy

thus establishing a continuum of care from testing HIV positive to end of life care.

FY 2008 activities will also include:

-implementation of a patient registration form for chronic HIV care;

-implementation of the new HIV Treatment Record (paper) developed by Columbia University ICAP for the

Province;

-training, orientation, mentoring and tools development to expand support group roles and functions to

include community-based support, wellness coaching, education and basic health assessment (as per the

national DOH basic package);

-continuation of garden production coaching by SCV and support group members to assist in setting up

home-based gardens

-integration of family planning, sexually transmitted infection and other reproductive health services into

chronic HIV care; and,

-implementation of the basic package of care through support groups for PLHIV and orientation of clinic

nurses.

Geographic changes will include a shift from Emalahleni to Nkonkobe Local Service Area (LSA), and

possibly to Makana (Port Alfred) LSA, pending provincial decisions.

SUMMARY:

Africare's Injongo Yethu Project will continue to encourage identification of HIV infection among TB clients,

and TB disease detection and management among HIV clients. Major emphasis is on local organization

development of clinics in the Hewu Hospital catchment area in the Eastern Cape and the feeder clinics for

Frontier Hospital and Glen Grey Hospital. Emphasis of project interventions is also on training, monitoring

and evaluation support through information technology development (the ARV and HIV electronic register)

and developing supportive supervision. FY 2008 will include Nkonkobe LSA and a selection of the clinics

feeding those hospitals.

BACKGROUND:

This is an ongoing activity that has received some support for training of nurses in TB and HIV care and an

orientation of Service Corps Volunteers on the frequency of HIV infection among TB clients. Testing of TB

clients has increased, but in many clinics is poorly documented in the counseling and testing program

(better documented in the TB program records). Implementation of TB prophylaxis guidelines for HIV-

infected clients in the Eastern Cape has been put on hold by the Eastern Cape Department of Health

(ECDOH). Health workers express frustration and difficulty in diagnosing TB in HIV-infected patients who

are sputum negative.

ACTIVITIES AND EXPECTED RESULTS:

Activities will focus on providing tools and mechanisms to improve the quality of home- and facility-based

management of TB screening and management in HIV-infected clients, and HIV screening and

management for clients on TB treatment. Tools for monitoring, supportive supervision and referral will also

be provided.

ACTIVITY 1: Improve HIV Testing Rates of TB Clients

The project will support development of a standard client HIV education flip chart for TB clients similar to the

CDC-supported antenatal care (ANC) counseling guide that achieved much success in Botswana. Nurses

from 10 clinics will be recruited to field-test the flip chart and the counseling routine and note any effect on

HIV testing among TB clients. Nurses will be encouraged to offer counseling both at the initiation of TB

therapy and after the two-month intensive treatment phase to clients who had declined testing at initiation.

South African Government DOT supporters from selected clinics will be provided with additional basic HIV

and AIDS training, particularly for those not recently trained or provided with an update and refresher

course. The flip chart piloted by clinics will be made available to DOT supporters from the same clinics in

order to further encourage HIV testing among the TB clients.

ACTIVITY 2: Improve TB Screening Among HIV Clients

Active TB screening will be implemented in home-based care along with an orientation of HIV chronic care

nurses on TB screening. In addition, key support group members will be trained to help screen for

pulmonary TB and some key signs of non-pulmonary TB and refer to the clinic. Increased screening will be

captured in the HBC records and the clinic chronic care record.

ACTIVITY 3: Training and Capacity Building

To ensure effective integration of TB and HIV care, doctors and nurses from Hewu Hospital, Sada CHC,

Frontier Hospital and Glen Grey Hospital will be prioritized for updated training on TB and HIV co-

management, using recent WHO and NDOH materials. Training for doctors will be open to 20 local general

practitioners. Routine technical information packets of information from e-newsletters, tools and guides from

PEPFAR partners, publications from USG cooperating agencies, such as WHO and the AIDS Vaccine

Bulletin will be collated and distributed to the doctors, HIV service managers and nurses in ARV clinics. The

project will subscribe to newsletters and training materials from various membership organizations on behalf

of the health care providers at the three hospitals.

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

The project will support the Chris Hani District HIV, AIDS, STI, TB (HAST) committee to create objectives

and a standing agenda item for monitoring progress toward integration of TB and HIV services.

Development of tools to monitor and evaluate the effectiveness of integration will be advocated.

ACTIVITY 5: Ensure and Monitor Cotrimoxazole Therapy Implementation

Cotrimoxazole therapy is widely given to HIV clients, but the effects are not routinely monitored. To ensure

that all appropriate clients benefit from cotrimoxazole, relevant data elements will be included in the HIV

patient electronic register and therapy will be included in the algorithms as will the proposed HIV client care

plans.

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

The flow of information and documentation of information between services to HIV-infected and TB patients

will be assessed for bottlenecks and potential for losing follow-up of clients using client flow analysis and

current client records to find where clients drop out of the system and delays are experienced. Africare will

collaborate with another PEPFAR partner, QAP to capitalize on, and to reinforce, principles and processes

of quality assurance that will allow facility teams to uncover their local constraints and to plan solutions.

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

TB clients will be informed of, and welcomed to the new HIV support groups at the clinics. It is understood

that some TB clients are not ready to be tested for HIV and might find support to do so in the group. FY

2008 activities will also include dissemination of the new TB guidelines, accompanied by refresher training

for hospital and private doctors. Africare's TB and HIV support contributes to PEPFAR's goal of 10 million

Activity Narrative: people receiving care.

SUMMARY:

Africare's Injongo Yethu Project will establish the structures and processes that will facilitate service delivery

and support to orphans and vulnerable children (OVC) in Lukhanji and Emalahleni Local Service Areas in

the Eastern Cape. Interventions are in support of the Department of Social Development's (DOSD) aims in

the National Plan of Action. Child Forums, Kids Clubs, counseling, health care, social services coordination

and livelihood will be linked together and to other Injongo Yethu Project activities to create an integral

support system. Major emphasis is on community mobilization, with additional emphasis on human

resource, training and local organizational capacity development. Target populations include OVC and their

caregivers.

BACKGROUND:

Started in FY 2007, the Project's OVC program and will continue build on existing community caregiver

services, the Service Corps Volunteers and Africare's programs with youth and faith-based organizations.

FY 2007 saw the establishment of more than 10 Child Protection Units, identification of households and

OVC in critical need, and initiation of direct service delivery. Originally designated as "Child Care Forums",

the local Department of Social Development (DOSD) team and the community decided to combine OVC

functions into the Child Protection Committees, also mandated to be established in each community and

with very similar functions.

ACTIVITIES AND EXPECTED RESULTS:

Africare's activities will continue in FY 2008, emphasizing the development of sound public sector and

community responses to OVC needs. Public sector departments involved are the Department of Social

Development (DOSD), Department of Health (DOH) and Department of Education (DOE). FY 2008 will

include efforts to engage the Department of Labor (DOL), Department of Agriculture (DOA).

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

In addition to the nine Service Corps Volunteers (SCVs) that will be recruited to support OVC community-

based activities in FY 2007, six more will be engaged in FY 2008. To support the identification and tracking

of support to OVC, Africare will support the Eastern Cape DOSD in designing and developing an OVC

services tracking system and other tools for identifying vulnerable households, their needs, and tracking

services delivered. SCVs, health sector community care-givers and the newly established Child Protection

Committees (CPCs) members will be trained to identify OVC and vulnerable households, and ongoing

household needs assessments will be initiated and made routine. CPCs will continue to be developed for 15

wards (or clusters of wards) to provide a mechanism for coordinating resources to meet the children's

needs. CPCs will also function as the accountability body for local OVC identification, monitoring and

services coordination. Small grants will be provided to the CPCs to enable them to meet and coordinate

activities for OVC. A memorandum of understanding will be signed with each CPC, each will be assessed

for its development and resource needs; each forum will meet at least quarterly. Africare support will be

provided through a Service Corps Volunteer to establish patterns of OVC needs identification, work

planning, and the development of an OVC community service plan. Kids' Clubs will be established with

Africare support, designed in conjunction with the DOSD and their district committee for HIV and OVC

("DACCA"). Workshops will continue to be held to jointly establish roles, functions, and the service

complement of CPCs and Kids' Clubs. CPCs, Kids Clubs, and community caregivers will link OVC and child

heads of households to social services for necessary support in addition to providing direct support where

they are capable.

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

Africare will provide grants and technical assistance to selected community-based organization (CBO)

members of CPCs. Two CBOs have been engaged and provided with initial grants. Orientation on financial

management and monitoring and evaluation will be provided to the currently engaged CBOs and as well as

those engaged in FY 2008 to cover the remaining CPCs. Grants will focus on enabling CBOs to provide

care and support to OVC in their communities. Training of CBO caregivers will enable them to monitor,

directly provide, and refer to specific services. Both service CBOs and public sector health volunteers will be

provided with tools and training to monitor health status and to promote child utilization of well-child health

services and to be cared for when sick. OVC households will be linked to ongoing and expanding food

garden projects, soup kitchens and locally available food parcels distributed by the DOSD, churches and

CBOs. A local legal aid service will be engaged to train child forums and volunteers in basic legal aid

support for OVC and families, such as wills, succession planning, identity documents, deferment of school

fees, etc. The project will facilitate the development of a referral system between the community, DOSD and

legal aid for common legal needs. The South African Depression and Anxiety Group (SADAG) will continue

to provide specific support in developing community-oriented psychosocial support training. They will initiate

caregiver support groups, train the support group leaders. The SADAG 'talking book' for OVC will be used

by community and household caregivers for facilitating discussion and engaging children and youth. They

will also establish a toll-free call line for support.

ACTIVITY 3: Direct Assistance to OVC

Africare will facilitate establishing effective referral patterns and access to social services and various

benefits. SCVs will be trained to assist CPCs and train child-headed households on home management,

services and entitlements. To foster school compliance with the provincial no-fee policy in disadvantaged

areas, minor repairs and rehabilitation or other school-wide benefits will be undertaken in exchange for

waiving fees for OVC. Enrollment by OVC in school and routine attendance will be monitored. Africare will

capacitate the community volunteers and child care forums to ensure that OVC in need of shelter get

referred. Monthly monitoring of access and utilization of a standardized package of services will continue in

FY 2008. Children and youth attending Kids' Clubs will be trained in Life Skills. Kids' Clubs leaders will be

trained in HIV prevention, AIDS care and support of OVC. Africare will provide small grants to Kids' Clubs to

organize recreational activities. Africare will seek leveraged matching funds. Peer Educators (40) and Peer

Counselors (40) will be trained to support children and youth attending Kids' Clubs and in the community.

Children heading households and older OVC will be targeted for training in vocational and livelihood skills

Activity Narrative: through vocational training centers and training organizations. Local organizations will be trained to support

the development of income generating activities (IGA), and OVC and caregivers will be assisted in securing

funding for IGA activities.

ACTIVITY 4: Access to Health Care

Home-based caregivers based at clinics will ensure that OVC under 2-year olds encountered in the homes

of their HIV clients are weighed, immunized, and those that are HIV-exposed are screened for infections,

receive their follow-up HIV test, and access care and treatment, when required. OVC caregivers (OVCGs)

deployed by the CBOs under each CPC will monitor clinic utilization for growth monitoring and

immunizations and will support the clinics in direct weight monitoring for high-risk children. Older children

encountered in the home will also be linked to clinic care and treatment services as needed. Schools and

Kid's Clubs will be alert to children and youth, who need referrals for healthcare and HIV treatment, linking

them through the structures above to ensure that clinic or hospital level care is provided.

New FY 2008 activities will include:

CPC members will continue to be trained in FY 2008 to provide community-based support and advocacy,

e.g. prevention of exploitation and abuse, prevention of "land-grabbing", and identification of children and

households in distress. CPC development will continue to be nurtured to provide a sustainable response to

the need for OVC identification and service coordination.

District and LSA-level committees established by the DOSD for children ("DACCA and LACCA) will be

supported to continue to map local services

Household-centered care will be strengthened through assessment and capacity building of the CBOs

engaged to monitor OVC in the community. Capacity building will be in the form of topical one-day

workshops on specific OVC issues, monitoring and evaluation, and on-site support. In addition to the two

CBOs engaged (for 4 wards) to date, additional CBOs will be engaged to cater for the remaining 11 CPC

catchment areas.

Kids clubs will be established in schools and communities to incorporate specific life skills such as life goal

planning, personal empowerment, caring for others, public speaking, writing skills, etc, as well as homework

support. Kids' clubs will also provide a venue for play, additional meals for young children, and access to

referral for professional social workers and others. Youth leadership and child participation will be nurtured

and developed through Kid's Clubs and engagement of the Youth Council in Queenstown to bring the voice

of youth into the design of services and to engage youth in caring for others.

Extending into Emalahleni Local Service Area (or other LSA assigned for clinical care, in order to ensure a

continuum of care)

Africare's activities focused on orphans and vulnerable children contribute to the PEPFAR goal of 10 million

people in care, including OVC.

SUMMARY:

Africare's counseling and testing (CT) activities will include linking testing to community events, increasing

the participation of people living with HIV (PLHIV) in the counseling process, and supporting clinics to

integrate CT into all services and ensure quality of counseling and testing. Major emphasis will be on

community mobilization and participation. Additional emphasis will be placed on strengthening quality and

short-term human resource support and training. The aim is to increase testing in communities among

adults and secondary school students. FY 2008 will also include interventions to encourage men to test.

BACKGROUND:

Counseling and testing in the Lukhanji Local Service Area (Eastern Cape) has been supported by Africare

in terms of encouragement of testing in community events and volunteer pre-test counseling. A perception

of limited time for counseling and testomg has been expressed as interfering with integrating counseling

and testing throughout clinic services, particularly in Sada Community Health Centre. Accredited training for

counseling and testing has been very limited in the district, hampering preparation of volunteers to support

the nurses.

ACTIVITIES AND EXPECTED RESULTS:

Four activities will focus on ensuring greater participation of PLHIV; increasing community mobilization; and

strengthening existing counseling and testing services.

ACTIVITY 1: Develop PLHIV for Counseling Support

PLHIV will be trained as both support group co-facilitators and CT counselors. On a voluntary basis, they

will support clinic and community-based testing activities, adding particular value to post-test counseling

and referral to support groups and services. CT services will be provided at public health facilities to

increase testing in areas that are widely disbursed and hard to reach.

ACTIVITY 2: Mobile CT Services

Mobile CT services will be initiated to ensure that CT services are provided to the whole community, in

particular the villages not in the immediate vicinity of the local clinic. Mobile services will be designed with

the Eastern Cape Department of Health (ECDOH) clinic teams to augment their reach. Where practical,

clinic nurses will join the mobile team to perform the test. Where required, a nurse recruited by the project to

support CT will provide testing. Service Corps Volunteers (SCV) from the clinics and community caregivers

who are trained can support pre- and post-test counseling and logistics. In order to address community

concerns about being tested by someone they know, SCVs can exchange sites and the Africare nurse will

test. Mobile testing will take place monthly, rotating sites. A compensation plan for volunteer community

caregivers supporting testing will be developed with the Lukhanji health team. To ensure maximum uptake,

the mobile CT team will work with the project's peer educators and drama group to provide entertainment in

the form of street theater (skits, songs, poems, monologues and dances) that include, but are not limited to,

HIV and AIDS themes. These preparatory sessions will help to reduce fear and tension while addressing

myths, misconceptions and promoting behavior change.

Linking with the project's initiative to ensure that every positive person is encouraged to enter care and

support services, each person testing positive will be (a) referred to a support group, (b) have CD4 count

drawn and results sent to the clinic of their choice, and (c) provided with a description of services available

at nearby facilities. Those who wish to be enrolled in chronic HIV care at the nearest clinic on that day will

have their enrolment form initiated.

ACTIVITY 3: CT Training

Training on CT will include both initial and refresher training. Refresher training will be conducted at least

once every three months for nurses and volunteers already trained in counseling and testing. Project

support will include hiring an accredited nurse trainer, training workshops, and supporting training sessions

with onsite follow-up. Training of SCVs and community caregivers from among the 18 clinics in the

Whittlesea community will strengthen the clinic's ability to provide more facility-based testing and to conduct

outreach. Community-based organizations providing home-based care will also benefit from the training of

their caregivers, as needed.

ACTIVITY 4: Optimize Clinic Flow for Integrated CT

Africare will review clinic flow, clinic efficiency and integration of services at three selected sites to increase

the amount of time allocated to CT services. Findings from the review will be analyzed in a workshop with

the clinic teams to identify options for increasing CT access to family planning clients, TB clients and

general clinic attendees. Support will be provided to teams piloting their changes. FY 2008 activities will

focus on engaging male health workers for counseling and testing as a key strategy to increase male

testing.

SUMMARY:

Africare's Injongo Yethu Project will continue to support increased quality of, and access to antiretroviral

therapy (ART) for adults and pediatrics, providing support for an electronic patient register, improvement of

treatment readiness and high-quality patient management. Hewu Hospital, Fort Beaufort Hospital and

Victoria Hospital will be assisted. Major emphasis is on building local organization capacity with minor

emphasis on training, strategic information and human resources. Human capacity development is focused

on doctors, nurses, local traditional healers and data management personnel. Implementation of the basic

care package will carry through to treatment sites in addition to care and support.

BACKGROUND:

This is an ongoing activity supporting treatment readiness and follow-up at Hewu Hospital and Sada

community health center. The referral rate from Hewu Hospital to Frontier Hospital for initiation of

antiretroviral treatment (ART) has increased. Challenges have included inadequate recording systems,

incomplete reporting, absence of a treatment readiness program in Hewu, and limited documentation of

client care and progress. Hewu Hospital has not yet been accredited, but is imminent. The treatment

support is linked to community-based activities that address HIV and AIDS, care and treatment awareness

and reduce stigma. Traditional healers and faith leaders provide spiritual support. The electronic patient

register is in process with Columbia University, described in the Basic Health Care and Support section of

the COP.

ACTIVITIES AND EXPECTED RESULTS:

Support for treatment emphasizes the management of patient care and services within public sector

facilities in Eastern Cape. Tools and onsite support will put mechanisms in place that will facilitate treatment

availability, quality, and service management.

ACTIVITY 1: Support Hewu Hospital in Establishing ARV Service

With support from the Eastern Cape Department of Health (ECDOH), the Africare team will design a

supportive strategic and operational planning process for the Hewu Hospital Wellness Centre and ARV

service that will assist the hospital in identifying the resources required to provide ARV services, including

staffing, drugs, guides and tools, equipment and furnishings. Support will be provided for the completion of

the wellness centre establishment as needed in term of filing systems, data management staff and

equipment, communication systems and temporary staff.

ACTIVITY 2: Development of an Electronic Patient Register

With another PEPFAR partner in the Eastern Cape, Columbia University, the project has worked with the

health information systems program to develop and implement an electronic patient register and record for

adult and pediatric patients on ARVs. Funding is supporting the adaptation of an open-source, tested

software and ensure that it includes all essential elements of information required locally and can link easily

with the existing health and hospital information systems. Africare's support will focus on the linking

individual patient data to the district health information system (DHIS) and HIV service management

reporting. Training and implementation support will be provided initially to Hewu Hospital, Frontier Hospital

and Fort Beaufort and Victoria Hospital, along with Sada Community Health Center. Training will be

provided for data capturers, health workers and service managers to us the information for client ART case

management.

ACTIVITY 3: Strengthen the Process of Treatment Readiness Patient Education

Support will be provided to identify and implement local best practices identified the Eastern Cape. ARV

readiness workshops will be conducted to improve quality of care at each hospital and referral sites

(approximately 15 clinics). A model ARV readiness patient education program will be adapted for these

supported facilities.

ACTIVITY 4: Continuing Professional Development

Access to continuing education on HIV disease management, ARV initiation and support, and drug supply

management will be facilitated, using existing training providers and programs. Continuing education

seminars for doctors, nurses and pharmacists will improve competence in evidence-based HIV and ARV

management through onsite mentoring of health workers. In-service training for nurses to support ART will

continue. Data and case management review meetings will be supported bi-monthly. Through an

institutional collaborating partner and/or identified mentors, medical and surgical inpatient doctors in each

hospital will be mentored in identifying and appropriately managing HIV patients in the general wards.

Training on pediatric HIV management will be implemented through onsite clinical mentoring for neonatal

HIV management and management of pediatric cases, and follow-up to promote early identification of

infants and children needing ARVs. In addition, general practitioners working in these facilities part-time will

be trained basic pediatric ARV care. Integration of TB and HIV care will be supported with training on TB

and HIV co-management.

ACTIVITY 5: Pilot for Utilizing Traditional Healers for Treatment Support

Traditional healers have expressed interest in becoming an integral part of client referral for treatment and

support of the client when on ARVs. A pilot group of traditional healers will be trained as ART aides that will

assist patients to adhere to treatment.

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

With data that will be available from the ARV software, case and service statistics reviews will be conducted

6-monthly, using client data (defaulter rates, treatment adherence rates, common ART side-effects

experienced, reasons for discontinuation, and CD4 counts at ART initiation) to monitor access to and

utilization of services, as well as patient outcomes. A transport voucher system will be developed to support

Activity Narrative: patients who decline ART because they are unable to afford the cost of transport to Frontier Hospital. This

system will be developed and implemented for adult patients from Hewu while awaiting accreditation, and

for pediatric clients until plans to decentralize pediatric care to Hewu are implemented. FY 2008 funds will

support the cost of transport and management of the documentation system.

FY 2008 Activities will also include:

- A shift in hospital sites to prevent overlap with other PEPFAR partners. Fort Beaufort and Victoria

Hospitals in Nkonkobe LSA (Amathole District), Port Alfred Hospital in Makana LSA (Cacadu District) and

possibly Cofimvaba and Settler's Hospitals. Assignments will be finalized through working with the Province

and PEPFAR team.

- Deployment of doctors seconded part-time to each hospital to help alleviate staffing pressures and to

ensure implementation of best practices and to help initiate ARVs in Primary Health Care sites as

determined by the DOH

- Deployment (and training, as necessary) of Pharmacy Assistants to hospitals where dispensing is a key

constraint to scaling up the volume of ARV patients.

- Support Group training in ARV literacy education for new HIV positive members

By supporting ARV service delivery programs, Africare will contribute to the realization of the PEPFAR 2-7-

10 goal of treating two million people with ART. These activities will also support efforts to meet the

treatment objectives outlined in the USG Five-Year Strategy for South Africa.