This activity was approved in the FY 2007 COP, was funded with FY 2007 PEPFAR funds, and is included

here to provide complete information for reviewers. The funding mechanism from field support to a local

agreement for Family Health International (FHI) is changing in October 2008 therefore a COP entry is being

made to reflect this change in mechanism and activity number only. FHI activities under MTCT are

expected to continue under the FY 2008 COP and funds are being requested in the new COP entry.

SUMMARY:

Family Health International (FHI) will collaborate with PEPFAR-funded prevention of mother-to-child

transmission (PMTCT) partners to strengthen PMTCT services in four provinces. FHI will provide a PMTCT

Training of Trainers (TOT) course designed for program implementers. Auxiliary nurses and lay counselors

will be equipped with appropriate knowledge and skills of PMTCT. With the provincial departments of health

(DOH), FHI will design and provide technical assistance (TA) to PMTCT facilities to improve the quality of

those services. This project will provide resources to other PEPFAR partners, including Elizabeth Glaser

Pediatric AIDS Foundation (EGPAF) and JHPIEGO. The target populations include men and women of

reproductive age, pregnant women, and people living with HIV and AIDS. The emphasis areas are

addressing male norms and behaviors, training and wraparound programs in family planning.

BACKGROUND:

Since FY 2004, with PEPFAR funding, FHI has provided TA to a number of South Africa provincial DOH

PMTCT facilities. The goal of this TA is to improve overall performance of selected PMTCT sites, with an

emphasis on promoting best practices including the provision of antiretroviral (ARV) prophylaxis and family

planning (FP) counseling and referrals. Since FY 2004, FHI has supported the provincial DOH in Limpopo

and Northern Cape provinces by providing training to over 211 PMTCT service providers, including nurses

and lay counselors, and on-site TA to 50 PMTCT facilities. In FY 2006 FHI continued to work in Limpopo

and Northern Cape provinces and extended TA to Free State. At the request of these provincial

Departments of Health and with endorsement from the national DOH, FHI is assisting in the development

and adoption of provincial PMTCT protocols. FY 2007 funding ensured that TA could continue to be

provided to Free State, North West, Limpopo and Western Cape provinces. With FY 2008 funding, the

project will build on the lessons learned from the two previous years of PEPFAR funding. FHI will develop

and make available on CD-ROM an interactive tutorial that can be used by other PMTCT implementing

agencies and the DOH. FHI will also continue to provide TA to improve overall PMTCT performance and

strengthen the systems necessary to support PMTCT programs (e.g. supervision and data management).

FHI, in conjunction with clinics, will also design strategies to improve outreach to male partners of women

availing themselves of PMTCT services, hence increasing gender equity in HIV programs and addressing

male norms and behaviors by providing training on couple counseling, and promoting male attendance at

antenatal visits with women (based on women's consent).

ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Capacity Building

FHI's activities will build on the FY 2006 and FY 2007 program in which FHI developed human capacity by

refining the current training course for auxiliary nurses and lay counselors and equipping them with the

knowledge and skills necessary to strengthen PMTCT services, including: (1) counseling and testing; (2)

provision of ARV prophylaxis; (3) counseling and support for safe infant feeding practices; and (4)

counseling on FP. Focusing on transferring skills to trainers to train providers, as well as to providers

directly, FHI will develop TOT training materials into a CD-ROM in FY 2007 and make it available as a

resource to the DOH, all PEPFAR partners, and other PMTCT stakeholders. The CD-ROM will include the

facilitator's guide and participant manual from the refresher course. Interactive in nature, the contents will

focus on the main components of a comprehensive PMTCT program and will have an emphasis on

increasing counselors' and nurses' knowledge of appropriate FP methods for women with HIV, including

those women receiving ARV treatment, strengthening counselors' communication and counseling skills

around FP for PMTCT clients, and providing referrals. In addition, FHI will continue to provide the TOT

course to other agencies supporting or implementing PMTCT programs (e.g., EGPAF, NDOH, JHPIEGO)

and work closely with them to provide additional TA to roll out the TOT curriculum through their programs.

ACTIVITY 2: Technical Assistance

FHI will continue to provide TA to the DOH in PMTCT facilities in four provinces (Free State, North West,

Limpopo and Western Cape) to improve program performance. Specifically, the scope of work for the TA is:

(a) conduct both pre-service and in-service training courses for auxiliary nurses and lay counselors to

strengthen the four main components of the selected PMTCT programs; and design the TA with the DOH to

ensure activities fit into the existing health system to help promote sustainability; (b) clarify performance

expectations for newly trained staff and managers and strengthen supportive supervision processes; (c)

strengthen referral systems to enhance continuity of care; (d) improve functional referrals from PMTCT to

FP services in order to promote healthy spacing of pregnancies and prevent unintended pregnancies

among post-partum PMTCT clients; (e) conduct training on couple counseling and create strategies to

involve male partners in PMTCT visits, and; (f) draw on the results of FHI's research on optimal timing for

FP counseling within PMTCT services to provide TA to facilities that will include the development of FP

messages to be incorporated into points in the service delivery system that have shown to increase the

likelihood of uptake of FP (e.g., pre-/post-test counseling, post-partum period, infant feeding counseling,

infant testing, or child health services).

This project contributes to PEPFAR 2-7-10 goals by reducing the number of new infections among infants

exposed to HIV and ensuring that HIV-infected pregnant women and infants are appropriately referred to

treatment, care and support services. In addition, by strengthening the FP component of PMTCT programs

FHI helps to prevent future unintended pregnancies in HIV-infected women.

This activity was approved in the FY 2007 COP, was funded with FY 2007 PEPFAR funds, and is included

here to provide complete information for reviewers. The funding mechanism from field support to a local

agreement for Family Health International (FHI) is changing in October 2008; therefore, a COP entry is

being made to reflect this change in mechanism and activity number only. FHI activities under AB are

expected to continue under the FY 2008 COP and funds are being requested in the new COP entry.

SUMMARY:

Family Health International (FHI) will provide technical assistance (TA) to three universities' peer education

programs to continue integration of abstinence and be faithful messages (AB) as well as life skills into the

ongoing activities of the peer education programs on university campuses. Using the curriculum developed

in FY 2005, the AB and life skills training will be extended to a cadre of peer educators (PEs) on each of the

campuses participating in this project. The PEs will then pass these skills on to other students on campus

primarily through interaction in ongoing, small behavior change groups. Emphasis areas are gender which

includes addressing male norms and behaviors, cross-generational sex and multiple sexual partnerships,

reducing violence and coercion, training, local organization capacity building, and wraparound programs in

family planning and education. Main target populations addressed are men and women of reproductive age

and people living with HIV.

BACKGROUND:

Currently, most efforts addressing sexuality and reproductive health needs for young people are focused on

out-of-school youth and those in secondary school in South Africa. Youth at institutions of higher learning

represent a special group at risk as they are often left unsupervised by both parents and teachers, who are

under the assumption that they are mature enough to protect their sexual and reproductive health. Available

evidence suggests that these young men and women have high sexually transmitted infection (STI) and

unintended pregnancy rates, an indication that they are not yet equipped with the knowledge and skills

required to protect themselves from these adverse outcomes.

In FY 2005, in consultation with the South African Universities Vice Chancellors' Association (SAUVCA) and

the Department of Education, FHI implemented a project that took place on three university campuses in

South Africa: University of the Western Cape, University of the Free State, Qwaqwa campus and University

of Limpopo, Medunsa campus. Each campus contributed to the development of the AB/life skills curriculum

which was subsequently implemented among 26 PEs from each of the three campuses. After the training,

PEs recruited six students each to take part in ongoing behavior change communication (BCC) groups on

their campus, reaching in total 468 students.

Life skills aim to enhance the students' ability to make responsible sexual health decisions and adopt

behaviors that will keep them free of STI and HIV infection, as well as avoid unintended pregnancies. The

curriculum included sessions on "Abstinence"; which promotes delaying sexual debut for youth under 14, as

well as secondary abstinence for older youth and "Be Faithful" for youth and adults in long-term relationship,

discouraging them to engage in multiple and concurrent sexual relationships which are the drivers of the

HIV epidemic. The AB prevention messaging will address secondary abstinence, values clarification, self-

esteem, communication, decision making and negotiation, and utilized participatory learning techniques.

Another key component of the AB/life skills training was a session on gender equity. The curriculum

complemented the universities' existing peer education curricula, which provides basic information about

prevention of HIV and AIDS. The BCC groups provided a safe place to explore strategies for adopting and

strengthening the AB life skills in their personal lives. Students were able to support each others' behavior

change process, including seeking counseling and testing (CT). Through one-on-one and group interaction,

the PEs took advantage of a variety of regularly scheduled campus events-such as orientation week,

condom week, and STI awareness week-to reach additional students with basic information on STIs, HIV

and unintended pregnancies and how to protect oneself and maintain a healthy lifestyle. The program also

promoted referrals between the PEs and student health or community health services for CT as well as

family planning (FP).

Major accomplishments to date include development of the AB life skills curricula and successful training of

the PEs. The program has gone beyond the university campuses and PE groups to be conducted in high

schools in communities near the campuses. A radio series was produced and launched on campus and

community stations throughout South Africa, reaching approximately 6,000,000 listeners. The show

addressed issues related to risk-reduction behaviors for STIs, HIV and unintended pregnancies that are

relevant for university students. The curriculum was also used by University of Nairobi for a similar

intervention.

The universities did not receive PEPFAR funding for FY 2006, however the universities were committed to

continue the BCC groups and supervision activities. While the activities are expected to continue with the

respective university funding, additional resources are needed to strengthen the longer-term

institutionalization of the life skills program.

ACTIVITIES AND EXPECTED RESULTS:

In collaboration with the Department of Education, in FY 2008 FHI will continue to work with the three

universities, University of the Western Cape, University of the Free State, Qwaqwa campus and University

of Limpopo, Medunsa campus, and explore opportunities to expand activities to tertiary institutions. FHI will

work in collaboration with JHU at the University of Western Cape and the University of Free State, Qwaqwa

campus to ensure that all PE programs are harmonized. To align the goals of the program with the

government goals, FHI will work closely with the Department of Education staff to further refine the program

and improve outreach. Further integrating AB life skills into their peer outreach program work plans, each

university will recruit new PEs for the AB life skills project, who will then recruit other students to participate

in small, ongoing BCC groups. TA will also be provided to strengthen supervision skills to ensure the quality

of the peer interactions, modeling problem solving skills, and shaping perceived peer/social norms on

sexual behaviors. The "Be Faithful" messages will also promote mutual monogamy, partner reduction and

full information on correct and consistent condom use will be provided.

Specific activities include:

Activity Narrative:

(1) Incorporating AB life skills program into existing peer education work plans in a cost-effective manner;

(2) Conducting AB life skills training for all PEs participating in the program;

(3) Providing refresher trainings to strengthen basic peer education/facilitation skills;

(4) Standardizing job aids and tools for PEs to use in small groups;

(5) Conducting supervision skills training for and provide TA to supervisors to help support PEs and the

BCC group process;

(6) Building and strengthening relationships between PEs and student health services, and formalize

referral links to health services;

(7) Integrating alcohol and substance abuse risk behaviors in the life skills program; and

(8) Monitoring AB, life skills and BCC group processes.

The project will help decrease the number of new infections by achieving the expected results which will

ultimately lead to a delay in sexual debut, a reduction in sex acts, fewer partners or a reduction in

unprotected sex.The activities contribute to the 2-7-10 PEPFAR's goals of averting of seven million new

infections.

SUMMARY:

Family Health International (FHI) will provide technical assistance (TA) to three universities' peer education

programs to continue integration of abstinence and be faithful messages (AB), condom and life skills into

the ongoing activities of the peer education programs on campus. Using the curriculum developed in FY

2005, the AB and life skills training will be expanded to include other prevention strategies, including

condom use. A cadre of peer educators (PEs) on each of the campuses participating in this project will be

trained. The PEs will then pass these skills on to other students on campus primarily through interaction in

ongoing, small behavior change groups. Emphasis areas include addressing male norms and behaviors,

reducing violence and coercion, training, local organization capacity building, and wraparound programs in

family planning and education. Main target populations addressed are men and women of reproductive age

and people living with HIV and AIDS.

BACKGROUND:

Currently, most efforts addressing sexuality and reproductive health needs for young people are focused on

out-of-school youth and those in secondary schools in South Africa. Youth at institutions of higher learning

represent a special group at risk as they are often left unsupervised by both parents and teachers, who are

under the assumption that they are mature enough to protect their sexual and reproductive health. Available

evidence suggests that these young men and women have high STI and unintended pregnancy rates, an

indication that they are not yet equipped with the knowledge and skills required to protect themselves from

these adverse outcomes. In FY 2005, in consultation with the South African Universities Vice Chancellors'

Association (SAUVCA) and the Department of Education, FHI implemented a project that took place on

three university campuses in South Africa: University of the Western Cape, University of the Free State,

Qwa-Qwa campus and University of Limpopo, Medunsa campus. Each campus contributed to the

development of the AB/life skills curriculum which was subsequently implemented among 26 PEs from each

of the three campuses. After the training, PEs recruited six students each to take part in ongoing behavior

change communication (BCC) groups on their campus, reaching in total 468 students. Life skills programs

aim to enhance the students' ability to make responsible sexual health decisions and adopt behaviors that

will keep them free of STI and HIV infection, as well as avoid unintended pregnancies. The curriculum

included sessions on AB, secondary abstinence, values clarification, self-esteem, communication, decision

making and negotiation, and utilized participatory learning techniques. Another key component of the AB/life

skills training was a session on gender equity. In FY 2008, the training will be expanded to include other

prevention messages beyond AB, including messages on condom use and safe sex. The curriculum

complemented the universities' existing peer education curricula, which provides basic information about

prevention of HIV and AIDS. The BCC groups provided a safe place to explore strategies for adopting and

strengthening the ABC life skills in their personal lives. Students were able to support each others' behavior

change process, including seeking counseling and testing (CT). Through one-on-one and group interaction,

the PEs took advantage of a variety of regularly scheduled campus events-such as orientation week,

condom week, and STI awareness week-to reach additional students with basic information on STIs, HIV

and unintended pregnancies and how to protect oneself and maintain a healthy lifestyle. The program also

promoted referrals between the PEs and student health or community health services for CT as well as

family planning (FP). Major accomplishments to date include development of the AB life skills curricula and

successful training of the PEs. The program has gone beyond the university campuses and PE groups to be

conducted in high schools in communities near the campuses. A radio series was produced and launched

on campus and community stations throughout South Africa, reaching approximately 6,000,000 listeners.

The show addressed issues related to risk-reduction behaviors for STIs, HIV and unintended pregnancies

that are relevant for university students. The curriculum was also used by University of Nairobi for a similar

intervention.

Although there was no FY 2006 funding, the universities were committed to continue the BCC groups and

supervision activities. While the activities are expected to continue with the respective university funding,

additional resources are needed to strengthen the longer-term institutionalization of the life skills program.

ACTIVITIES AND EXPECTED RESULTS:

In collaboration with the Department of Education, in FY 2008 FHI will continue to work with the three

universities: University of the Western Cape, University of the Free State, Qwa-Qwa campus and University

of Limpopo, Medunsa campus, and explore opportunities to expand activities to Technikons. FHI will work in

collaboration with John Hopkins University (JHU) and the Department of Education at the University of

Western Cape and the University of Free State, Qwaqwa campus to ensure that all PE programs are

harmonized and do not overlap. To align the goals of the program with the government goals, FHI will work

closely with the Department of Education to further refine the program and improve outreach. Further

integrating ABC life skills into their peer outreach program work plans, each university will recruit new PEs

for the life skills project, who will then recruit other students to participate in small, ongoing BCC groups. TA

will also be provided to strengthen supervision skills to ensure the quality of the peer interactions, modeling

problem solving skills, and shaping perceived peer/social norms on sexual behaviors.

Specific FY 2008 activities include: 1) Continue to incorporate ABC life skills program into existing peer

education work plans in a cost-effective manner; 2) Conduct ABC life skills training for all PEs participating

in the program; 3) Provide refresher trainings to strengthen basic peer education/facilitation skills; 4)

Standardize job aids and tools for PEs to use in small groups; 5) Conduct supervision skills training for and

provide TA to supervisors to help support PEs and the BCC group process; 6) Build and strengthen

relationships between PEs and student health services, and formalize referral links to health services; and

7) Monitor ABC, life skills and BCC group processes.

The project contributes to the prevention of 7 million new infections as per PEPFAR 2-7-10 goals. The

project will help decrease the number of new infections by achieving the expected results which will

ultimately lead to a delay in sexual debut, a reduction in sex acts, fewer partners or a reduction in

unprotected sex.

This activity was approved in the FY 2007 COP, was funded with FY 2007 PEPFAR funds, and is included

here to provide complete information for reviewers. The funding mechanism from field support to a local

agreement for Family Health International (FHI) is changing in October 2008 therefore a COP entry is being

made to reflect this change in mechanism and activity number only. FHI activities under HBHC are

expected to continue under the FY 2008 COP and funds are being requested in the new COP entry.

SUMMARY:

Family Health International (FHI) will continue to improve access to holistic services for people living with

HIV and AIDS (PLHIV) and their families by enhancing palliative care (PC) programs and strengthening

links to ARV, counseling and testing (CT), family planning (FP), and other essential services. Emphasis

areas are pre-service and in-service training, local organization capacity development and wraparound

programs in family planning. Target populations are people living with HIV and AIDS and men and women

of reproductive age.

BACKGROUND:

The FHI-supported Integrated Community Palliative Care (ICPC) model is the first public sector palliative

care model at the district level funded by the South African Government with technical assistance from FHI.

As requested by the Departments of Health (DOH) and Social Development, FHI provides support to both

community- and facility-based PC services at the primary care and hospital level, while strengthening the

linkages between PC, CT, ARV and family planning (FP) for comprehensive care and support. FHI's

interventions strengthen the physical, spiritual, social, psychological and preventive aspects of PC, and

leverage government resources through service networks to meet multiple care needs. Tighter links

between PC, CT, ARV and FP services, in particular, afford men and women the opportunity to improve

their overall quality of life through integrated services. Since FY 2005, FHI and partners trained 828

community volunteers and provided services to over 12,000 home-based care (HBC) clients in Mpumalanga

and KwaZulu-Natal; trained 50 government HBC volunteers in Limpopo and Northern Cape using the

Health/Welfare Sector Education and Training Authority curriculum; trained 484 health care professionals in

PC; and provided support to the Johannesburg Hospital Palliative Care Team (HPCT), reaching out to more

than 4,000 clients. In the communities where they are working, FHI is expanding pediatric PC services to

ensure HIV-infected children are receiving appropriate care, and setting up a mobile clinic to improve

access to integrated services in remote HBC programs. FHI carries out PC activities with government and

community-based organizations (CBOs), including Project Support Association-South Africa (PSASA), the

South African Council of Churches, South Africa Red Cross, Nightingale Hospice and Evelyn Lekganyane

HBC.

ACTIVITIES AND EXPECTED RESULTS:

FHI will continue to strengthen access to integrated services as a part of a comprehensive palliative care

package for PLHIV and their families in Mpumalanga, KwaZulu-Natal, Limpopo, Northern Cape and

Gauteng provinces. This includes the ICPC model in 2 provinces. Effort will be made to ensure equitable

access to care services for both males and females and increased participation by men will be encouraged

in service delivery. The activities expand existing services that CBOs and government care programs

currently provide with an emphasis on promotion of the HIV preventive care package. With FY 2008

funding, FHI will further institutionalize the program within government and CBOs, while also expanding its

reach. FHI will emphasize capacity building and local skills transfer, and will also stress gender sensitivity in

counseling and community outreach, promote couples counseling, and assist HBC programs to develop

strategies to alleviate the care burden on girls.

ACTIVITY 1: Strengthening community-based organizations

Benefiting HBC clients, family members and caregivers in Mpumalanga, KwaZulu-Natal, Limpopo, and

Northern Cape provinces, FHI will continue to work with community groups through outreach to :1) Provide

technical assistance (TA) to HBC volunteers to identify PC, CT, ARV and FP needs in the household and to

refer to appropriate services; 2) Leverage government and partner resources by building/strengthening

formal referrals between HBC projects and CT sites, nearby ARV providers, and FP clinics; 3) Train HBC

volunteers to assist clients with adherence to ARV therapy and care interventions; e.g. referral for

cotrimoxazole prophylaxis and caring for caregivers; 4) Strengthen TB management and nutritional

assessment, monitoring and supplements, including and referrals to government/NGO services for food

parcels; 5) Support select HBC programs through financial assistance, supportive supervision TA, and

reporting; 6) Provide PC training for health providers and HBC programs using the nationally accredited

curriculum, and expand services to include pediatric PC as appropriate, and; 7) Conduct trainings for ARV

providers on prevention with positives including FP referral for HIV-infected couples, including those on

ARVs. Addressing prevention with HIV-infected individuals is an important part of a 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.

ACTIVITY 2: Strengthening government programs

FHI will provide TA, training and financial support to four districts of Limpopo and Northern Cape.

Specifically, FHI will continue to work with government to: 1) Train district-level PC health providers in pain

and symptom assessment and management, TB and other opportunistic infection screening, pediatric PC,

psychosocial and spiritual needs of PLHIV and affected families, PMTCT and FP counseling; 2) Implement

mechanisms for quality assurance and supervision, as per standard operating procedures; 3) Conduct

district-level workshops for family members, traditional healers, and local AIDS councils to promote care,

support and treatment services; reduce discrimination and stigma; increase awareness of HIV-infected

individuals needs; and support pediatric PC, and; 4) Strengthen referral networks between primary health

care and CBO services, including linkages with health and social welfare sectors for grants, legal aid, micro-

finance, spiritual support, CT, ARVs, and FP.

ACTIVITY 3: Technical assistance to Johannesburg

Activity Narrative:

HPCT FHI will continue to support the Johannesburg HPCT and other government-accredited ART sites by

increasing access to pediatric PC and reinforcing the integration of HIV and FP services. Through TA to

nurse managers, nurses, midwives, medical officers, coordinators and other providers in ART sites, FHI will

continue to improve the capacity of Johannesburg HPCT, including strengthening linkages with community-

based organizations to enhance client follow-up and contribute to identification of new clients. In addition,

FHI will provide TA to strengthen prevention with positives, including increasing providers' knowledge and

skills to address the FP needs of their ART clients.

ACTIVITY 4: Support to the NDOH

To guide the HIV/FP integration efforts described above, and in response to specific requests from the

DOH, FHI will support National DOH (NDOH) and provincial staff in Mpumalanga, KwaZulu-Natal, Northern

Cape, Limpopo and Gauteng provinces to strengthen integration of family planning and HIV services. With

separate funding, FHI will help the NDOH to revise the current sexual and reproductive health curriculum to

include guidelines for HIV-infected couples, including those on ARVs. In FY 2008, FHI will provide TA to the

NDOH on implementing the new curriculum and integrating HIV and FP services, particularly in PC service

sites. In FY 2008, FHI will continue to support NDOH and provincial staff to build on government operational

plans and address gaps, including: 1) Providing mentoring and on the job training to enhance prevention

with positives through integration of HIV and FP services; 2) Enhancing functional referrals between HIV

and FP services; 3) Providing technical assistance to the NDOH to continue to roll out the revised sexual

reproductive health (SRH) curriculum and ensure that more providers are equipped with skills to address

the SRH needs of HIV-infected women and men; 4) Collaborating closely with district DOH management to

strengthen supportive supervision for integrated HIV/FP services, including use of provider tools that

reinforce new FP counseling skills and revision of routine monitoring forms to include FP information and

indicators.

These activities contribute to the PEPFAR goal of providing care services to 10 million. The activities also

support the USG strategy for South Africa by collaborating closely with the DOH to improve access to and

quality of basic care and support.

This activity was approved in the FY 2007 COP, was funded with FY 2007 PEPFAR funds, and is included

here to provide complete information for reviewers. The funding mechanism from field support to a local

agreement for Family Health International (FHI) is changing in October 2008 therefore a COP entry is being

made to reflect this change in mechanism and activity number only. FHI activities under HTXS are

expected to continue under the FY 2008 COP and funds are being requested in the new COP entry.

This is a new activity in FY 2008.

SUMMARY:

Family Health International (FHI) will use FY 2008 funding to continue to expand access to integrated

services for HIV-infected and affected individuals in home-based care (HBC) programs by strengthening the

linkages between HBC and counseling and testing (CT) through establishing additional mobile clinics in

underserved areas in Mpumalanga and KwaZulu-Natal provinces. FHI will work with the Departments of

Health as well as PEPFAR partners, Project Support Association of Southern Africa (PSASA), Right to Care

(RTC), and BroadReach, and will refer patients in need of antiretroviral treatment (ART) to government-

accredited institutions for ART initiation. The emphasis areas for the following activities are in-service

training, local organization capacity building, and health-related wraparound programs in family planning,

safe motherhood, and tuberculosis. Target populations addressed are people living with HIV and AIDS and

men and women of reproductive age.

BACKGROUND:

In response to requests from the national and provincial Departments of Health and Social Development,

FHI has been strengthening the linkages between home-based care (HBC), counseling and testing (CT),

TB, antiretroviral treatment (ART) and family planning (FP) services for comprehensive treatment, care and

support. This project addresses the need to establish formal referral and follow-up mechanisms for CT and

ART and other essential healthcare services, such as FP, in HBC programs where clients are often in need

of ART. Experience suggests that improved access to ARV services in South Africa is improving the health

status of many HIV-infected individuals, leading to a return of libido and sexual activity, and this also

requires careful decisions about their sexual and reproductive health. Tighter links between palliative care

(PC), TB, CT, ARV and FP services, in particular, afford men and women the opportunity to improve their

overall quality of health through integrated services. FHI is creating and strengthening functional referral

mechanisms between CT, HBC, ARV and FP service programs in Mpumalanga and KwaZulu-Natal in

collaboration with PSASA and the South African Council of Churches (SACC) HBC programs. To date, over

500 new clients have initiated ARVs through the program referral network. Access to ART is still a major

constraint in these rural programs. PSASA's and SACC's HBC programs typically reach out to low-resource,

isolated communities where HIV service needs are high and transport to services is prohibitively expensive.

In FY 2006, FHI and its partners established a mobile clinic to provide better access to CT,

diagnosis/treatment of sexually transmitted infections (STI), ARV services, and FP. These integrated mobile

services target HBC caregivers, clients and their families, as well as the surrounding communities.

Additional units are being added in FY 2007 to reach those who reside in remote, underserved areas in

Mpumalanga and KwaZulu-Natal. This will enable project partners to cover a larger geographical area and

meet the needs of more HBC clients and family members.

ACTIVITIES AND EXPECTED RESULTS:

In close collaboration with the Mpumalanga and KwaZulu-Natal Departments of Health (DOH), PSASA,

SACC, RTC and BroadReach, FHI will expand access to quality integrated services for infected and

affected individuals in HBC programs through a continuation of the project and through continued support to

four mobile service units to provide CT, ARV services, STI screening and FP services in rural, underserved

areas. PSASA and SACC will provide basic care and support services and refer clients for services offered

by the mobile clinics and provide follow-up and ART adherence at the HBC level. Nearby DOH facilities will

process lab work for CD4 counts and place clients on ARVs according to clinical protocols. Specifically FHI

will continue to (1) support the four mobile clinics that were established in FY 2006 and 2007, based in

Mpumalanga and in KwaZulu-Natal; (2) serve remote HBC sites in Mpumalanga and KwaZulu-Natal of

which the program participants and immediate community will have access to the mobile clinics; (3) hire and

supervise local mobile clinic staff (professional nurse and one counselor in each mobile clinic) to provide

CT, STI and FP services and ARV referrals as it is anticipated that patients' treatment by the mobile clinic

staff will be transferred to public sector sites as soon as these sites have the necessary capacity; (4) train

four professional nurses and four counselors to oversee the quality of CT, ARV screening, TB screening

and treatment, STI testing and treatment, FP services and counseling; (5) train four professional nurses and

four counselors on couple counseling and gender awareness, and ensure it is staffed by qualified health

professionals; (6) work with HBC volunteers in mobile clinic service sites to provide referrals for CT, TB,

STI, FP and ARV referrals services; (7) conduct outreach to HBC projects and communities through IEC

materials and household visits; and (8) use the mobile clinics to transport clients to doctors or facilities for

urgent care.

FHI will leverage resources from partners and the DOH for all commodities. FHI will support a Management

Information System to collect service and referral data relating to all patients. A monitoring and evaluation

specialist, who will be hired to spearhead this effort in FY 2007, will continue to be supported in FY 2008.

Also, in FY 2008, COP activities will be expanded to train approximately 40 government officials (10 per

mobile support unit) on maintenance and management. All activities will be implemented closely with local

partners with an aim towards bolstering capacity to take ownership of the mobile clinics by September 2009.

These activities will contribute to the PEPFAR 2-7-10 goals by increasing the number of people receiving

ARV treatment.