Elizabeth Glaser Pediatric AIDS Foundation implements a comprehensive HIV care and treatment program

in South Africa that is funded with Track 1 central funding, as well as South Africa COP funding. The

activities do not differ across the funding mechanisms, and this entry is thus a repeat of the South Africa

COP entry. All targets are reflected in the South Africa COP entry.

BACKGROUND:

The long-term goal of the EGPAF care and treatment program in South Africa is to increase life expectancy

amongst HIV-infected persons by increasing access to care and treatment services and service utilization.

Primary emphasis areas are human capacity development and expansion of services through training and

task shifting, local organization capacity building, development of infrastructure, policy and guidelines, and

strategic information. Primary populations to be targeted include infants, men and women, pregnant women,

people living with HIV (PLHIV), and public and private healthcare providers.

Project Help Expand ART (HEART) will expand geographic coverage of services in FY 2008. HEART/South

Africa is part of a larger worldwide initiative by EGPAF to support care and treatment services, and receives

both Track 1 and in-country PEPFAR funding. The program's focus is on integrating PMTCT services to

provide a family-centered model of care that includes access to treatment for HIV-infected pregnant women,

couple counseling, partner testing and screening for TB.

EGPAF utilizes PEPFAR resources to complement those of the KwaZulu-Natal (KZN) Department of Health

(DOH) and private partners, such as faith-based organizations (FBOs) and other non-governmental

organizations (NGOs). These resources fund staff, infrastructure, drugs, laboratory testing and provide

technical support. EGPAF will identify gaps in the program at the site level and implement activities to

address the needs. The intent is to facilitate national and provincial plans and work with the government and

partners to transition programs to South Africa government (SAG) support.

EGPAF has a partnership with a private NGO, the AIDS Health Care Foundation (AHF); this is a cost-

sharing relationship (drugs and staff) to support the AHF care and treatment program. McCord Hospital, a

faith-based organization, is a sub-grantee of EGPAF. The EGPAF partnership with the DOH includes

support for human capacity development, infrastructure rehabilitation and technical support for sites in KZN.

The existing sites are:

(1) McCord Hospital, Durban;

(2) AHF (Ithembalabantu Clinic), Umlazi, Durban;

(3) KZN DOH, Pietermaritzburg Up/Down-referral program (Edendale Hospital and four referral clinics,

Northdale Hospital and five referral clinics); and

(4) KZN DOH, Vryheid Hospital plus three referral clinics, Benedictine Hospital and three referral clinics,

and Edumbe Community Health Centre (CHC) plus one referral clinic, in Zululand District.

This partnership with the DOH will be expanded to the whole Free State province, to Ramotshere Moiloa

(Zeerust) and Tswaing (Delareyville) sub-districts in the North West, to all of the Umgungundlovu and

Zululand districts in KZN, and the Eastern Ekurhuleni and Lesedi sub-districts in Gauteng.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

EGPAF will support training of healthcare providers on the following:

1. Screening and treatment of TB/HIV and opportunistic infections, ART in pregnancy, and referral systems

(between PMTCT and ART);

2. Supporting systems to improve access to care and treatment of children (including early infant diagnosis);

3. Capacity building at sites for implementation and management of the comprehensive care, management

and treatment support program;

4. M&E;

5. Project management; and

6. Funding health workers to complete a HIV and AIDS Diploma at the University of KwaZulu-Natal.

In addition EGPAF will provide technical assistance for the creation of outreach programs to build capacity

at primary healthcare (PHC) clinics for downward and upward referral in order to maintain patients on ART,

initiate new patients on therapy, and decongest treatment sites that have reached capacity.

ACTIVITY 2: Down Referral Process

The KwaZulu-Natal Health Department (KZNDOH) started providing comprehensive care and treatment

services to HIV-infected patients in May 2004 at hospital level. PHC clinics will be capacitated so that they

are able to manage stable patients on ART referred down from the hospitals or community health centers

(CHCs), and also up refer those that are eligible for initiation of ART to hospital or CHCs that are ARV

accredited sites.

The KZNDOH aims to make ART accessible to all by expanding and strengthening existing HIV and AIDS

care and treatment service delivery. A number of CHCs have been accredited by the national and provincial

health departments and will initiate ART. The PHC clinics conduct rapid HIV testing, CD4 testing and

provide the first, second and third adherence counseling sessions, which is also done at CHC and hospital

level, and then refer patients to accredited CHCs or hospitals for initiation. The KZNDOH has identified the

Pietermaritzburg and Zululand Districts as areas needing immediate support as they are poorly resourced

with high HIV seroprevalence rates. The KZNDOH has requested that EGPAF support be extended to these

districts. The districts have identified clinics where stable patients on treatment can be referred to continue

ART management.

ACTIVITY 3: Pediatric Care and Treatment

Activity Narrative: EGPAF's goal is to ensure that 10 percent of all patients on treatment are children, which has not been

achieved in the Zululand district. To strengthen pediatric HIV care and treatment, EGPAF will provide

training on early infant diagnosis, pediatric HIV clinical staging and diagnosis and ART in children, in

addition to provision of staff, strengthening the linkages between PMTCT and care and treatment.

The Edendale and Northdale pediatric HIV clinic has the largest cohort of pediatrics in the province on ART.

The hospital down refers stable patients to the care of the PHC clinics to free up space for new pediatric

patients.

EGPAF aims to:

1. Increase the rate of down referral of stable children on ART;

2. Increase the up referral of new eligible children for initiation of therapy; and

3. Improve linkages between PMTCT programs and care and treatment programs.

EGPAF will provide financial and technical support to eight PHC clinics in the catchment area of the

Edendale and Northdale hospital in Pietermaritzburg, thus capacitating them to: (1) receive and manage

transferred stable pediatric patients on ART from the pediatric HIV clinic; and (2) provide screening and

preparation of eligible HIV-infected patients at three PHC facilities for up referral and initiation of ART at

Edendale Hospital Pediatric HIV clinic. The same approach will be applied as we expand to other provinces,

namely Free State, North West and Gauteng Provinces.

ACTIVITY 4: Counseling and Testing (CT)

The focus will be strengthening comprehensive HIV and AIDS care and treatment services using a family-

centered approach to increase access to CT, by fast-tracking TB, STI, and family planning patients to CT; to

integrate PMTCT with HIV and AIDS care and treatment; to improve referral of eligible pregnant mothers,

partners, family members, and HIV-infected infants and children to treatment sites; to screen for

opportunistic infections. With this focus, EGPAF will increase pediatric care and treatment, couple

counseling, partner testing, and testing for siblings. For patients who test HIV positive and are not yet

eligible for ART, they will be retained through wellness clinics, support groups, patient tracking, etc. The

overall goal is to expand coverage of HIV and AIDS care and treatment services to reach mothers, partners

and children who would not otherwise have access to these services.

The increase in funding in FY 2008 will be used to expand EGPAF program activities viz. human capacity

development, down-referral process, pediatric care and treatment as well as counseling and testing

activities to the Free State, North West and Gauteng Province. In addition, EGPAF will strengthen M&E

systems at all levels of service delivery.

The activities contribute to the PEPFAR 2-7-10 goals.