SUMMARY:

Activities support the provision of palliative care under the comprehensive antiretroviral treatment (ART)

program carried out by Catholic Relief Services (CRS) in 25 field sites in 8 provinces in South Africa. The

area of emphasis is the improvement of quality of life to people living with AIDS who are not yet on

antiretroviral treatment (ART), ensuring their wellness to delay the necessity of commencing the ART for as

long as possible, ensuring optimal health for persons on ART, and ameliorating pain and discomfort for

those in the terminal stages of the disease. The field sites target those in need of these services, who live in

the catchment area of the site, and who lack the financial means to access services elsewhere.

BACKGROUND:

AIDSRelief (the Consortium led by CRS) received Track 1 funding in FY 2004 to rapidly scale up ART in

nine countries, including South Africa. In FY 2005, FY 2006 and FY 2007, South Africa COP funding was

received to supplement central funding, with continued funding applied for under COP 2008. The activity is

implemented through two major in-country partners, Southern African Catholic Bishops' Conference

(SACBC) and the Institute for Youth Development South Africa (IYD-SA).

All sites operate under the terms of a Memorandum of Understanding (MOU) with the provincial Department

of Health (DOH) in which they operate, observing the national and provincial treatment protocols. There is a

concerted effort at each site to ensure coordination with the South African Government (SAG) and

sustainability by either having the SAG provide antiretroviral drugs, or by referring stable patients in to the

SAG treatment plan. Progress made in this regard is discussed below under activities and expected results.

Contrary to initial expectations, the most difficult issue has been ensuring that men access HIV care and

treatment services. Currently, only a third of patients on ART in the program are men. Many of the

challenges faced in the implementation are rooted in social and cultural backgrounds of the South African

male population, which AIDSRelief is trying to address by involving men while doing home-based care, as

well as putting increased focus on family-centered CT. In addition, AIDSRelief will involve dieticians at

selected sites to identify nutritional deficiencies and problems with patients, in order to assist with referral

and proper food supplementation where needed.

ACTIVITIES AND EXPECTED RESULTS:

With funding provided in FY 2008, AIDSRelief will continue implementing activities in support of the South

African national ARV rollout. Of the 25 existing field sites activated in March 2004, two have transferred all

their ART patients into SAG sites, and have ceased providing treatment. Two new field sites have been

activated in FY 2007 to enroll additional ART patients in support of the SAG rollout plan.

Utilizing technical assistance from AIDSRelief staff members and South African experts, ongoing support

and guidance will be provided to sites in the form of appropriate refresher medical training courses, patient

tracking and reporting, monitoring and evaluation mechanisms and other necessary support.

Basic palliative care services including elements of the preventive care package will be provided by the 25

field sites to patients through clinic-based and home-/community-based activities aimed at optimizing quality

of life for HIV-infected clients and their families throughout the continuum of illness, by means of pain and

symptom diagnosis and relief; psychological and spiritual support; clinical monitoring, related laboratory

services, management of opportunistic infections and other HIV and AIDS-related complications (including

pharmaceuticals); integrated prevention services including prevention with positives; and culturally-suitable

and religiously-appropriate end-of-life care. Patients within the CRS home-based care network will be given

cotrimoxazole prophylaxis where necessary. Effort will be made to ensure equitable access to care services

for both males and females.

The home-based carers are recruited through parish networks, and are deployed in the areas they live in,

with the intention that they should serve patients who live within the walking distance of their homes. All

provincial DOHs pay stipends to their caregivers. Home-based carers within the CRS network tend to pay

their caregivers the same stipend that the DOH pays theirs, as the training that they undergo is the same,

as is the workload. Stipends paid to caregivers vary from one site to another according to the differences in

stipends paid by different provinces. Caregivers are also reimbursed for transport expenses.

AIDS is stigmatized in many South African communities because of the association with death. This is

because of the belief that AIDS inevitably leads to death. As the number of patients on treatment grows,

and as communities see that those on treatment are living normal, healthy lives, stigma is decreasing visibly

and more and more patients are presenting themselves to be tested, either in CT, or if they know that they

are positive, to have their CD4 counts tested and see whether they qualify for treatment. This process has

been accelerated by the way in which patients on treatment at each site are used as community peer

educators and counselors.

All activities will continue to be implemented in close collaboration with the SAG HIV and AIDS directorate

and the respective provincial authorities to ensure coordination and information sharing, thus directly

contributing to the success of the SAG's own rollout and the goals of PEPFAR. These activities are also

aimed at successful integration of AIDSRelief activities into those implemented by the SAG, thus ensuring

long-term sustainability.

Holistic palliative care services are provided to all people who come to the field sites irrespective of their

age, gender, nationality, religious or political beliefs. Historically, adults with HIV of both genders (children to

a lesser extent) have been admitted for palliative care services in partner field sites providing such services.

Palliative care services are provided by SACBC and IYD-SA at their respective sites, through the provision

of services aimed at optimizing quality of life for HIV-infected patients and their family members,

psychological support, management of opportunistic infections (where necessary), other HIV and AIDS

related illnesses, and end-of-life care provided either at the clinic level (where available) or through home-

based care mechanism. Field sites managed by SACBC provide a vast range of services, ranging from

basic (home-based care) palliative support, to in-house, facility-based beds and full palliative care services,

depending on the specifics of each site. IYD-SA also provide a different range of palliative care services,

ranging from referral to other SAG clinics in the area, to home-based carers who provide compassionate

Activity Narrative: and valuable services to palliative care patients. Even though prevention is not a specific program activity of

the overall program, it is promoted through provision of information to patients regarding HIV and prevention

of spreading the virus (prevention with positives). Secondly, skills training is provided to vulnerable

populations, empowering them to make safer choices about their lives. Additionally, AB messages are

shared with the target population, as well as accurate information regarding condoms is provided.

Some of the AIDSRelief sites also receive PEPFAR and other funding through different sources for the

provision of OVC care. The overlapping of these services provides OVC with access to both care and

treatment services provided under the program.

On the staffing front, AIDSRelief is making a conscious effort towards staff retention, through skills

development and strengthening, retreats and debriefing sessions for the staff at the site level where burnout

and compassion fatigue support groups are facilitated. In addition, staff remuneration is monitored and, to

the extent possible within the faith-based environment, reasonable packages are offered. The task shifting

strategy involves shifting certain tasks that medical nurses can do (such as screening the initial patients,

follow-up and monitor stable patients) from medical doctors so that the overall workload is more

manageable. Treatment counselors and community care workers are encouraged to provide pre- and post-

test counseling, adherence training and support and help with basic administrative follow-on work. Other

activities include considerations of community care workers conducting the oral rapid HIV tests, and nurses

only doing the confirmation tests if necessary.

FY 2008 COP activities will be expanded to include nutritional supplementation for patients receiving care or

treatment under the program, primarily to support the effective use of antiretroviral drugs for the patients

already on ART, or to assist patients awaiting to be placed on ART by providing them with necessary

nutritional supplements, and increasing their chances of accepting ARV drugs once placed on ART. In

addition, cotrimoxazole prophylaxis will be given to qualifying HIV-infected persons receiving palliative care

within the operational guidelines of the host country and the donor, with special attention given to exposed

or infected children.

With supplemental funding in FY08, the following activities will be added:

a) Open and staff a new wellness center in Winterveldt for HIV care and treatment services (satellite center)

b) Provide additional space (parkhome) in Orange Farm for HIV care and treatment services

c) Open a satellite HIV care and treatment program in Pary

d) Implement a new patient data system to accurately collect routine HIV care and treatment data -

including equipment where necessary.

SUMMARY:

Activities are implemented to support provision of TB diagnosis under the comprehensive antiretroviral

treatment (ART) program carried out by Catholic Relief Services (CRS) in 25 field sites in 8 provinces in

South Africa. The focus of the activity is on diagnosing patients with TB so that they can be referred to the

South African Government TB program for treatment, and commence with ART while on TB treatment as

soon as the doctor at the site sees this as being medically feasible. The field sites target those in need of

these services, who live in the catchment area of the site, and who lack the financial means to access

services elsewhere.

BACKGROUND:

AIDSRelief (the Consortium led by Catholic Relief Services) received Track 1 funding in FY 2004 to rapidly

scale-up antiretroviral therapy in nine countries, including South Africa. In FY 2005, FY 2006 and FY 2007,

South Africa COP funding was received to supplement central funding, with continued funding applied for in

FY 2008. The activity is implemented through two major in-country partners, Southern African Catholic

Bishops' Conference (SACBC) and the Institute for Youth Development South Africa (IYD-SA).

All sites operate under the terms of a Memorandum of Understanding (MOU) with the provincial Department

of Health (DOH) in which they operate, observing the national and provincial health protocols. There is a

concerted effort at each site to ensure coordination with the South African Government (SAG) and

sustainability by diagnosing TB in potential ART patients, referring them to nearby SAG TB treatment

facilities, and commencing ART once the patients are ready.

ACTIVITIES AND EXPECTED RESULTS:

With funding provided in FY 2008 AIDSRelief will continue implementing the activities in support of the

South African national ARV rollout. Of the 25 existing field sites, activated in program year 1 (Mar '04 - Mar

'05), two have transferred all their ART patients to SAG rollout facilities in FY 2006, and have ceased

providing treatment. Two new field sites have been activated in FY 2007 to replace these sites and to enroll

additional ART patients in support of the SAG rollout plan.

Utilizing technical assistance from AIDSRelief staff members and South African experts, ongoing support

and guidance will be provided to sites in the form of appropriate refresher medical training courses, patient

tracking and reporting, monitoring and evaluation mechanisms and other necessary support.

All TB treatment in South Africa is provided for free by the SAG. Screening of TB patients is problematic in

NGO sites, but this programmatic area is strengthened with CDC-Atlanta technical assistance and

increased focus in FY 2008. AIDSRelief will screen all patients who present themselves to field sites for TB,

and will perform laboratory smear microscopy and culture (if indicated according to NDOH algorithms) on

those suspected of having TB. If laboratory tests are positive, they will be referred to the SAG TB program

for treatment, as per the agreement with the government. This activity includes additional training and

commodities for the vast network of home-based carers to implement a single TB screening algorithm within

the home setting, which improves referrals.

As part of the home-based care training, all home-based carers have to complete a module in TB DOTS.

Most of them were selected as ART adherence monitors in the first place because of the considerable

experience they have gained over the years in implementing the TB DOTS program.

AIDS (in itself and its relation to TB/HIV) is stigmatized in many South African communities because of the

association with death. This is because the perception exists that AIDS inevitably leads to death. As the

number of patients on treatment has grown, and as communities see that those on treatment are living

normal, healthy lives, stigma is decreasing visibly and more and more patients are presenting themselves to

be tested, either in VCT, or if they know that they are positive, to have their CD4 counts tested and see

whether they qualify for treatment. This process has been accelerated by the way in which patients on

treatment at each site are used as community peer educators and counselors.

As described earlier, all activities will be implemented in close collaboration with the South African

Government's health authorities to ensure coordination and information sharing, thus directly contributing to

the success of the SAG rollout and the goals of PEPFAR. These activities are also aimed at successful

integration of AIDSRelief activities into those implemented by the SAG, thus ensuring long-term

sustainability.

SUMMARY:

Catholic Relief Services (CRS) activities are implemented to support provision of counseling and testing

(CT) under the comprehensive antiretroviral treatment (ART) program carried out by Catholic Relief

Services (CRS) in 25 field sites in 8 provinces in South Africa. The program aims to establish the HIV status

of as many residents of the catchments area of each site as possible, with a view to determine their CD4

counts, so that they can be placed on ART as soon as necessary. Major emphasis is placed on community

mobilization/participation, with minor emphasis given to the development of network/linkages/referral

systems, development of human resources and training. Specific target populations include the general

population, people affected by HIV and AIDS, nurses and other healthcare workers.

BACKGROUND:

AIDS Relief (the Consortium led by Catholic Relief Services) received Track 1 funding in 2004 to rapidly

scale-up ART in nine countries, including South Africa. In FY 2005, FY 2006 and FY 2007, PEPFAR funding

was received to support central funding, with continued funding applied for under COP 2008. The activity is

implemented through two major in-country partners, Southern African Catholic Bishops' Conference

(SACBC) and the Institute for Youth Development South Africa (IYD-SA).

All sites operate under the terms of a Memorandum of Understanding (MOU) with the provincial Department

of Health (DOH) in which they operate, observing the national and provincial protocols. Many patients

present themselves for CD4 tests and/or ART after having undergone CT at the South African Government

(SAG) clinic.

Contrary to initial expectations, the most difficult issue has been ensuring that men benefit from the CT

activities offered. It is mostly women who undergo CT at the field sites. At each field site, home-based

caregivers, who are based in their communities, are vigorously recruiting men to undergo CT. A problem

experienced by all treatment programs in South Africa is the reluctance of males to present themselves for

treatment. CRS sites attempt to overcome this by encouraging females to attend adherence sessions with

their partners. Once the participation of males has been secured in this way, they are encouraged to

undergo CT and/or CD4 testing.

ACTIVITIES AND EXPECTED RESULTS:

With funding provided in FY 2008 AIDSRelief will continue implementing the activities in support of South

African national ARV rollout. Of the 25 existing field sites, activated in program year 1 (March 2004 - March

2005), two have transferred all their ART patients into the SAG rollout, and have ceased providing

treatment, and two new field sites have been activated in the same period of FY 2007 to replace them..

ACTIVITY 1: Support for SAG Rollout

Two new field sites have been activated in FY 2007 period to enroll additional ART patients in support of the

SAG rollout plan. Utilizing technical assistance from AIDSRelief staff members and South African experts,

ongoing support and guidance will be provided to sites in the form of appropriate refresher medical training

courses, patient tracking and reporting, monitoring and evaluation mechanisms and other necessary

support.

At each field site, staff are trained in counseling techniques, including the provider-initiated testing and

counseling (PITC) in support of the HIV & AIDS and STI National Strategic Plan, 2007-2011. Trained nurses

are employed at each site, and they are able to perform rapid tests. Those patients who are identified as

HIV-infected undergo CD4 and viral load tests. If their CD4 count is below 200, they commence with ART.

The home-based caregivers provide care to large numbers of patients, many of them not necessarily people

living with HIV. The caregivers are trained to be aware of possible symptoms that might be AIDS-related (for

example, weight loss or persistent diarrhea). Where a caregiver suspects that illness might be AIDS-related

they give the patients appropriate counseling and advise them to be tested.

In sites with onsite medical services, counseling and testing will be provided by trained nurses and

counselors, though the majority of patients in the AIDSRelief program receive free counseling and testing in

public sector facilities. Commodity procurement (test kits) is provided for by Department of Health.

All activities will continue to be implemented in close collaboration with the South African Government's HIV

and AIDS Unit and the respective provincial authorities to ensure coordination and information sharing, thus

directly contributing to the success of the South African Government's own rollout and the goals of

PEPFAR. These activities are also aimed at successful integration of AIDSRelief activities into those

implemented by the South African Government, thus ensuring long-term sustainability.

FY 2008 COP activities include the provision of PITC for all patients visiting the partner treatment sites, as

well as family-oriented CT which will try to include all members of a family of the person currently on ART.

These activities are in line with the efforts to encourage testing for HIV for increased number of people,

while leaving them the option of refusing the testing if they feel they should not have it. Application of rapid

tests of a non-blood nature, are being considered as one of the tools in the implementation of the program,

along with PCR testing for children younger than 12 months. It is hoped that the increased rate of voluntary

testing for HIV and AIDS will assist additional people who are in need of treatment across the program.

SUMMARY:

Activities support procurement of antiretroviral (ARV) drugs under the comprehensive ART program carried

out by Catholic Relief Services (CRS) in 25 sites. Coverage extends to eight provinces in South Africa

(excluding the Western Cape). The emphasis areas are human capacity development and local

organization capacity building. The target population includes people affected by HIV and AIDS as well as

higher risk populations such as migrant workers and refugees.

BACKGROUND:

AIDSRelief (the Consortium led by Catholic Relief Services) received Track 1 funding in FY 2004 to rapidly

scale-up antiretroviral therapy (ART) in nine countries, including South Africa. Since FY 2005, in-country

funding has supplemented Track 1 funding, and this will continue in FY 2008. The activity is implemented

through two major in-country partners, Southern African Catholic Bishops' Conference (SACBC) and the

Institute for Youth Development South Africa (IYD-SA).

ACTIVITIES AND EXPECTED RESULTS:

With funding provided in FY 2008, AIDSRelief will continue implementing the activities in support of the

South African Government (SAG) national ART rollout. In the interest of maximizing available funds the

focus will be placed on strengthening the existing sites' provision of services rather than on assessing and

activating new sites. Utilizing technical assistance from AIDSRelief staff members and South African

experts, ongoing support and guidance will be provided to sites in the form of appropriate refresher medical

training courses, patient tracking and reporting, monitoring and evaluation mechanisms and other

necessary support.

ARV drugs are provided to all qualifying HIV patients who present at the sites, irrespective of their age,

gender, nationality, religious or political beliefs. The access to non-South Africans is particularly significant,

as the public sector rollout program is restricted to South African and legal refugees and asylum seekers.

However, South Africa has a large displaced population, including economic migrants who do not have

South African identity documentation. Historically, about 90% of adults and 10% of children with HIV have

been receiving ARV drugs through the 25 partner sites.

ARV drugs purchased will be used by the 25 sites to treat ARV patients through clinic-based and home-

based activities aimed at optimizing quality of life for HIV-infected clients and their families. For most of the

25 sites, ARV drugs are currently being purchased centrally through a Johannesburg-based pharmaceutical

company, and delivered via courier to the field sites monthly on a patient-named basis. CRS is billed once a

month for all site deliveries after verification of drugs delivered to each site. The opportunity of accessing

preferential cost drugs is being utilized through cooperation with GlaxoSmithKline where available. Although

the AIDSRelief sites have not experienced stock-outs in significant volume, they have been experienced on

a limited number of occasions. Efforts to address or prevent such occurrences in the future include

substitution by a more expensive drug on stock (all approved by the appropriate regulatory authorities of the

host country and the donor).

Generic medications purchased comply with the USG PEPFAR Task Force requirement of FDA approval as

well as approval from the Medicines Control Council of South Africa.

All activities will continue to be implemented in close collaboration with the SAG's HIV and AIDS Unit and

the respective provincial authorities to ensure coordination and information sharing, directly contributing to

the success of the SAG's own rollout and the goals of PEPFAR. These activities are also aimed at

successful integration of AIDSRelief activities into those implemented by the government, thus ensuring

long-term sustainability.

All sites operate in terms of a Memorandum of Understanding with the provincial Department of Health in

which they operate, observing the national and provincial treatment protocols. There is a concerted effort at

each site to ensure sustainability by either having the SAG provide antiretroviral drugs, or by down referring

stable patients in to the public primary healthcare clinics after providing training for the SAG clinic staff. St.

Mary's Hospital, which accounts for more than a third of patient numbers, has already been accredited as a

SAG rollout site. Sinosizo is receiving drugs from Department of Health due to its status as a down-referral

clinic for Stanger Hospital. At Centocow and Bethal, all patients are already receiving drugs through the

SAG rollout.

In terms of the actual drug procurement, AIDSRelief in South Africa has a centralized procurement system

of ARV drugs, which already provides the economies of scale in terms of drug pricing to the extent possible

(outside of the SAG-mandated single exit price). This centralized procurement system buys drugs in

volume, and keeps sufficient stock levels to supply the AIDSRelief sites with drugs and ensure no stock-

outs occur. The centralized procurement system also manages losses due to expiry of the drugs, and

ensures compliance with FDA and MCC (Medicines Control Council of South Africa) requirements. Each

patient has their 6-month repeat prescription originally assigned by the doctor and then dispensed by the

pharmaceutical supplier, which is revised where necessary (in line with SAG guidelines).

In terms of monitoring of the program, the majority of the AIDSRelief sites are utilizing the centrally-based

laboratory services provider Toga (a PEPFAR prime partner) that conducts blood tests (CD4, viral load etc.)

for the sits, using the courier service available in country to deliver the blood samples, and reporting back to

the sites on the results through either e-mail or an online electronic reporting system setup by the

Laboratory services provider.

Due to good existing infrastructure in South Africa, AIDSRelief sites are able to perform viral load and CD4

tests once every six weeks, to monitor the treatment progress and possible failure on the individual patient

level. These analyses are conducted by each of the AIDSRelief sites, using the data provided by the

Laboratory services provider, as part of the clinical management of the patients. The majority of the

AIDSRelief sites also use hand-held lactate meters (provided for free by the laboratory services provider) to

screen for hyperlactatemia, which is the most common severe side effect of patients who have been on

treatment for prolonged periods of time.

Activity Narrative:

Feedback on program level of the progress and viral suppression is regularly provided by a clinical expert at

the Desmond Tutu HIV Foundation, using the laboratory data provided by Toga Labs on patients whose

blood was tested through their facilities.

FY 2008 COP activities will be expanded to include increased collaboration with the SAG to ensure long-

term sustainability of the program, through different arrangements that vary from one province to another.

These include the transfer of "stable" patients (on ART for 6 months or longer) to public sector health

facilities, and then enrolling additional patients at the AIDSRelief partner site. Other options include

provision of free ARV and opportunistic infections drugs and laboratory tests for SAG-accredited facilities

run by AIDSRelief, or those that are physically located on SAG-owned premises, thus allowing them to

receive free drugs or services. As in the case above, this allows the AIDSRelief sites to enroll additional

patients on ART. Other examples include provision of ARV drugs by the SAG, and home-based care and

support and adherence follow-up by the AIDSRelief-run partner site. All the different models of collaboration

are individually discussed with the provinces where the partner sites operate, and largely depend on

specific needs and operating environment of each treatment site and SAG authorities, but are designed to

ultimately allow long-term sustainability and success of the program.

This activity will directly contribute to the goal of 2 million individuals on treatment of the PEPFAR 2-7-10

goals.

SUMMARY:

Activities are implemented to support provision of quality ARV services under the comprehensive

antiretroviral treatment (ART) program carried out by Catholic Relief Services (CRS) in 25 sites in 8

provinces in South Africa. Major emphasis will be on human capacity development and local organization

capacity building. The target population includes people affected by HIV and AIDS as well as higher risk

populations such as migrant workers and refugees.

BACKGROUND:

AIDSRelief (the Consortium led by Catholic Relief Services) has received Track 1 funding since FY 2004 to

rapidly scale up antiretroviral therapy (ART) in 9 countries, including South Africa. Since FY 2005, South

Africa in-country funding was received to supplement central funding. The activity is implemented through

two major in-country partners, Southern African Catholic Bishops' Conference (SACBC) and Institute for

Youth Development South Africa (IYD-SA).

ACTIVITIES AND EXPECTED RESULTS:

With funding provided in FY 2008 AIDSRelief will continue implementing the activities in support of the

South African Government (SAG) national ARV rollout. In the interest of maximizing available funds the

focus will be on strengthening the existing sites providing services rather than on assessing and activating

new sites. Utilizing technical assistance from AIDSRelief staff members and South African experts, ongoing

support and guidance will be provided to sites in form of appropriate refresher medical training courses,

patient tracking and reporting, monitoring and evaluation mechanisms and other necessary support.

ARV services will be provided through the 25 sites to ARV patients through clinic-based and home-based

activities to optimize quality of life for HIV-infected clients and their families. All the relevant healthcare

providers and administrative support staff at the sites will be trained to implement the ART program, using

government-approved training curricula. Staff who have already received initial training will undergo

refresher courses (either in-house or external), coupled with exchange of training courses and materials

between sites with active support from the local training provider, Kimera training center. Treatment

adherence training is provided to all patients who are enrolled on the ART program.

In most sites home-based care networks will follow up and support patients. This follow-up is conducted

through direct visits to patients through the extensive home-based care outreach at the SACBC sites, while

IYD-SA sites follow up through means of telephonic contact in most cases. In case the patient cannot be

reached, a "treatment buddy" is contacted to inquire the whereabouts of the patients who did not come back

for the monthly drug package. Inevitably, some patients become lost-to-follow-up in spite of all the efforts to

locate them, due to migrating populations and illegal immigrants served by the program. This number

currently stands at less than 4% of the patients ever enrolled on the program.

Each site ensures that HIV-infected patients are screened for tuberculosis (TB) prior to placing them on

antiretroviral treatment, and are referred to TB treatment if they tested positive. Screening and testing for TB

is conducted in a number of different ways, and these testing methods are specific to each site. While

screening is conducted by a medical professional at each of the sites, in most cases patients are referred to

the nearby SAG medical facility for TB testing and are only enrolled in antiretroviral treatment once they

have completed two months of TB treatment, or have been found not to have active TB.

PEPFAR funding will also be used to support laboratory services, which are outsourced to a private

provider, Toga Laboratories (a new PEPFAR partner since FY 2007). A courier service collects blood that is

drawn at each site, and delivers these samples to the laboratories. Results are e-mailed or faxed back to

the site within 48 hours of the laboratory receiving the blood samples.

The program is designed to improve each site's capacity to implement the national ART program in the long

-term, and to strengthen clinical, administrative, financial and strategic information systems. Sites will be

assisted in developing appropriate policies and protocols and in setting up sound financial and strategic

information systems. Each site will also develop a unique community mobilization plan for the ART program

and implement it in collaboration with relevant community organizations and leaders. Many of the sites are

already involved in HIV and AIDS community mobilization activities and these will be linked to ART

services. These lessons learned will be of value to other partners working in the non-governmental

organization (NGO) sector.

All activities will continue to be implemented in close collaboration with the Department of Health HIV and

AIDS Unit and the respective provincial authorities to ensure coordination and information sharing, and this

will directly contribute to the success of the SAG's own rollout and the goals of PEPFAR. These activities

are also aimed at successful integration of AIDSRelief activities with those implemented by the South

African Government, thus ensuring long-term sustainability.

All sites operate under the terms of a Memorandum of Understanding (MOU) with the provincial Department

of Health in which they operate, observing the national and provincial treatment protocols. There is a

concerted effort at each site to ensure sustainability by having the SAG provide antiretroviral drugs, or by

down referring stable patients into the SAG's primary healthcare clinics after providing training for the SAG

clinic staff. St. Mary's Hospital, which accounts for more than a third of patient numbers, has already been

accredited as a SAG rollout site. Sinosizo receives drugs from the National Department of Health due to its

status as a down referral clinic for Stanger Hospital, and at a further two sites, Centocow and Bethal, all

patients already receive drugs via the SAG rollout. Monthly statistics are shared with the South African

National Department of Health, as well as with relevant provincial health departments in provinces where

AIDSRelief implements the program.

There is a concerted effort to include men and children in the program, and all sites have specific plans to

increase enrolment, including couple counseling and using a family-based approach. Although there is no

specific PMTCT program, eligible pregnant women are provided with triple therapy to ensure maximum viral

suppression to prevent the transmission to the baby. Newborn babies are provided with monotherapy after

birth. AIDSRelief sites are encouraged to provide babies with cotrimoxazole after 4-6 weeks of life, and

Activity Narrative: PCR testing is conducted when relevant. Mothers are encouraged to use safe feeding practices as

appropriate to individual circumstances. Most sites have clinic-based gardens to assist with nutrition

programs, and several sites provide nutrition supplements, as per South African treatment guidelines. All

sites provide ART access to non-South Africans, including refugees. Some of the AIDSRelief sites also

receive PEPFAR and other funding through different sources for the provision of OVC care. The

overlapping of these services provides OVC with access to both care and treatment services provided

under the program.

In terms of the continuous qualitative review of the program, the annual clinical evaluation is done on

available patient data by two South African ART experts, who not only evaluate the data within the program

but also compare it to other large resource-limited programs, such as the program in Khayelitsha.

Even though prevention is not a specific program activity of the overall program, it is promoted through

provision of information to patients regarding HIV and prevention of spreading the virus (prevention for

positives). Secondly, skills training is provided to vulnerable populations, empowering them to make safer

choices about their lives. Additionally, AB messages are shared with the target population, as well as

accurate information regarding condoms is provided.

The CRS treatment program supports the PEPFAR goal of treating 2 million people with antiretroviral drugs.