SUMMARY:

The International Training and Education Center on HIV (I-TECH) FY 2008 COP activities will be expanded

to include technical assistance (TA) activities to enhance the Mpumalanga Department of Health (DOH)

RTC's organizational and human capacity to train Mpumalanga health care workers (HCW with the primary

target audience being doctors and nurses) on the care and treatment of concomitant HIV and TB and

thereby increase access to quality concomitant TB/HIV care and treatment in the province. Funds will be

used to support the technical (e.g., the development/modification of TB/HIV curricula in accordance with

national guidelines; curricula accreditation) and human capacity development of the Mpumalanga DOH

RTC (MRTC) to train Mpumalanga HCW on HIV/AIDS, tuberculosis (TB) and sexually transmitted infections

(STIs) care and treatment. The primary emphasis area for these activities is local organization capacity

building to affect the care and treatment of patients with HIV and TB. Human capacity development and

strategic information are secondary emphasis areas. The primary target organization is a host country

provincial government organization and its medical teams comprised of doctors and nurses.

BACKGROUND:

I-TECH has been supported by PEPFAR for the past five years to work in the Eastern Cape province, with

the invitation and support of the South Africa (SA) National DOH and EC DOH, to develop the

organizational and human capacity of the EC RTC to train/mentor clinicians in the care and treatment of

HIV, AIDS, TB and STI. Organizational TA to the EC RTC included strategic planning, infrastructure

development, human resource development and management, small grant or proposal development, the

development of memoranda of understanding, financial management, marketing, health management

information systems, and disseminating best practices to improve program efficiency and effectiveness.

These activities will be extended to Mpumalanga province in FY 2008 and implemented by the primary

partner. Human capacity development of the EC RTC included the longitudinal mentoring of its clinical

teams by experienced I-TECH HIV specialists and infectious disease clinicians on the care and treatment of

HIV/AIDS/TB/STI and the art of effectively mentoring others. These clinical human capacity development

activities will be extended to the MRTC in FY 2008 and will be implemented by I-TECH's sub-contractor, the

University of California at San Diego (UCSD) Owen Clinic.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Building, In-country Mentoring of the Mpumalanga Regional Training Centre

(MRTC) Clinical Team

This activity expands I-TECH's in-country mentoring program to Mpumalanga. FY 2008 funds will be used

to mentor MRTC clinical staff to develop their mentoring skills as well as their clinical skills in the treatment

of concomitant TB/HIV patients, complex case management, rapidly emerging treatment complications, and

evidence-based clinical decision-making. Six I-TECH UCSD mentors will individually accompany MRTC

medical team members as they travel to sites in the province to provide onsite mentoring to Mpumalanga

clinicians while seeing together up to 50 patients per week. Mentoring will also include technical assistance

centered on systems strengthening provided to MRTC RTC sites/feeder clinics. FY 2008 PEPFAR funds will

support UCSD Owen Clinic administrative staff time, and the salaries, travel, lodging and expenses for six

infectious disease or HIV specialists to travel to Mpumalanga during FY 2007 for one month stays.

ACTIVITY 2: Program Sustainability: In-country Mentoring of the Mpumalanga Regional Training Centre

(MRTC) Clinical Team to Develop and Update Curricula

FY 2007 PEPFAR funds supported a needs assessment of the Mpumalanga HCW TB/HIV training needs.

In 2008, the results will be utilized to assist the MRTC to develop/modify and accredit its TB and HIV

training courses for health care providers, and develop training plans. In addition, I-TECH will respond to

other training needs of the MRTC HCW based on the results of the needs assessment, such as TB/HIV/STI

curricula revision and update. Training will be provided through a high-level training specialist who will

mentor MRTC staff to update curricula according to provincial and national guidelines. This transfer of skills

activity will include developing and strengthening monitoring and evaluation of training programs in this

region. FY 2008 funds will be used to support the salary, travel and lodging cost of a training technical

expert. Contingent upon the availability of FY 2008 funds and depending on the training needs of MRTC

HCW, additional training will be provided through sponsorship at national or international training summits,

study tours, or other preceptorships.

ACTIVITY 3: Human Capacity Building: Distance-based ongoing clinical consultation

This activity was first funded for the Eastern Cape RTC by PEPFAR in FY 2005. During UCSD/RTC

trainings, EC clinicians are encouraged to contact the RTC team for clinical consultation as needed, who

then forward the query and response to the UCSD Owen Clinical mentors for additional guidance before

delivering their consultative advice. In FY 2008, PEPFAR funds will be used to expand this activity to the

Mpumalanga RTC HCW. Funds will support UCSD consultants' time (a portion of salaries) related to the

time spent fielding consultations; estimated at five consults per week.

These activities contribute to the overall PEPFAR 2-7-10 goals and to program sustainability by improving

the organizational and human capacity of the MRTC to effectively treat affected patients and mentor other

HCW on the care and treatment of concomitant TB/HIV care and treatment, thereby increasing both access

to and the quality of TB/HIV care and treatment.

SUMMARY:

I-TECH carries out activities to support the expansion of HIV and AIDS, tuberculosis (TB) and sexually

transmitted infection (STI) care and treatment in the Eastern Cape (EC) through on-the-job clinical

training/mentoring activities. The primary emphasis area for these activities is human capacity development;

minor emphasis areas are strategic information and local organization capacity building. The primary target

populations are doctors (public and private), pharmacists (public), and nurses (public)

BACKGROUND:

I-TECH has been working in the EC since 2003 to develop the capacity of clinicians in the care and

treatment of HIV and AIDS, TB and STI. The activities described here were first funded by PEPFAR

between FY 2004 and FY 2007. The EC Department of Health (ECDOH) specifically requested I-TECH to

conduct on-the-job training and mentoring to augment didactic trainings conducted by the Eastern Cape

Regional Training Centre (ECRTC) and other professional training organizations in the EC, as well as the

placement of I-TECH mentors in the EC for longer periods of time (i.e., six to twelve months) to allow

ongoing mentoring. Treatment/ARV Services activities were and will continue to be largely implemented by

I-TECH's subcontractor, the University of California at San Diego (UCSD) Owen Clinic. I-TECH central

office (Seattle) and South Africa country staff have and will continue to provide oversight and logistical

support related to this activity.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Building and Program Sustainability: In-country Intensive Mentoring of the

ECRTC Clinical Team

This activity continues the work begun in FY 2004 to mentor the EC RTC clinical teams in-country. FY 2008

PEPFAR funds will continue to support I-TECH's intensive mentoring model of the ECRTC's medical teams

on a limited basis as the ECRTC medical teams' clinical care and mentoring capacities have improved. It is

expected that up to three new RTC clinical team medical officers will be mentored by experienced ECRTC

clinical team members and by year-round I-TECH UCSD mentors (see Activity 3). Specific activities for

which FY 2008 PEPFAR funds will be used are itemized in Activity 2; Activity1 will occur simultaneously

with Activity 2.

ACTIVITY 2: Human Capacity Building: Educational support of EC clinicians via in-country clinical

training/mentoring and monitoring

In FY 2008 I-TECH and UCSD mentor teams will be placed in the EC year-round to mentor the two full-time

I-TECH clinical mentors (see Activity 6 below), the I-TECH mentoring coordinator (see Activity 4), and

health care workers (HCW) in EC clinics (includes clinics targeted and not targeted by the ECRTC in their

FY 2008 plan). The I-TECH and UCSD mentor teams will include one to two clinical mentors: up to six

infectious disease or HIV fellows spending a minimum of two months during each rotation, and up to six

expert UCSD HIV faculty physicians, pharmacists or nurse practitioners spending a minimum of a month

during each rotation. FY 2008 funds will support UCSD Owen Clinic administrative staff time, and the

salaries, travel, lodging and expenses for the Owen Clinic mentor teams. I-TECH UCSD mentors and the

Owen Clinic Director will visit the Mpumalanga regions to provide clinical mentoring (see Palliative Care;

HIV/TB). Depending on the results of I-TECH's Limpopo Needs Assessment, clinical mentoring may be

provided in this province (see Other Policy/Systems Strengthening). Up to six mentors are allocated for

these two activities.

ACTIVITY 3: Sustainability: Mentorship Coordinator

This activity began in FY 2007 whereby PEPFAR funds were used to hire a local mentorship coordinator in

the EC to plan and coordinate the in-country logistics and support for the UCSD clinical mentors, and

provide clinical mentoring to Eastern Cape HCW. In FY 2008, funds will be used to pay the coordinator's

salary and in-country travel expenses, as well as one trip to the UCSD Owen Clinic for intensive mentoring.

ACTIVITY 4: Human Capacity Building and Sustainability: Precepting senior level EC clinicians at the Owen

Clinic

This activity began in FY 2004 whereby PEPFAR funds were used to support the air travel, lodging and per

diem of committed EC clinicians to travel to the Owen Clinic for a two-week intensive training on systems of

care and clinical management. The intent of this activity is to develop EC clinician leadership to champion

HIV treatment issues through the further development of clinical skills, and increased knowledge of systems

of care and quality improvement methodologies. FY 2008 funds will support the air travel, lodging and per

diem to intensively train 2 ECRTC health care workers, the mentoring coordinator (see Activity 3), and the

two full-time I-TECH South Africa doctors for two weeks each at the Owen Clinic on systems of care and

clinical management issues (see Activity 6).

ACTIVITY 5: Human Capacity Building: Distance-based ongoing clinical consultation

This activity was first funded by PEPFAR in FY 2005. During UCSD/ECRTC trainings, EC clinicians are

encouraged to contact the RTC team for clinical consultation as needed, who then forward the query and

response to the UCSD Owen Clinical mentors for additional guidance before delivering their consultative

advice. Achievements toward FY 2007 goals include the provision of 48 distance consultations to Eastern

Cape HCW in the first months of FY 2007. In FY 2008, PEPFAR funds will support UCSD consultants' time

(a portion of salaries) related to the time spent fielding consultations; estimated at five consults per week.

Activity 6: Human Capacity Building and Sustainability: Developing the treatment and mentoring capacity

of two in-country clinical mentors

I-TECH's FY 2008 activities will be expanded to hire and mentor two doctors as full-time I-TECH mentors in

the EC. Funds will be used to pay the doctors' salaries for twelve months and in-country travel expenses, as

well as one trip each to the UCSD Owen Clinic for intensive mentoring.

Activity Narrative:

ACTIVITY 7:

Funds will be used to support pharmacovigilance capacity building. Health care workers will be trained on

filling out the South African government forms for pharmacovigilance. Routine meetings will also be held

with health care workers to highlight issues of data quality and interpretation of the data from the routine

reporting for pharmacovigilance. The objective of this activity it to ultimately improve the quality of care that

patients receive in public sector facilities.

By training a large cadre of healthcare workers to provide ARV services, I-TECH will contribute to the

PEPFAR goal of providing treatment to 2 million people by increasing access to quality HIV/AIDS/TB/STI

care and treatment.

SUMMARY:

I-TECH activities are currently carried out to support sustainability of HIV, AIDS, TB and STI care and

treatment programming in the Eastern Cape (EC) province through four components: 1) establishing I-

TECH field offices in South Africa (SA); 2) providing organizational development and human capacity

building technical assistance (TA) up to three Regional Training Centers (RTC); 3) supporting the EC

Department of Health (ECDOH) HIV and AIDS program; These activities are continued in FY 2008. The

primary emphasis area for these activities is local organization capacity building. Strategic information and

human capacity development are secondary emphasis areas. The primary target population is a non-

governmental organization.

BACKGROUND:

I-TECH has been working in the EC since 2003 to develop the capacity of the RTC to train/mentor clinicians

in the care and treatment of HIV, AIDS, TB and STI. The majority of activities described here (exceptions

include expansion activities) were first funded between FY 2003 and FY 2007. I-TECH established an office

in the EC beginning January 2007, is collaborating with other EC PEPFAR partners, and has/will conduct

field assessments of TA needs with 16 EC PEPFAR partners to identify programmatic TA activities which

could be supported by I-TECH. I-TECH is working in SA at the invitation of the ECDOH, and its activities are

supported by the NDOH HIV/AIDS Directorate. All activities described under this program area with the

exception of TA related to the development of clinical care information systems will be implemented by the

primary partner. TA related to clinical care information systems will be implemented by the primary partner

and its subcontractor, UCSD Owen Clinic.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Technical assistance to NDOH Human Resource Department (HRD) to develop Regional

Training Centres (RTC) nationally

I-TECH as part of its HCD program will assist the National Department of Health HRD responsible for the

establishment and monitoring of RTC in each province to develop policies and guidelines to strengthen

provincial RTCs and improve the quality of HIV/AIDS/STI/TB (HAST) training programs. I-TECH will also

work with the national department to develop tools to monitor the quality of services rendered by these

RTCs, identify provincial RTCs in need of technical support and develop a plan of action to assist those

identified.

ACTIVITY 2: TA to Mpumalanga RTC

I-TECH will assist the Mpumalanga and Limpopo RTC in:

-Developing policies and guidelines and a governance structure for the RTC.

-Develop capacity of RTC staff in developing assessment tools to assess training needs of health care

providers in the province

-Develop the capacity of RTC staff in developing yearly HAST training plans for the province and conducting

quarterly reviews of training and develop skills of RTC and district training staff to monitor quality of training

programs

-Develop skills of RTC staff in curriculum development and integration of new national and international

guidelines into existing curricula and seeking accreditation with SAQA

-Develop capacity of RTC staff to track, monitor and assess HAST training done by other NGO within the

province

-Develop capacity of RTC and other district trainers to monitor quality of training and assessment of skills

transfer.

-Develop facilitation skills of district trainers in Mpumalanga, Eastern Cape and Limpopo provinces

-Development and production of HAST training manuals for accredited training

-Purchase of teaching aids such as data projectors, lap tops, demonstration models and other visual aids to

be used by the RTC to train health care workers

ACTIVITY 3. Development of training and facilitation skills of trainers

I-TECH will develop capacity of district and RTC trainers to ensure a pool of qualified trainers are available

in each of these provinces (Mpumalanga, Eastern Cape and Limpopo) to continue developing capacity of

health care workers. These training programs will utilize a variety of training techniques to ensure transfer of

skills. These trainings will also include the techniques on assessing training programs. For this activity I-

TECH will utilize the services of a local service provider accredited to conduct such trainings.

Activity 4. Prevention with Positives

I-Tech will develop capacity of trainers at the Regional Training Centre in 3 provinces (Mpumalanga,

Eastern Cape and Limpopo Provinces) to integrate Prevention with Positive for PLHIV into the HIV and

AIDS training curriculum and content material for both health care professionals and lay health care

workers. This integrated curriculum will ensure that HIV and AIDS training programs are updated with

messages and programs on Prevention with Positives

Activity 5

I-TECH will also train the trainers of all three RTCs on prevention with positives, develop their skills to

impart these trainings to others and mentor them on conducting the actual training.

I-TECH will also assist the RTCs in developing and disseminating quick reference guides on Prevention

with Positives to be used by health care providers and lay health care workers in all settings (i.e. facility,

community and home based settings). These quick reference guides will serve as prompt tools for health

care providers and lay health care workers.

Through development of capacity of RTC to increase the pool of competent health care workers to deliver

quality HIV and AIDS services and thus increasing access to a much wider population in need of these

services, I-TECH will contribute to reaching PEPFAR's 2-7-10 goals.

Activity Narrative: SUMMARY: