SUMMARY:

At the request of the National Department of Health and CDC, Leonie Selvan Communications (LSC) will

continue to use PEPFAR funding to broaden the current integrated prevention of mother-to-child

transmission (PMTCT) strategy to ensure improved implementation and integration of PMTCT on national,

provincial and facility levels. LSC are continuing to build on the integrated PMTCT strategies developed by

Kagiso Communications using FY 2005 funding, while broadening the scope of the strategies to cut across

the three levels of implementation. The primary emphasis area for the activity is local organization capacity

development; with secondary emphasis on community mobilization/participation, training, development of

network/linkages/referral systems, information, education and communication (IEC), quality assurance and

supportive supervision. Target populations include South African Government workers, public healthcare

workers, traditional leaders, traditional healers, traditional birth attendants, family planning clients, pregnant

women, people living with HIV and AIDS (PLHIV), families of PLHIV, community-based organizations

(CBOs) and non-government organizations (NGOs).

BACKGROUND:

Using FY 2005, FY 2006 and FY 2007 funding, LSC has facilitated the development and implementation of

a national training curricula for professional healthcare workers and community healthcare workers. The

focus of the South African National PMTCT curriculum is PMTCT and infant feeding. This is a five-day

intensive curriculum that focuses on all aspects of maternal and child health in the context of HIV. Using FY

2007 funding, LSC conducted a stakeholder's analysis to identify all PMTCT activities around the country,

identify overlaps in services, gaps and challenges. Results of the stakeholder's analysis will be presented at

a PMTCT stakeholder's forum in November 2007. At this forum the National PMTCT Program Manager will

encourage better collaboration between donors, stakeholders and ensure that PMTCT support reaches

areas of greatest need. Using FY 2008 funding, and the results of the stakeholder analysis Leonie Selvan

Communications will facilitate the development of one national PMTCT implementation plan and will

convene two stakeholder forums to ensure stakeholder collaboration monitor progress on the national

implementation plan. In addition, Leonie Selvan Communications will continue to work with PMTCT course

directors and trainers facilitating the development of a mentoring system to support healthcare workers at

the facility level. At the national and provincial level, the LSC will also focus on strengthening of linkages

and networks between PMTCT and treatment programs, ensuring that pregnant women who test positive

are staged and referred for monitoring. While much of the emphasis during 2007 has been on assessing

and developing tools to meet the activities and strategies described above, the focus during 2008 will be on

implementation and assessment of the success of these activities.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Identification of Gaps and Bottlenecks to PMTCT Implementation and strengthening

collaboration between stakeholders and donors.

Although the PMTCT program is five years old, challenges to implementation are still inherent in the

program. There are a substantial number of partners supporting the national PMTCT program, and a large

number of donors working with provincial and national government. However, uptake remains at 55% and

nevirapine only reaches about 30% of women who need it. This is partly due to a lack of collaboration by

stakeholders and donors, and support not covering many of the high transmission areas. At the request of

the national department of health, LSC will convene two stakeholder forums. At the first stakeholder forum,

LSC will present the stakeholders analysis conducted in FY 2007 and, together with the national PMTCT

program, identify geographical gaps in stakeholder support, gaps in service delivery and challenges to

quality PMTCT implementation. LSC, together with the CDC's NDOH -laced technical advisor will work with

the national program to develop one PMTCT operational plan. A second stakeholder forum will be

conducted six months after the completion of the national operational plan. The purpose of the second

stakeholder forum will be to monitor progress towards implementation of the plan. The stakeholder forum

will bring together stakeholders from government, universities, implementing partners, NGOs, CBOs, donor

organizations, traditional healers and traditional leaders. Expected results of this activity include the

development and implementation of program-specific activities to address challenges to PMTCT uptake and

ensure greater coverage of PMTCT service delivery.

.

ACTIVITY 2: Development of Mentorship Program

Using PEPFAR funding, Leonie Selvan Communications will continue to work with the NDOH, provincial

PMTCT course directors and trainers. Provincial course directors and provincial trainers are responsible for

the implementation of in-service PMTCT and Infant Feeding training for cadres of health care workers

involved in maternal and child health service delivery. FY 2008 funding will be used to set up and maintain a

mentoring system for healthcare workers and community healthcare workers. A core group of course

directors and trainers from each province will be identified and trained as mentors to assist healthcare

workers with implementation at the facility level after they have attended training. The role of the mentor will

be to ensure that training translates into improved service delivery. In addition, funding will be used to

facilitate a mentor network allowing the mentors to support and assist each other. The mentorship program

will also ensure that individuals working at the National AIDS hotline are trained in PMTCT issues and that

counselors answering the phones are able to answer questions appropriately. Expected results of this

activity will be capacity building of healthcare workers and community healthcare workers.

ACTIVITY 3: Development of Tools to Strengthen Linkages between PMTCT and Treatment Programs.

One of the priority areas identified in order to improve PMTCT service delivery for FY 2008 is to strengthen

linkages between PMTCT and treatment, care and treatment programs. One of the downfalls of the PMTCT

program is that service delivery takes place away from the treatment program. HIV-infected pregnant

women are identified during antenatal care, but in many cases do not receive a CD4 test, and referred to

treatment programs if eligible. The national policy states that all pregnant women testing positive should be

staged and referred to antiretroviral services. However, the reality is that most HIV-infected pregnant

women are not given a CD4 test and are not referred to treatment programs for monitoring. As a result, after

delivery, most of these women are lost to follow up and only show up at health facilities with advanced

stages of AIDS. To address this challenge, PEPFAR funding will be used to work with the national and

Activity Narrative: provincial departments of health to develop strategies for healthcare workers to ensure better linkages

between PMTCT and treatment programs. Since this activity is coordinated through the NDOH, all PEPFAR

supported partners will participate in activities aimed at addressing these challenges. This will also ensure

that all tools being used by PEPFAR partners are in line with the NDOH PMTCT messaging.

These activities contribute to the 2-7-10 PEPFAR goals by ensuring improved PMTCT implementation,

identifying women eligible for antiretroviral treatment (ART) early and ensuring appropriate monitoring of

HIV-infected pregnant women. This will result in a significant number of infections averted via vertical

transmission and a great number of women enrolled in ART programs.

SUMMARY:

At the request of the National Department of Health (NDOH) and CDC, Leonie Selvan Communications

(LSC) will use PEPFAR funding to review the existing Youth Friendly Training Manual for Nurse Youth

Health Providers, as well as other material pertaining to this target group. The material will be updated and

reworked to ensure that it is user friendly and accessible. Prior to revising the material, focus groups will be

held with nurse youth health providers to determine their perceptions of the existing material and to identify

any specific needs or areas of improvement, if necessary. The updated manual will be piloted at provincial

level before being finalized. Train the trainer forums will be held at the launch of the new Youth Friendly

Training Manual for Nurse Youth Health Providers so that facilitators are familiar and comfortable working

with the revised manual. In addition, Leonie Selvan Communication will work with the NDOH to develop a

tool kit for school-based peer educators. The emphasis area for this activity is in-service training as health

workers and peer educators on youth friendly services and building capacity of local organizations. This will

be done by providing tool kits to school-based peer educators from different non-government organizations

to ensure the delivery of quality peer education messages. Target populations for this activity are

adolescents aged 10-24 and adults which includes all health care workers.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Review and Consolidation of Existing Materials

There are currently a number of different curricula being used by the NDOH to train nurses and other health

care workers on the specific needs of youth in the context of HIV and AIDS. In addition, there is a number of

different curricula that focus on the establishment and implementation of youth-friendly services. At the

request of the NDOH, Leonie Selvan Communications will review the curriculum and make

recommendations for a single curriculum that encompasses aspects from the multiple sources. The new

materials will focus on ensuring that all youth between the ages of 10- 18 receive HIV prevention messages

when they visit health services. The primary focus of this activity is abstinence. However, for youth that are

already sexually active the focus will be on the B component of the AB program and will be linked with other

prevention activities of the NDOH to ensure the provision of condoms and clear and consistent messaging

around condom usage.

ACTIVITY 2: Focus Groups with Youth Nurses

In order to ensure that the specific needs of youth are addressed and incorporated into the curriculum and

materials to be developed, Leonie Selvan Communications will conduct nine focus group discussions with

nurses from youth friendly clinics. All nine provinces will be represented in the focus groups to ensure that

provincial youth issues can also be address in the materials and curriculum. The results of the focus group

will be presented to the NDOH youth directorate with the curriculum review outlined in activity Both activity

one and activity two will culminate in the development of a youth friendly training manual for nurse

providers. The national youth program will ensure that all youth nurse providers are trained in the curriculum

ensuring the provision of youth friendly service delivery in the context of HIV.

`

ACTIVITY 3: Materials for Peer Educators

At the request of the National Department of Health and CDC, Leonie Selvan Communications (LSC) will

use PEPFAR funding to identify, source and develop a range of suitable promotional material for peer

educators. This material will include bags to carry their manuals and hand-outs when they visit schools.

Marketing material in the form of leaflets, posters and brochures will be designed and developed to assist

peer educators market the peer education program. In addition, a Resource Pack/tool kit will be developed

to ensure that they have all the necessary materials, handouts and resources to conduct quality peer

education workshops. Prior to developing material focus groups will be held with a cross-section of peer

educators to identify what marketing and training material works best for them. New material will be

designed/ developed based on the outcomes of the focus groups.

This activity contributes to the PEPFAR 2-7-10 goals by ensuring access to youth friendly services in the

context of HIV and AIDS. In addition, this project will assist in ensuring the sustainability of the national peer

educator program by providing the peer educators with a standard set of resources to conduct quality peer

education activities.