SUMMARY:

This project promotes a mix of community-based and clinical counseling and testing (CT) models. The

Society for Family Health and the Population Services International (SFH/PSI) will manage a franchise

network (under the brand name, New Start) of 12 stand-alone CT sites, each with a mobile CT program.

From these CT sites, SFH will provide training and support to at least six healthcare facilities to increase the

number of tuberculosis (TB) patients who receive HIV CT in clinical settings, and to private healthcare

workers to enable them to make CT a routine part of medical care. Emphasis areas include community

mobilization/participation, development of network/linkages/referral systems, local organization capacity

development, quality assurance/quality improvement/supportive supervision and training. Primary target

populations include men and couples for CT in non-medical settings, and TB patients for CT in medical

settings. Higher risk populations such as prisoners, sex workers, and men who have sex with men are

targeted when possible.

BACKGROUND:

Activities are ongoing. New Start opened in December 2004. At this time, 83% of FY 2006 has elapsed and

New Start has achieved 76% of its FY 2006 client flow goal and exceeded its training target. The program

addresses gender issues primarily by targeting men and couples for CT. To date, 52% of clients are male

and 11% are couples. Although funding for the TB/HIV project only arrived in July 2006, one medical facility

in Durban was able to begin working with New Start in August, 2006. SFH works closely with and has

strong support from the South African government at national and provincial levels. The program started off

with PEPFAR funding and today is co-funded by the South African government.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1:

SFH will manage a network of 12 stand-alone CT sites, each operating a mobile and workplace CT

program. SFH will manage three sites, and partner NGOs will manage the remaining nine sites. SFH will

provide technical, financial, management, marketing, and quality assurance support to the nine sites. The

nine partner-managed "franchise" New Start sites will open in late 2006 and early 2007. Non-profit CT

franchising has proven effective at building the capacity of local NGOs to provide CT services and increase

client flow. New Start franchising is based on standardized systems for management, training, supervision,

quality assurance and referrals and linkages to other services. SFH, the South African government and the

National Institute for Communicable Diseases (NICD) will train New Start counselors and testing staff. SFH

and NICD will carry out quality assurance. Marketing activities will use radio, public relations, print media

and community mobilization to reach men and couples. Beginning in late 2006, Levi's will promote New

Start services through Levi's stores, Levi's sponsored mobile CT and Levi's media activities. Mobile CT and

below-the-line marketing will continue to target prisoners, men who have sex with men, and commercial sex

workers when possible. Mobile CT activities will expand and work with a variety of hosts -- including

workplaces, NGOs, communities, churches, and government agencies such as the prison system and the

commuter rail system. New Start has an agreement with the Anglican church to provide CT services

through its parishes. New Start CT protocols include non-medical TB and STI screening. Each New Start

site has a site-specific referral guide to allow counselors to refer clients to an array of post-test care and

support services. Each New Start site also has a Referral Coordinator to maintain linkages with referral

points. From New Start sites, SFH will provide training and support to NGOs not part of the New Start

network in CT service provision and to private doctors in routine offer CT using rapid test kits. These

training and quality assurance activities will be carried out in partnership with NICD and the FPD, the

training arm of the South African Medical Association.

ACTIVITY 2:

SFH will increase the number of TB patients who are tested and referred for HIV treatment. The project will

partner with and mentor NGO, private sector and/or government facilities, strengthen already existing

systems and work to fill important gaps where the testing and referral of TB patients can be improved. The

support provided to these TB healthcare providers will depend on the needs of the facilities. Support will

include some or all elements of the following assistance models: (a) SFH will provide training and support to

partner organizations in routine provider-initiated CT, so that partner organizations can introduce routine

testing for TB patients. (b) SFH will provide training and support to partner organizations in client-initiated

CT, so that partner organizations can introduce and manage their own CT operations in TB facilities. (c)

SFH will create New Start satellite operations at TB facilities. Partner organizations will provide space and

support to New Start to provide CT from TB facilities on a daily basis. (d) SFH will provide training and

support to partner organizations who wish to open New Start franchises within TB facilities.

Franchise partners will be fully integrated into the New Start network. Gender issues will be addressed

through targeting men and couples for CT services, including testing targeting male construction workers.

Testing rates among men are low. Encouraging couple CT allows women a structured environment to

address HIV issues with their male partners. Diminishing HIV stigma is best achieved by increasing the

number of people who learn their HIV status and disclose to family and friends. The proposed activities

encourage sustainability by focusing on human capacity and organizational development. Franchising

develops the capacity of a network of NGOs to provide high quality services, including the development of

workplace programs that bring in revenue to partner NGOs. The proposed activities also encourage a

sustainable response to the need to test large numbers by providing training and support to private doctors

to make CT a routine part of medical care. Mobile CT activities bring together non-health sectors of society

such as churches or workplaces in the fight against HIV.

ACTIVITY 3:

PSI/SFH will develop and carry out a mass media campaign to encourage HIV counseling and testing.

PSI/SFH will work in partnership with at least one private sector partner. The campaign will be national and

will culminate in a one week testing drive. This testing week will bring together PSI/SFH's New Start static

site and mobile testing services, the testing services of other service providers, including other NGO and

Government of South Africa testing services. The campaign's private sector partner will associate its brand

Activity Narrative: with the campaign and spend its own funds on the campaign. Media used will include television or radio and

public relations. The campaign and one-week testing drive will take place in late 2007 or early 2008. SFH is

developing the campaign, selecting campaign target groups, determining private sector partners and

developing testing targets. SFH will work closely with the government of South Africa to ensure that the

campaign has government support and buy-in at all levels.

ACTIVITY 4:

SFH will partner with Careworks, a private organization which provides healthcare services. Careworks will

provide mobile CT services to men in construction works and in mining throughout the country. This activity

is aimed at reaching men who would otherwise not access testing services at public healthcare facilities.