SUMMARY:

BroadReach Healthcare (BRHC) supports integrated ARV services that include PMTCT, doctor

consultations, lab testing, adherence support, patient counseling, remote decision support, quality

assurance (QA), and data management. The main emphasis area is capacity building, with minor emphasis

on strategic information and human capacity development (training). The primary target population is

pregnant women.

BACKGROUND:

PEPFAR funds support BRHC initiatives that provide HIV and AIDS clinical management, care and support

services to HIV-infected individuals in areas where the SAG rollout has not yet been implemented and

assists ART rollout in the public sector. The BRHC PEPFAR program began in May 2005 and now operates

across 5 provinces. BRHC is supporting approximately 5000 individuals directly with care and treatment and

15,000 indirectly. BRHC taps private sector health professionals to provide comprehensive care and

treatment, fostering capacity-building initiatives within the public health system, and supporting community-

based programs. BRHC leverages PLHIV support programs to identify and assist with treatment literacy,

adherence support and ongoing community mobilization, prevention education activities, and positive living

initiatives. BRHC also works to build capacity in public health facilities, focusing efforts on human capacity

development (HCD) activities, including clinical didactic training, clinical mentorships, patient training and

operational assistance training. BRHC is expanding its provision of staff and infrastructure support to SAG

facilities. Finally, BRHC is expanding its involvement in the design of scaleable down referral models in

partnership with faith-based organizations (FBOs), community-based organizations (CBOs), and public-

private partnerships (PPPs).

ACTIVITIES AND EXPECTED RESULTS:

To ensure that patients are armed with accurate and practical HIV prevention strategies, BRHC will carry

out the following activities:

ACTIVITY 1: Clinical Services

BRHC patients will be treated in accordance with national guidelines by ensuring that all elements for

effective treatment are provided in a coordinated manner. Patients see doctors regularly, and will receive

laboratory tests, HIV and AIDS education (complete with prevention messages), management of sexually

transmitted infections (STIs), adherence support, counseling, cotrimoxazole prophylaxis and linkage to

other support and wellness services. Pregnant women identified through the BRHC program and partner

sites will be offered PMTCT services in line with SAG guidelines. PMTCT services include counseling and

testing (see subsequent activity); counseling and support for maternal and infant nutrition; access to ARV

treatment and safe infant feeding practices. Linkages will be made to pediatric treatment. At each facility a

"tracer" will be employed full time to ensure that appointments are kept, opportunistic infections are treated,

CD4 counts monitored and referrals completed.

ACTIVITY 2: Human Capacity Development (HCD)

BRHC will provide comprehensive HIV and AIDS training that includes PMTCT to its network of providers

including doctors, nurses, pharmacists and other healthcare professionals through a variety of initiatives

including remote decision support, telemedicine, web-based training, didactic training, and clinical

mentoring from experienced clinicians. Comprehensive HIV and AIDS training for health professionals

includes prevention and management of sexually transmitted infections, PMTC, ART management,

tuberculosis (TB), adherence, management of complications and side-effects, and pediatric HIV

management. BRHC will continue to train patients and support group facilitators on topics including

prevention and PMTCT, HIV and AIDS, ART, adherence, living positively, and accessing psychosocial

support in communities.

ACTIVITY 3: Counseling and Testing

BRHC will work with partner sites to ensure that pregnant women are counseled and tested for HIV, and

offered access to PMTCT. This will be done by both private general practitioners who are in the BRHC

network and at the government facilities where BRHC works.

ACTIVITY 4: Support to SAG

BRHC will conduct an initial needs assessment at each SAG partner facility. The assessments will identify

problems that impact overall capacity and efficiency. Solutions for each institution include recruitment and

salary support for doctors, nurses, and pharmacy staff. BRHC general practitioners provide part-time

services at SAG facilities, and train SAG staff in HIV care and treatment and related management. Other

support may include infrastructure, such as refurbishment, equipment and supplies procurement. This will

also include strengthening linkages between essential HIV support services such as PMTCT to ensure clear

referral procedures, patient tracking, and reporting of intervention results.

These activities directly contribute to the PEPFAR 2-7-10 goals by attempting to prevent new infections

among infants.

SUMMARY:

BroadReach Healthcare (BRHC) supports integrated ARV services that include doctor consultations, lab

testing, adherence support, patient counseling, prevention, remote decision support, quality assurance

(QA), and data management. BRHC's emphasis areas are capacity building (major); with minor emphasis

on strategic information and human capacity development (training). Primary target populations include

adolescents, adults, and people living with HIV.

BACKGROUND:

The BRHC PEPFAR program began in May 2005 and now operates across five provinces. BRHC is

currently supporting approximately 5000 individuals directly with care and treatment and 15,000 indirectly.

Prevention is a new activity area for BRHC. BRHC will endeavor to understand SAG priorities around

prevention, including those articulated in the new National Strategic Plan (NSP), and formulate site-specific

prevention plans that reflect SAG priorities and facility needs. BRHC prevention activities will take two

forms: first, as stand alone prevention interventions; and second, as integrated interventions within BRHC

treatment program activities. In response to site specific needs, BRHC prevention activities will support

ongoing prevention activities within SAG facilities, as well as support new initiatives that fill gaps in

prevention priorities identified by the site and SAG guidelines.

ACTIVITIES AND EXPECTED RESULTS:

To ensure that patients are armed with accurate and practical HIV prevention strategies, BRHC will carry

out the following activities:

ACTIVITY 1: Prevention Training (HCD)

BRHC will provide HIV and AIDS prevention training to its network of healthcare providers including doctors,

nurses, pharmacists and other healthcare professionals, as well as public sector health professionals at its

partner sites through a variety of initiatives including remote clinical decision support, telemedicine, web-

based training, didactic training, and clinical mentoring from experienced clinicians. More specifically, the

topic of HIV prevention is covered in the three day training for Nurses and Lay Counselors; in the five day

University of KwaZulu-Natal training for Professional Nurses; the 10 module HIV/AIDS Clinical Training

online course for Doctors; and the 1-3 day HIV Treatment Literacy training for ARV Coordinators and

Counselors. In addition BRHC will integrate a prevention module into the one day quarterly Adherence

Training for BRHC patients.

ACTIVITY 2: Strategic Prevention Partnerships (Outreach)

BRHC will form strategic partnerships with local CBOs and FBOs and companies that are actively engaged

in prevention activities in the BRHC catchment area in order to support existing activities that are aligned

with SAG policy, and to help create new programs should any gaps exist. Support to CBOs/FBOs may

include provision of resources to support approved prevention activities (human resources, funds,

equipment). BRHC will also leverage these strategic partnerships for condom distribution and educational

materials on the proper use of condoms.

ACTIVITY 3: Condom Distribution

BRHC will distribute condoms and materials on proper condom use through a variety of channels.

Distribution channels will include GP offices (~50 outlets); public sector hospitals and affiliated clinics (~100

sites); and through the BRHC IEC program to patient support groups (~10). As stated previously, BRHC will

also provide condoms to partner CBOs/FBOs that are active in prevention activities in the community. The

BRHC IEC team will run prevention outreach campaigns to local companies and engage them in prevention

activities such as the distribution of condoms and prevention messages to employees.

ACTIVITY 4: Prevention Integration

BRHC will integrate prevention activities and messages into its treatment program activities. This will be

accomplished in two principle areas: 1) Prevention with Positives (PwP) in the Clinical Setting; and 2)

Prevention in the Counseling Setting. PwP activities will be coordinated through BRHC public sector sites

and GP offices, and will involve the distribution of targeted prevention messages [printed materials] for HIV

infected individuals by the BRHC IEC team; prevention education sessions for patients, buddies and family

members conducted by the BRHC IEC team; and condom distribution at all clinical service outlets. Second,

BRHC will also utilize the CT setting to distribute targeted prevention materials [printed materials] and will

review counseling guidelines to ensure that prevention messages are delivered during counseling sessions.

This will be made available at all sites where BRHC supported CT services are offered. Condoms will also

be supplied and made available to individuals undergoing counseling and testing services.

These activities directly contribute to the PEPFAR 2-7-10 goals by attempting to prevent new infections.

SUMMARY:

BroadReach Health Care (BRHC) activities include doctor consultations, lab testing, adherence support,

patient counseling, remote decision support, quality assurance monitoring, training for both patients and

health professionals, support groups and data management. Basic Care and Support activities are in

support of individuals participating in an antiretroviral therapy (ART) program, largely representing the

population of those HIV-infected, but not yet eligible for ART. The major emphasis is on human resources

with minor emphasis on quality assurance and training. These emphasis areas are realized through clinical

and non-clinical services, human capacity development, quality assurance, referrals and linkages and South

African Government (SAG) support including meeting equipment, infrastructure and human resource needs.

Primary target populations include people living with HIV and AIDS (PLHIV) and their families/households,

program managers, public and private doctors, nurses, laboratory workers, pharmacists, other health care

workers, the business community/private sector, CBOs, FBOs, and NGOs.

BACKGROUND:

PEPFAR funds support BRHC initiatives which provide HIV and AIDS clinical management, care and

support services to HIV-infected, uninsured individuals in public sector government facilities and areas

where the SAG ART roll-out has not yet reached or where there is high demand. The BRHC PEPFAR

program began in May 2005 and now operates in 15 communities across five provinces. Today, BRHC is

supporting approximately 3,500 individuals directly with care and treatment and 15,000 indirectly. The

BRHC mission is to tap into private sector health professionals to provide comprehensive care and

treatment, fostering capacity building initiatives and service delivery within the public health system, and

partnering with and supporting community-based programs with sustainable impact on long-term patient

care. BRHC leverages the community-based PLHIV support programs to identify and assist with treatment

literacy, adherence support and ongoing community mobilization, prevention education activities, and

positive living initiatives. In addition, BRHC works to build capacity in public health facilities, focusing on

human capacity development including clinical training, clinical mentorships, patient training and operational

assistance training. BRHC is expanding its provision of additional staff and infrastructure support to SAG

facilities. Finally, BRHC is expanding its involvement in the design of scaleable down referral models in

partnership with FBOs, CBOs, and as a partner in innovative public-private partnerships (PPPs).

ACTIVITIES AND EXPECTED RESULTS:

The primary goal of this program area is to ensure that new patients are started on ART when clinically

qualified and enrolled patients continue to receive outstanding care and support.

ACTIVITY 1: Clinical Services

BRHC patients will be treated in accordance with SAG ARV National Guidelines and provided regular

doctor visits, laboratory tests, HIV and AIDS education, counseling, TB screening, and cotrimoxazole

prophylaxis. Using a family-centered approach, BRHC will recruit eligible family members of HIV-infected

patients - including greater numbers of men and children - in order to improve the health of

families/households and facilitate family doctor visits and drug pick ups. Care includes the preventive

package, symptom and pain management, a care support program (during the time from when a patient

finds out his or her HIV-infected status until eligible for ART), are care during and after the initiation and

possibly failure of ART. Patient nutrition and wellness needs will be met by the provision of multivitamin

supplements, and doctor, patient and facilitator training in nutrition.

ACTIVITY 2: Human Capacity Development

1) BRHC will continue to provide training to its network of providers including doctors, nurses, pharmacists

and other healthcare professionals through a variety of initiatives including remote decision support,

telemedicine, web-based training, didactic training, and clinical mentoring from experienced HIV and AIDS

clinicians. Comprehensive HIV and AIDS training for health professionals includes ART Management, TB,

adherence support, management of complications and side-effects, prevention and pediatric HIV

management.

2) BRHC will continue to focus on community training on topics including HIV and AIDS, ART, adherence

support, living positively and prevention with positives, universal precautions and accessing psychosocial

support in communities. BRHC will continue to train support group facilitators on topics including HIV and

AIDS, ART, adherence, disclosure, and linking patients with psychosocial services in the community.

ACTIVITY 3: Support to SAG

BRHC will support capacity development for care and support services at partner SAG facilities. According

to SAG articulated needs, these services will include commodity procurement, healthcare financing, human

resource recruitment and salary support (for doctors, nurses, pharmacy staff etc.), BRHC doctors providing

temporary services at SAG facilities, training of SAG staff in HIV care and treatment and/or ART program

management, and physical infrastructure building/refurbishment and equipment procurement. BRHC will

work with SAG staff to improve operational efficiency in SAG facilities through needs assessments including

identification of key bottlenecks and then generate and implement solutions. Additionally, BRHC will support

SAG National Department of Health (NDOH) efforts, by assisting with development of down-referral models.

Finally, BRHC will build on its existing public-private (PPP) model (SAG - BRHC - Daimler Chrysler) in East

London and develop new PPPs to further involve small to medium enterprises in supporting employees and

dependents in the communities where they operate, alleviating some of the burden on government services.

ACTIVITY 4: Referrals and Linkages

Development of linkages and referral systems will be provided through strengthened referral networks

between the public and private sectors (including referring stable patients back to the SAG ARV program),

assistance to local clinics to facilitate SAG down referral process. Finally, BRHC will continue to expand its

community-based linkages with CBOs in order to refer patients in need of non-USG funded food parcels

and other wraparound services intended to support patients.

Activity Narrative:

ACTIVITY 5: Quality Assurance/Quality Improvement (QA/QI):

Recognizing the critical role of monitoring and evaluation in ensuring a successful program, BRHC QA/QI

activities include regular internal data and systems audits, collection of patient level surveillance data,

exception reports, doctor-specific feedback report, and doctor decision-making support. The BRHC

adherence program monitors and evaluates patient adherence through monitoring of drug pick up

information, clinical reports, self-reported adherence, and pill counts.

All BRHC activities articulated in the FY 2007 COP will be scaled up significantly in FY 2008 through its

partnerships with 15 SAG hospital systems (which include hospitals and affiliated CHCs and PHCs).

With FY 2008 funding, BRHC's palliative care activities will be expanded and enhanced as follows:

-BRHC will continue to support QA/QI at each of its public sector partner hospitals through QA

assessments, systems re-engineering, and the development of reporting systems that provide program

management feedback that is used to improve program performance and more closely monitor patient care.

-Strengthen down referral activities between public sector hospital partners and their affiliated clinics

(PHCs) by re-engineering referral processes, improved data management and patient tracking, and training.

-Training for health professionals at all public sector sites (hospitals and PHCs)

-HIV and AIDS Literacy training for patients as part of community mobilization

-Expanded care and treatment activities through the BRHC PPP to additional Daimler Chrysler supply chain

companies/employees and their families and communities.

-Staff augmentation: BRHC will provide additional salary support to fill key positions within SAG partner

hospital sites. BRHC will also work with the site to motivate for the creation of permanent posts where

needed and ensure that BRHC/PEPFAR supported staff are incorporated into subsequent site budgets to

ensure a sustainable staffing solution

BRHC Basic Healthcare and Support activities directly contribute to the 2-7-10 objectives of supporting 10

million people with basic healthcare and support by expanding these services in South Africa.

SUMMARY:

BroadReach Healthcare's (BRHC) activities include doctor consultations, lab testing, adherence support,

patient counseling, remote decision support, quality assurance monitoring, training for both patients and

health professionals, support groups and data management.

BACKGROUND:

PEPFAR funds support BRHC initiatives that provide HIV and AIDS clinical management, care and support

services to HIV-infected individuals in areas where the SAG rollout has not yet been implemented and

assists ART rollout in the public sector. BRHC taps private sector health professionals to provide

comprehensive care and treatment, fostering capacity-building initiatives within the public health system,

and supporting community-based programs. BRHC leverages PLHIV support programs to identify and

assist with treatment literacy, adherence support and ongoing community mobilization, prevention education

activities, and positive living initiatives. BRHC also works to build capacity in public health facilities, focusing

efforts on human capacity development (HCD) activities, including clinical didactic training, clinical

mentorships, patient training and operational assistance training. BRHC is expanding its provision of staff

and infrastructure support to SAG facilities. Finally, BRHC is expanding its involvement in the design of

scaleable down referral models in partnership with faith-based organizations (FBOs), community-based

organizations (CBOs), and public-private partnerships (PPPs).

ACTIVITIES AND EXPECTED RESULTS:

BRHC will continue to work with the national and provincial Departments of Health and specifically with the

HAST (HIV, AIDS STI, and TB) managers to prioritize interventions designed to address weaknesses

(identified by the departments of health) in the DOTS and TB/HIV programs. BRHC will focus on improving

policy adherence and patient follow-up. Individuals will be hired for each site as tracers to track patients and

ensure that referrals are completed. BRHC is setting aside funding to develop (with other relevant partners

or agreement counterparts) standardized tools to ensure that policies and guidelines recommended by

NDOH are followed, including guidelines for infection control. BRHC will continue to integrate TB/HIV

interventions with existing agreement programs as BRHC works seamlessly and side by side with

government employees at government facilities.

ACTIVITY 1: Human Capacity Development (HCD)

This program aims to provide TB care and treatment for HIV-infected patients by strengthening the TB skills

of health professionals through didactic training and clinical mentorships focusing on TB, TB/HIV coinfection

and systems integration. Health professionals will also receive decision support and training from the BRHC

clinical expert panel and disease management system for difficult cases. At the local level, HCD efforts will

target the communities in which the program operates by providing training and information, education and

communication (IEC) to patients and support group facilitators on TB, as well as HIV and AIDS, ART,

adherence, living positively, and accessing clinical psychosocial support and linkages to other sectors and

initiatives in their communities.

ACTIVITY 2: Support to SAG

This program will support the SAG TB program to increase the capacity of facilities in the testing and

identification of TB patients. This will be accomplished through general healthcare financing which could

include commodity procurement such as screening equipment to salary support of TB-focused clinical staff.

Salary support would be given in line with government facility rates along with transition plans for the

government facility to absorb the staff into their budget within a finite period. Alternatively staff would be

financed on a contract basis while plans were implemented in government facilities to accommodate staffing

needs. Further assistance could be given in assisting with health professional recruitment and developing

retention strategies, as well as supporting BRHC network doctors who assist with TB/HIV care and

treatment within government health facilities in their communities in order to increase treatment capacity.

Training of these doctors assists with sustainability as it provides ongoing stable support to government

facilities and allows government infrastructure to cope with fluctuating need through the provision of

sessionals. Finally, BRHC will support SAG TB/HIV efforts through infrastructure upgrade by building and/or

refurbishing hospital/clinic/lab space and purchasing equipment as needed, in order to support government

clinic activities such as screening, diagnosis and closely supervised treatment. The approach would be to

address the individual needs of each facility within areas where BroadReach provides assistance in the

form of ARV treatment or CT services across the provinces.

BRHC activities in support of TB treatment will be guided by consultations at national, provincial and district

level re: government identified shortcomings in TB programs. These interventions may include human

resource support, equipment, facility-specific policy development and business systems according to SAG

articulated needs. BRHC program support priorities will reflect SAG-identified priorities. Moreover, BRHC

HIV and TB/HIV integrated activities will build on and support pre-existing initiatives at sites, and integrate

with the facility, and district, provincial and national TB and TB/HIV programs. TB/HIV services will also be

integrated with all other related care and support services offered at facility level.

ACTIVITY 3: Referral Networks

Additional support to SAG will be provided in the form of systems strengthening around TB/HIV activities.

This will include improvement of referral linkages between the private sector general practitioners (GPs) and

public sector facilities that treat BRHC patients for TB infection in the BRHC Comprehensive Care model. In

addition, BRHC may work with government sites to facilitate linkages between TB and HIV clinics, as well

as creating capacity and linkages within communities to support BRHC patients with TB/HIV coinfection

within the context of a BRHC supported public-private partnership with Daimler Chrysler (PPP). These

linkages will be established by implementing referral processes between caregivers by holding workshops,

creating referral material (referral forms that inform the receiving provider where the patient originated and

the findings of the original provider), and informing various groups of activities in the area. Processes will

specify whether HIV patients with TB are referred to HIV clinics or TB clinics or vice versa. The expected

outcome is that patients are treated holistically and not in isolation by various providers. Since these

Activity Narrative: diseases are closely linked it is important that the treating physician treats the patient for TB and HIV so that

s/he is able to manage treatment regimes. BRHC will institute processes to ensure smooth referrals and

coordinated patient management for co-infected patients. These processes may include employing TB/HIV

case managers, integrating HIV and TB databases to facilitate patient tracking, support DOTS programs,

utilize home-based carers to monitor and support patients. Patients with TB should have access to HIV

testing and should they require ARV therapy, they would need to be treated or referred to an ARV facility.

ACTIVITY 4: Quality Assurance/Quality Improvement

TB/HIV activities will benefit from the same level of oversight and quality control as all other aspects of the

BRHC treatment program including regular internal data and systems audits, collection of patient level

surveillance data, exception reports, doctor-specific feedback report, and doctor decision making support,

and community-based modified (directly observed treatment) DOTS programs. TB/HIV quality assurance is

further enhanced by the tracking of co-infected patients through screening, diagnosis and treatment through

the use of improved clinical forms and referral forms. A clinical oversight committee provides any guidance

to GPs regarding complicated cases presenting with TB/HIV coinfection. Data collection and reporting on

TB, and TB/HIV coinfection will be integrated into ARV Program management reports to ensure constant

monitoring of patients and to facilitate program improvement.

All BRHC activities articulated in the FY 2007 COP will be scaled up significantly through partnerships with

15 SAG hospital systems (which include hospitals and affiliated CHCs and PHCs). With FY 08 funding,

activities will be expanded/enhanced (i.e. no new activities) as follows:

-BRHC supports QA/QI at each of its public sector partner hospitals through QA assessments, systems re-

engineering, and the development of reporting systems that provide program management feedback to

improve program performance.

-As part of systems re-engineering BRHC will focus on improving integration between HIV/AIDS treatment

programs and TB programs for testing, treatment coordination and referrals.

-Strengthen down referral activities between public sector hospital partners and their affiliated clinics by re-

engineering referral processes, improved data management and patient tracking, and training.

-Training for health professionals at all public sector sites (hospitals and PHCs) covers TB/HIV co-

management.

-HIV/AIDS literacy training for patients as part of community mobilization.

-Staff augmentation: BRHC will provide additional salary support to fill key positions within SAG partner

hospital sites. BRHC will also work with the site to motivate for the creation of permanent posts where

needed and ensure that BRHC/PEPFAR supported staff are incorporated into subsequent site budgets to

ensure a sustainable staffing solution.

SUMMARY:

The primary goal of BroadReach Healthcare's (BRHC) counseling and testing (CT) is to ensure that those

testing positive for HIV are started on antiretroviral treatment (ART) when clinically qualified and enrolled

patients continue to receive outstanding care and support. CT is the entry point for this goal. BRHC also

supports activities that include test-kit procurement, meeting infrastructure and human resource demands,

increasing testing uptake, prevention, patient counseling, referral systems, and training. Primary target

populations include children, adolescents, adults, pregnant women, and people living with HIV (PLHIV).

BACKGROUND:

PEPFAR funds support BRHC initiatives that provide HIV and AIDS clinical management, care and support

services to HIV-infected individuals in areas where the South African Government (SAG) rollout has not yet

been implemented and assists ART rollout in the public sector. The BRHC PEPFAR program began in May

2005 and now operates across five provinces. BRHC is supporting approximately 5,000 people directly with

care and treatment and 15,000 indirectly. BRHC taps private sector health professionals to provide

comprehensive care and treatment, fostering capacity-building initiatives within the public health system,

and supporting community-based programs. BRHC leverages PLHIV support programs to identify and

assist with treatment literacy, adherence support and ongoing community mobilization, prevention education

activities, and positive living initiatives. BRHC also works to build capacity in public health facilities, focusing

efforts on human capacity development (HCD) activities, including clinical didactic training, clinical

mentorships, patient training, and operational assistance training. BRHC is expanding its provision of staff

and infrastructure support to SAG facilities. Finally, BRHC is expanding its involvement in the design of

scaleable down referral models in partnership with faith-based organizations (FBOs), community-based

organizations (CBOs), and public-private partnerships (PPPs).

ACTIVITIES AND EXPECTED RESULTS:

The primary goal of the program is to ensure that those testing positive for HIV are started on ART when

clinically qualified and enrolled patients continue to receive outstanding care and support. CT is the entry

point for this goal.

ACTIVITY 1: Voluntary Counseling and Testing

BRHC will provide access to rapid voluntary counseling and testing (CT) at enrollment sessions and, where

available, CD4 testing services for patients who test positive to determine eligibility for treatment. In

accordance with SAG guidelines, BRHC patients will be properly counseled (pre- and post-test), tested, and

referred as appropriate to a BRHC network doctor or to an accredited SAG facility.

ACTIVITY 2: Support to South African Government

BRHC will expand access and availability of CT by (1) procuring testing materials (rapid test kits when

unavailable through the government system); (2) improving operational efficiency through needs

assessment, identification of operational bottlenecks, implementing solutions to address bottlenecks; (3)

assisting with refurbishing physical space at government clinics/hospitals; and (4) advising SAG partner

clinics on increasing CT uptake and improving the percentage of results received. BRHC will further support

SAG efforts in meeting the increased demand created by testing. This will range from providing salary

support for counselors to improved processes and systems for enrolling and following up greater numbers

of new patients.

ACTIVITY 3: Outreach

Using a family-centered approach to care and treatment, BRHC will encourage the testing of families and

households, utilizing patients already enrolled in the BRHC program as a point of entry. BRHC will also

promote community-based programs such as support groups, CBOs, and churches as entry points for CT

services.

ACTIVITY 4: Referrals and Linkages

All HIV-infected patients identified through BRHC-supported CT efforts, will be linked (via BRHC network

doctors, home-based care (HBC) and support groups) to other services such as TB care, nutrition and

wellness, and psychosocial support.

ACTIVITY 5: Human Capacity Development

BRHC may enhance the quality of CT services at selected sites (assigned by the relevant district

authorities) through training and mentoring for counselors, health professional staff, outreach workers and

support group facilitators. In addition to training, BRHC will assist CT programs at sites by providing salary

support to counselors as sites expand access to CT services.

BRHC's CT activities directly contribute to the 2-7-10 objectives by identifying infected individuals who are

unaware of their HIV status and who may be eligible for treatment. Greater numbers of people tested

means meeting the treatment and care and support objectives. Moreover, prevention messages given to

both infected and uninfected individuals during post-test counseling will contribute to the goal of averting 7

million infections.

All BRHC activities articulated in the FY07 COP will be scaled up significantly in FY 2008 through its

partnerships with 15 SAG hospital systems, which include hospitals and affiliated community and primary

health centers.

The FY 2007 activities will be expanded and enhanced in FY 2008 as follows:

BRHC will support quality assurance at each of its public sector partner hospitals through quality assurance

assessments, systems re-engineering, and the development of reporting systems that provide program

Activity Narrative: management feedback that is used to improve program performance and more closely monitor patient care.

This includes monitoring, tracking and reporting on CT activities at partner sites.

As part of systems re-engineering BRHC will focus on improving CT referrals at sites to boost the number of

patients tested, and the numbers that receive their results and ultimately enroll in treatment. A special effort

will be made to test family members of patients in an effort to boost family-centered care initiatives at sites

through partnerships with CBOs and home-based care organizations.

SUMMARY:

BroadReach Healthcare's (BRHC) antiretroviral (ARV) drug activities include drug procurement and

distribution, training for health professionals on drugs, supporting pharmacy staff salaries, training patients,

quality assurance (QA), and data management. BRHC's emphasis areas are human capacity development,

local organization capacity building, and strategic information. Primary target populations include children,

adolescents, adults, pregnant women, and people living with HIV (PLHIV).

BACKGROUND:

PEPFAR funds support BRHC initiatives that provide HIV and AIDS clinical management, care and support

services to HIV-infected individuals in areas where the South African Government's (SAG) rollout has not

yet been implemented and assists ART rollout in the public sector. The BRHC PEPFAR program began in

May 2005 and now operates across five provinces. An additional province will be added in FY 2008. BRHC

is supporting approximately 5,000 individuals directly with care and treatment and 15,000 indirectly. BRHC

taps private sector health professionals to provide comprehensive care and treatment, fostering capacity

building initiatives within the public health system, and supporting community-based programs. BRHC

leverages PLHIV support programs to identify and assist with treatment literacy, adherence support and

ongoing community mobilization, prevention education activities, and positive living initiatives. BRHC also

works to build capacity in public health facilities, focusing efforts on human capacity development (HCD)

activities, including clinical didactic training, clinical mentorships, patient training and operational assistance

training. BRHC is expanding its provision of staff and infrastructure support to SAG facilities. Finally, BRHC

is expanding its involvement in the design of scaleable down referral models in partnership with faith-based

organizations (FBOs), community-based organizations (CBOs), and public-private partnerships (PPPs).

ACTIVITIES AND EXPECTED RESULTS:

The primary goal of this program area is to ensure that new patients are started on antiretroviral treatment

(ART) when clinically qualified, and enrolled patients continue to receive high-quality care and support.

Monitoring of CD4 counts, viral loads, and resistance testing are part of the monitoring system. For

continued program sustainability, BRHC continues to work on the transference of costs to government, and

already in the North West province, the provincial government provides all drugs.

ACTIVITY 1: Drug Procurement and Distribution

BRHC will continue commodity procurement of ARVs through its supply chain vendors including its courier-

based pharmacy partners. BRHC will oversee the delivery of drugs to the accredited community-based

providers. In some instances, the community-based providers will be paid a capitated rate per patient and

those providers will be procuring drugs according to PEPFAR standards and national guidelines. BRHC will

negotiate best available pricing for USG and SAG approved ARV drugs. Community-based providers are

trained in drug forecasting, procurement and supply chain management.

BRHC partners with a private mail order pharmacy provider, Pharmacy Direct (PD), in its procurement and

distribution efforts for the BRHC general practitioners (GP) network. Pharmacy Direct liaises directly with

the BRHC GP network to manage patient prescriptions, dosing, medicine delivery and pick-up of returned

medicines. In partnership with Pharmacy Direct, BRHC manages patient adherence through monitoring of

medicine collection and regular data reports.

ACTIVITY 2: Human Capacity Development (HCD)

BRHC will continue to provide comprehensive HIV and AIDS training to its network of providers including

doctors, nurses, pharmacists and other healthcare professionals through a variety of initiatives including

remote decision support, telemedicine, web-based training, didactic training, and clinical mentoring from

experienced HIV and AIDS clinicians. Topics include drug supply chain logistics, operational improvements

for drug management, tracking for expiration dates, comprehensive ART management, adherence,

management of complications and side-effects, prevention and pediatric HIV management. BRHC-

supported human capacity development activities, such as training and clinical mentoring, will also take

place within SAG facilities.

ACTIVITY 3: Support to SAG

BRHC will support capacity development for drug procurement and pharmaceutical management at partner

SAG facilities. BRHC has conducted a needs assessment that examined the operational processes for drug

procurement, forecasting, stock management, and dispensing, and has used this assessment to streamline

its supply chain management.

ACTIVITY 4: Quality Assurance/Quality Improvement

BRHC maintains a close relationship with its drug procurement and distribution client. The client provides

regular feedback and reports to BRHC regarding delivery problems, missed medicine pick-ups, and collects

all unused medicines. Drug distribution, pick-up, and returns data is collected and maintained in the BRHC

program database. This data feeds into numerous reports including doctor-specific feedback reports and

patient exception reports.

This activity facilitates the ARV service delivery component of the project, which contributes directly to the

PEPFAR 2-7-10 goal of two million people receiving treatment. BRHC will contribute to PEPFAR's vision

outlined in the Five-Year Strategy for South Africa by expanding access to ART services for adults and

children, building capacity for ART service delivery, and increasing the demand for and acceptance of ARV

treatment.

SUMMARY:

BroadReach Healthcare's (BRHC) antiretroviral (ARV) services activities include training for health

professionals, management support, laboratory support, quality assurance, and community outreach.

BRHC's emphasis areas are human capacity development, local organization capacity building, and

strategic information. Primary target populations include children, adolescents, adults, pregnant women,

and people living with HIV (PLHIV).

BACKGROUND:

PEPFAR funds support BRHC initiatives that provide HIV and AIDS clinical management, care and support

services to HIV-infected individuals in areas where the SAG rollout has not yet been implemented and

assists ART rollout in the public sector. The BRHC PEPFAR program began in May 2005 and now operates

across 5 provinces. Activities will expand to a sixth province in FY 2008. BRHC is supporting approximately

5000 individuals directly with care and treatment and 15,000 indirectly. BRHC taps private sector health

professionals to provide comprehensive care and treatment, fostering capacity-building initiatives within the

public health system, and supporting community-based programs. BRHC leverages PLHIV support

programs to identify and assist with treatment literacy, adherence support and ongoing community

mobilization, prevention education activities, and positive living initiatives. BRHC also works to build

capacity in public health facilities, focusing efforts on human capacity development (HCD) activities,

including clinical didactic training, clinical mentorships, patient training and operational assistance training.

BRHC is expanding its provision of staff and infrastructure support to SAG facilities. Finally, BRHC is

expanding its involvement in the design of scaleable down referral models in partnership with faith-based

organizations (FBOs), community-based organizations (CBOs), and public-private partnerships (PPPs).

ACTIVITIES AND EXPECTED RESULTS:

To ensure that new patients are started on ART when clinically qualified and enrolled patients continue to

receive quality care and support, BRHC will carry out the following activities:

ACTIVITY 1: Clinical Services

BRHC patients will be treated in accordance with national guidelines by ensuring that all elements for

effective treatment are provided in a coordinated manner. This includes addressing issues of human

resources, provision of technical expertise, training, information, education and communication (IEC),

community mobilization, laboratory and testing, drug logistics, equipment and supplies, physical space,

M&E, and other cross-cutting support functions such as budgeting, finance, policy, and planning support.

Patients see doctors regularly, and will receive laboratory tests, HIV and AIDS education, adherence

support, counseling, cotrimoxazole prophylaxis and linkage to other support and wellness (including

prevention) services. Patient nutrition and wellness needs will be assisted by local FBOs and NGOs (e.g.

food parcels). BRHC supports patients through the private sector until those patients can access treatment

through public services. BRHC continues to expand its support to strengthening services in the public

sector.

ACTIVITY 2: Human Capacity Development (HCD)

BRHC will provide comprehensive HIV and AIDS training to its network of providers including doctors,

nurses, pharmacists and other healthcare professionals through a variety of initiatives including remote

decision support, telemedicine, web-based training, didactic training, and clinical mentoring from

experienced clinicians. Comprehensive HIV and AIDS training for health professionals include ART

management, tuberculosis (TB), adherence, management of complications and side-effects, prevention,

and pediatric HIV management. BRHC human capacity development activities, such as training and clinical

mentoring, will also take place within SAG facilities. BRHC will continue to train patients and support group

facilitators on topics including HIV and AIDS, ART, adherence, living positively, and accessing psychosocial

support in communities. The BRHC adherence program supports patients by providing features such as

treatment buddies, support groups, cell phone message reminders, a patient call center and adherence

counseling.

ACTIVITY 3: Support to SAG

BRHC will conduct an initial needs assessment at each new SAG partner facility. The assessments will

identify problems that impact overall capacity and efficiency. Solutions for each institution include

recruitment and salary support for doctors, nurses, and pharmacy staff. BRHC will also work with the site to

motivate for the creation of permanent posts where needed and ensure that BRHC/PEPFAR supported staff

are incorporated into subsequent site budgets to ensure a sustainable staffing solution. BRHC general

practitioners provide part-time services at SAG facilities, and train SAG staff in HIV care and treatment and

related management. Other support may include infrastructure, such as refurbishment, equipment and

supplies procurement. Finally, BRHC will build on its existing public-private partnership (PPP) model with

SAG and Daimler Chrysler in East London and develop new PPPs to further involve private companies in

supporting small business employees and dependents in communities where they operate.

ACTIVITY 4: Referrals and Linkages

Support systems for treatment will be provided by strengthening referral networks between the public and

private sectors, including referring stable patients back to the SAG ARV program, and support to local

clinics to facilitate SAG up and down referral. Finally, BRHC will continue to expand its linkages with CBOs

in order to refer patients in need of food and other community services.

ACTIVITY 5: Quality Assurance/Quality Improvement (QA/QI)

Recognizing the critical role of M&E in a successful treatment program, BRHC QA/QI activities include

regular internal data and systems audits, collection of patient-level surveillance data, exception reports,

doctor-specific feedback report, and doctor decision-making support. The BRHC adherence program

monitors patient adherence through monitoring of drug pick-up information, clinical reports, self-reported

adherence, and pill counts. BRHC will also work with SAG facilities to improve data management and

Activity Narrative: medical records systems.

ACTIVITY 6: Pediatric care and treatment

BRHC will expand pediatric enrollment using a family-centered approach. BRHC will encourage testing of

families/households, using patients already enrolled in the BRHC program as the index case and point of

entry into the household. By recruiting eligible family members, BRHC will enroll greater numbers, including

children, into the program. Finally, the family-centered approach will allow BRHC to link an entire household

to a single doctor in order to facilitate doctor visits and drug pick ups.

All BRHC activities articulated in the FY07 COP will be scaled up significantly in FY08 through its

partnerships with 15 SAG hospital systems (which include hospitals and affiliated community health centers

(CHC) and primary health care clinics (PHCs).

All of the above activities will serve to greatly enhance sites' ability to enroll significantly greater numbers of

patients onto ARV treatment.

These activities directly contribute to the PEPFAR 2-7-10 goals by increasing the number of people

receiving ARVs, improving access to HIV services, and increasing the capacity of local organizations.