SUMMARY:

Mpilonhle is a new South African community-based organization registered in 2007 with the South African

Directorate for Non Profit Organisations (NPOs). It is dedicated to improving the health and well-being of

adolescents in high schools in Umkhanyakude District Municipality, KwaZulu-Natal (KZN) through its

"Mpilonhle Mobile Health and Education Project". Mpilonhle will become operational in late 2007 with a

single mobile unit funded with support from Oprah's Angel Network, and expand with two further mobile

units funded by PEPFAR. Mpilonhle expects to recruit and hire 40 staff members who will be based at

Mpilonhle offices in Mtubatuba, KZN.

Mpilonhle's Abstinence and Be Faithful (AB) prevention activities include school-based provision of (1)

health screening, (2) health education, and (3) computer-assisted learning, delivered through mobile clinic

and computer laboratory facilities to 12 secondary schools in the rural KwaZulu-Natal province. Emphasis

areas are gender, human capacity development, and education wraparound programs. Targeted

populations are adolescent males and females aged 10-24 and teachers.

BACKGROUND:

This is a new PEFPAR funded activity to be implemented under the FHI Umbrella Grants Mechanism

(UGM). Mpilonhle has the broad support from district and provincial South African Government (SAG)

leadership. AB prevention activities will be implemented in Umkhanyakude District Municipality, the poorest

and most rural district in KwaZulu-Natal that has extremely high HIV prevalence rates. Services will be

delivered using mobile units traveling to rural secondary schools. Students in these schools suffer from

physical remoteness, scarcity of health services and generally inadequate resources. Partners include the

Department of Education (DOE), the South African Democratic Teachers' Union (SADTU), District Health

Services, district and municipal leadership, including the Traditional Authorities. The local Department of

Education officials, school principals, district and municipal mayors, teachers and students have expressed

the acceptability of school-based voluntary counseling and testing (VCT).

ACTIVITIES AND EXPECTED RESULTS:

The AB prevention activities will be provided through mobile facilities beginning in January 2008. There will

be a cost sharing of resources through the Oprah Winfrey Angels funding. Each mobile health unit will have

four counseling rooms, a nurse room, and two group education areas - one for HIV and health education,

and one for computer training. Each mobile unit will be staffed by a primary health care nurse, four health

counselors, a health educator, and a computer educator. Each unit will serve four participating secondary

schools, staying at each school for one week per month during the eight-month school year. The project

will have three mobile facilities, allowing it to serve 12 secondary schools in total. Each participating

secondary school has an average of 800 students. Six of the 12 schools have been initially selected by

identifying principals who expressed interest in participation. With greater knowledge of the proposed

project there has been a greater expression of interest and the remaining six schools will be determined

through deliberations with the Mayors of Umkhanyakude District Municipality, Mtubatuba Municipality, and

Hlabisa Municipality, and with local officers of the Department of Education and the Traditional Authority.

Mpilonhle will conduct three main activities in the AB Program Area, as described below.

ACTIVITY 1: School-Based Health Screening

The health counselor will provide students with an annual individualized health screening that is

comprehensive, integrated, and appropriate; however the emphasis is on HIV prevention and promotion of

risk perception. It includes voluntary counseling and testing (VCT) and individualized AB counseling.

Through this activity, young people will be screened for tuberculosis (TB), sexually transmitted infections

(STIs) and other common health problems. Those who are HIV-infected will be referred for CD4 count and

further management at the nearest appropriate health facilities. The premise behind the health screening is

to ensure that young persons are reached before they begin having sex. The main messages will focus on

abstinence, delay of sexual debut for young people (10 -14years). For older youth (15 -19 years) who are

sexually active they will be encouraged to revert to secondary abstinence. For those most at risk sexually

active (20 -24 years) information on correct and consistent use of condoms will be given and encouraged to

limit number of sexual partners (i.e. be faithful). VCT will be an entry point to prevention programs,

especially for sexually active students, including in-school OVC.

ACTIVITY 2: School-Based Health Education

The health educator will provide students with four 90-minute small-group HIV, general health and life skills

education sessions per year that will discuss the basic facts about: HIV and STIs; VCT; TB; anti-retroviral

therapy (ART); prevention of mother-to-child transmission of HIV (PMTCT); a balanced Abstinence-Be

Faithful-Condoms (ABC) approach to HIV prevention; reducing stigma and discrimination against people

living with HIV and AIDS (PLHIV); promoting healthy lifestyles including the avoidance of substance abuse

and the promotion of exercise and good nutrition; and promoting mutual respect between men and women.

An age-appropriate curriculum on these topics has been developed by the Educational Development Center

(EDC) and the South African Democratic Teacher's Union (SADTU). Existing material developed by the

EDC and SADTU, and the World Health Organization (WHO), the summarized WHO publication "Teachers'

Exercise Book for HIV Prevention", will be used because it conforms to the SA DOE's Life Skills curriculum.

This curriculum will also be submitted to the SA DOE for approval, and for certification of conformity with the

Life Skills curriculum. The curriculum will also be sent to UNICEF for their inputs. This curriculum

emphasizes the traditional three-part public health theory of improving Knowledge, Attitudes and Practice

(KAP) skill-building methods in topics such as risk reduction, decision-making, and social responsibility, as a

way of preventing HIV infection, providing support to those infected and affected by HIV, fighting stigma and

discrimination, and dealing effectively with the challenges of everyday life. The skill-based HIV education

will provide focused messages about the benefits of delaying sexual debut and other safe sexual behaviors.

Activities will aim to develop students' self-esteem to build their resilience, assist them to make informed

choices and develop communication skills.

ACTIVITY 3: School-Based Computer-Assisted Learning

Activity Narrative:

The computer educator will provide students in participating schools with four 90-minute small-group

computer education sessions per year. This training will focus on how to use computers, basic software, the

internet; and computer-assisted learning for improved school performance, HIV prevention, and general

health promotion. The computer-based health education lessons are packaged to address the life skills

needs of youth and are consistent with SAG guidelines. The AB messages are internationally recognized,

appropriately researched messages. This activity is intended to improve student learning, raise number of

pupils who graduate (graduation rates), and augment employability. These outcomes can in turn increase

women's socio-economic status, and reduces their vulnerability to coercive, cross-generational, and

transactional sex.

Sustainability will be achieved through (1) political commitment from district and municipal governments,

and the local Department of Education; (2) the relatively low-tech and easily replicable nature of many core

program features; (3) minimal dependence on scarce health professional such as doctors and nurses; (4)

the ability of rugged mobile facilities to reduce the need for additional investments in fixed physical

infrastructure; (5) the possibility of adapting the VCT service delivery model to workplaces as well as

schools; (6) the multi-dimensionality of program activities, which includes HIV and AIDS, general health,

and education related activities, and which broadens the scope of donors interested in funding continuation

and scale-up of activities.

Building human capacity in remote rural areas will occur by maximizing the capacities and skills of relatively

abundant lay health workers to enable them to perform critical yet scarce services such as VCT, health

screening and personalized risk assessment, and health education. This will help shift the burden of these

activities away from relatively scarce professional health workers such as nurses and doctors. The

organization will build the technical expertise and capacities of lay health workers through rigorous training

and regular refresher courses, and through the technological support provided by the Information

Technology components of the program.

This activity addresses gender issues through (1) the provision of AB education to large numbers of

adolescent males and females encouraging males to respect females, abandon gender stereotypes, and by

discouraging multiple sex partners; (2) computer education which promotes female educational attainment,

self-confidence and self-reliance, and employability, which in turn reduce vulnerability to HIV, in particular

coercive, cross-generational and transactional sex; and (3) health education that promotes safer behavior

and gender-sensitive attitudes among men and yield benefits to women when making informed choices with

regard to their sexual health.

These activities will contribute to 2-7-10 PEPFAR goals of preventing seven million new HIV infections.

SUMMARY:

Mpilonhle is a new South African community-based organization registered in 2007 with the South African

Directorate of NGOs. It is dedicated to improving the health and well-being of adolescents attending high

schools in Umkhanyakude District Municipality, KwaZulu-Natal (KZN) through its "Mpilonhle Mobile Health

and Education Project" whose key activities are described below. It will begin operations in late 2007 with a

single mobile unit funded with support from Oprah's Angel Network, and expand with two further mobile

units funded by PEPFAR funds. It is currently building up its staff, which is expected to be 40 persons

targeting 12 high schools with approximately 800 students, totaling 9,600. These activities will be based in

the Mpilonhle office in Mtubatuba, KZN.

Mpilonhle activities consists of community-based health screenings, which will be conducted by health

counselors at 24 community-based (non-school) sites, and will consist of a core of HIV preventive services

including individualized voluntary counseling and testing (VCT); personalized abstinence, Be Faithful and

correct and consistent condom use (ABC) counseling, and condom provision to sexually active youth and

adults; and group HIV and health education sessions. These services will be delivered through mobile clinic

and mobile computer laboratory facilities to 24 community (non-school) sites in rural KwaZulu-Natal.

Emphasis areas are: gender, human capacity development and strategic information. Target populations

are adolescents aged 15-24 and adults.

BACKGROUND:

This is a new PEFPAR activity. Mpilonhle works with broad support from district and provincial South

African Government (SAG) leadership. The Condom/Other Prevention activities will be implemented in

Umkhanyakude District Municipality, the poorest and most rural district in KwaZulu-Natal, and one that has

extremely high HIV prevalence rates. Services will be delivered using mobile units traveling to rural

secondary schools. These schools and their students suffer from physical remoteness, scarcity of health

services and generally inadequate resources. Partners include the Department of Education, the South

African Democratic Teachers' Union (SADTU), District Health Services and district and municipal

leadership, including that of Traditional Authorities. School principals, local Department of Education

officials, district and municipal mayors and focus groups of teachers and students have expressed the

community acceptability of school-based VCT.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Community-Based Health Screening

Mobile community-based and community-focused health screenings will be conducted by HIV and AIDS

counselors at 12 school locations. Each mobile facility consists of a paired-up mobile clinic and mobile

computer laboratory, staffed by one primary care nurse, four health counselors, one health educator, and

one computer educator. Each mobile facility will rotate across four school locations, allowing three mobile

facilities to serve 12 sites in total. These community sites will be determined in collaboration with the mayors

of Umkhanyakude, Mtubatuba, and Hlabisa Municipalities. The OP activity will consist of correct and

consistent condom use programs which support the provision of accurate information about condom use to

reduce risks for HIV infection and support access for those most at risk populations.

Provision and promotion of information on correct and consistent condom use will be coupled with

information about abstinence and behavior change; the importance of HIV counseling and testing (CT),

knowing one's HIV status, partner reduction and mutual faithfulness as risk reduction methods. The HIV

preventive services include personalized ABC messaging, behavior change, HIV and AIDS counseling,

group computer trainings that include health messaging, and group HIV and health education sessions. In

addition to these services, Mpilonhle provides referrals to other community-based services for prevention of

mother-to-child transmission (PMTCT), antiretroviral treatment (ART), tuberculosis (TB) and psychosocial

support; referrals to a social worker for assistance with accessing government grants and support for

orphans and vulnerable children (OVC) or people living with HIV (PLHIV); general health screening and

referral for care and other services as required. These preventive services will be offered within the context

of a health screening service that provides other health services besides HIV prevention. The broadness of

these services, and the fact that it addresses other health concerns beyond HIV, is likely to attract a larger

number of students with non-HIV-related health concerns to Mpilonhle's services, thereby raising the

number of people they reach with HIV prevention.

ACTIVITY 2: School-Based Health Education

Mpilonhle health educators will provide students with four small-group HIV, health and life skills education

sessions per year that will discuss the basic facts about: HIV and STIs; CT; TB; anti-retroviral therapy

(ART); prevention of mother-to-child transmission of HIV (PMTCT); a balanced Abstinence-Be Faithful-

Condoms (ABC) approach to HIV prevention; reducing stigma and discrimination against people living with

HIV and AIDS (PLHIV); and promoting respect between men and women. The HIV preventive outreach is

not limited to the four health education sessions, but is supplemented by the health screening session

described in Activity 1 and the health messages in the computer-assisted learning. An age-appropriate

curriculum on these topics has been developed by the Educational Development Center (EDC) and the

South African Democratic Teacher's Union (SADTU), drawing on existing material developed by the EDC

and SADTU, and the World Health Organization (WHO) summarized in the WHO publication "Teachers'

Exercise Book for HIV Prevention", and in conformity with the SA DOE's Life Skills curriculum. This

curriculum will also be submitted to the SA DOE for approval, and for certification of conformity with the Life

Skills curriculum. This curriculum emphasizes the traditional three-part public health theory of improving

Knowledge, Attitudes and Practice (KAP) skill-building methods in topics such as risk reduction, decision-

making, and social responsibility, as a way of preventing HIV infection, providing support to those infected

and affected by HIV, fighting stigma and discrimination, and dealing effectively with the challenges of

everyday life. The skill-based HIV education will provide focused messages about the benefits of delaying

sexual debut and other safe sexual behaviors. Activities will aim to develop students' self-esteem to build

their resilience, assist them to make informed choices and develop communication skills.

ACTIVITY 3: School-Based Computer-Assisted Learning

Activity Narrative:

An Mpilonhle computer educator will provide students in participating schools with four 90-minute small-

group computer education sessions per year. This training will focus on how to use computers, basic

software, the internet; and computer-assisted learning for improved school performance, HIV prevention,

and general health promotion. The computer-based health education lessons are packaged to address the

life skills needs of youth and are consistent with SAG guidelines. The AB messages are internationally

recognized, appropriately researched messages. This activity is intended to improve student learning, raise

number of pupils who graduate (graduation rates), and augment employability. These outcomes can in turn

increase women's socio-economic status, and reduces their vulnerability to coercive, cross-generational,

and transactional sex.

Sustainability of activities is facilitated by political commitment from district and municipal governments, and

the local Department of Education to scale-up and to fund-raise in support of such scale-up; the relatively

low-tech and easily replicable nature of many core program features, minimal dependence on scarce health

professional such as doctors and nurses; the ability of rugged mobile facilities to reduce the need for

additional investments in fixed physical infrastructure; declining prices over time for the program's

information technology (IT) requirements, the possibility of adapting the service delivery model to

workplaces as well as schools, the multi-dimensionality of program activities, which includes HIV and AIDS,

general health, and education related activities, and which broadens the scope of donors interested in

funding continuation and scale-up of activities.

Building human capacity in remote rural areas contributes to future sustainability of the program. Mpilonhle

will respond to this challenge by maximizing the capacities and skills of relatively abundant lay health

workers through rigorous training and regular refresher courses to enable them to perform critical yet

currently scarce services such as VCT, health screening and personalized risk assessment, and health

education, shifting the burden of these activities away from relatively scarce professional health workers like

nurses and doctors.

This activity will contribute to PEPFAR 2-7-10 goals of preventing 7 million new HIV infections, and

providing care and support to PLHIV. This activity addresses gender issues through the provision of ABC

education and services to large numbers of females in the general population; computer education which

promotes female educational attainment and employability, which in turn reduce their vulnerability to HIV,

and in particular to coercive, cross-generational and transactional sex; health education that promotes safer

behavior and gender-sensitive attitudes among men and yield benefits to women who become their sexual

partners. This activity will also promote consistent use of condoms and behavior change through the

reduction of sexual partners.

SUMMARY:

This is a follow on PEFPAR funded activity to be implemented through Mpilonhle. Mpilonhle is working with

the support from district and provincial South African Government (SAG) leadership. It will begin operating

in late 2007 with a single mobile unit funded with support from Oprah's Angel Network, and expand with two

further mobile unites funded by PEPFAR funds. It is currently building up its staff, which is expected to be

40, and is based in the Mpilonhle office in Mtubatuba, Kwazulu-Natal (KZN).

Mpilonhle will provide elements of HIV-related clinical care and social care through two main activities: 1)

provision of HIV-related screening, care and prevention, and 2) school and community-based HIV and AIDS

education. These activities will be delivered through mobile clinics deployed to secondary schools and

community (non-school) sites in rural KwaZulu-Natal. Emphasis areas are gender and human capacity

development. Target populations are adolescents aged 10-24, adults, and PLHIV.

BACKGROUND:

Mpilonhle is a new South African community-based organization registered in 2007 with the South African

Directorate of NGOs. It is dedicated to improving the health and well-being of adolescents in high schools in

Umkhanyakude District Municipality, KwaZulu-Natal through its "Mpilonhle Mobile Health and Education

Project" whose key activities are described below. The care activities will be implemented in Umkhanyakude

District Municipality, the poorest and most rural district in KwaZulu-Natal, and one that has extremely high

HIV prevalence rates, at 39.1%.

Implementation will take place in representative rural secondary schools and non-school sites that suffer

from physical remoteness, poor health conditions, and inadequate resources. Partners consist of the

Department of Education, PLHIV, the South African Democratic Teachers' Union, District Health Services,

and District Municipality and Municipal leadership, including that of Traditional Authorities. School principals,

local Department of Education officials, district and municipal mayors and focus groups of teachers and

students have expressed the community acceptability of school-based CT.

ACTIVITIES AND EXPECTED RESULTS:

These activities will be provided through mobile clinics that visit schools to address the needs of PLHIV in

the secondary school population and that visit non-school sites to address the needs of adult PLHIV in the

general population. These activities will satisfy minimum requirements for Palliative Care by providing

PLHIV with clinical services, integrated prevention, psychological support, and support with social services.

Each mobile clinic is staffed by one primary care nurse, four health counselors, and one health educator.

Each mobile clinic will visit a participating secondary school one week per month for eight months per year.

ACTIVITY 1: Screening and provision of basic HIV-related clinical and social care and HIV prevention

messaging at schools and in communities

The first care component is the clinical aspect which includes HIV and AIDS counselors offering one-on-one

health screening, messaging and referrals for preventive care services at secondary schools via a mobile

clinic. This will include screening and treating for symptoms indicative of Opportunistic Infections (OI) and

other HIV-related illnesses (including TB); individualized counseling on HIV prevention and behavioral

change; provision of counseling and testing (CT); provision of counseling in nutrition and personal hygiene;

psychosocial support for students (including support for disclosure of status); and referral to essential HIV

and AIDS services such as PMTCT, ART, symptoms and pain (including screening and referral to TB

services). A mechanism will be established to provide parental consent and referrals for family members of

HIV-infected students. The partners and focus groups of teachers and students have expressed the

community acceptability of schools-based CT and HIV prevention and care services. Effort will be made to

ensure equitable access to care services for both males and females. The second care component is the

social aspect which includes screening of HIV-related social problems and referrals to a staff social worker

for assistance with accessing government grants and legal services for; PLHIV and their families.

ACTIVITY 2: Group HIV and AIDS education sessions

An HIV and AIDS educator will conduct group education sessions at secondary schools and in surrounding

communities that will discuss the basic facts about HIV prevention and care targeted. Topics include the

importance of HIV prevention (AB for adolescents and ABC for adults); CT; prevention and care of

opportunistic infections including TB, ART adherence; accessing PMTCT services; nutrition counseling; and

the importance of personal hygiene and utilizing safe water to reduce diarrheal disease. Information,

Education and Communication (IEC) materials will also be provided. Mpilonhle will work with community

leaders and PLHIV to reduce stigma and discrimination against PLHIV and raise community awareness to

mobilize for essential HIV prevention, care and treatment services. Efforts will be made to engage male

community members and promote respect between men and women in communities. Support will be

provided for disclosure of HIV status and strategies to reduce disclosure-related gender-based violence will

be encouraged. An age-appropriate curriculum will be developed by the Educational Development Center

(EDC) and the South African Democratic Teacher's Union (SADTU), drawing on material developed by the

EDC in collaboration with SADTU, and the World Health Organization. This curriculum emphasizes the

traditional three-part public health theory of improving Knowledge, Attitudes, and Practice, skill-building

methods in topics such as risk reduction, being faithful, decision making, and social responsibility, as a way

of preventing HIV infection, providing care to those infected and affected by HIV, respect for women,

fighting stigma and discrimination, and dealing effectively with the challenges of everyday life. Group health

education provides supportive social care in the form of efforts to reduce stigma and efforts to increase

community awareness of care, prevention, and treatment. Providing care to those infected and affected by

HIV, respect for women, fighting stigma and discrimination, and dealing effectively with the challenges of

everyday life.

Building human capacity in remote rural areas is a critical issue. Mpilonhle responds to this challenge by

maximizing the capacities and skills of relatively abundant lay health workers through rigorous training and

regular refresher courses to enable them to perform critical yet currently scarce services such as the

promotion of elements of the preventive care package, provision of screening for Opportunistic Infections,

Activity Narrative: basic pain and symptoms management, and health education thus shifting the burden of these activities

away from relatively scarce professional health workers. Gender issues will be addressed in the provision of

basic HIV screening and care and prevention messaging to large numbers of male and female adolescent

and adult PLHIV support for disclosure of HIV status and reduction of gender-based violence), involvement

of male adolescents and adults in the program mobilization of community leaders for promoting community

efforts against stigma and discrimination, and for raising awareness regarding HIV prevention, care and

treatment.

Sustainability of activities is facilitated by political commitment from District and Municipal governments, and

the local Department of Education to scaling-up and to fund-raising in support of such scaling-up; the

relatively low-tech and easily replicable nature of many core program features; minimal dependence on

scarce health professional such as doctors and nurses; the ability of rugged mobile facilities to reduce the

need for additional investments in fixed physical infrastructure; declining prices over time for the program's

information technology requirements; the possibility of adapting the service delivery model to workplaces as

well as schools; the multi-dimensionality of program activities, which includes HIV and AIDS, general health,

and education related activities, and which broadens the scope of donors interested in funding continuation

and scale-up of activities.

These activities will contribute to PEPFAR goals of providing palliative care to 10 million HIV-infected

individuals and their families.

SUMMARY:

Mpilonhle is a new South African community-based organization registered in 2007 with the South African

Directorate of NGOs. It is dedicated to improving the health and well-being of adolescents in high schools in

Umkhanyakude District Municipality, KwaZulu-Natal (KZN) through its "Mpilonhle Mobile Health and

Education Project. It will begin operations in late 2007 with a single mobile unit funded with support from

Oprah's Angel Network, and expand with two further mobile unites funded by PEPFAR funds. It is currently

building up its staff, which is expected to be 40, and is based in the Mpilonhle office in Mtubatuba, KZN. The

Mpilonhle program will provide orphans and vulnerable children (OVC) with support to access education,

economic support, psychosocial support, legal assistance. Mpilonhle will reach the OVC through the

implementation of three schools-based activities (1) health screening, (2) health education and (3) computer

-assisted learning. These services will be delivered through mobile clinic and computer laboratory facilities

to OVC in 12 secondary schools in rural KwaZulu-Natal, South Africa. The emphasis areas for the Mpilonhle

program will be on gender and local organization capacity building. The targeted populations are

adolescents aged between 10 and 24 years and OVC among secondary school students.

BACKGROUND:

This is a new activity to be implemented by a local NGO, Mpilonhle, with support from the South African

Government leadership at the district and provincial level in KwaZulu-Natal. Activities will be implemented in

the Umkhanyekude District, the poorest and most rural district in KwaZulu-Natal province, with one of

highest HIV prevalence. Mpilonhle will implement activities in 12 rural secondary schools that have

inadequate resources in the Umkhanyekude District Municipality. Approximately 33% of secondary school

students have lost at least one parent. Partners consist of the Department of Education, the South African

Democratic Teachers' Union, District Health Services, and District and Municipal leadership.

ACTIVITIES AND EXPECTED RESULTS:

Mpilonhle will conduct three schools-based activities for OVC: health screening, health education, and

computer-assisted learning. These count as OVC support since they provide supportive health care

services, increasing access to education, economic support, and supportive social services including legal

aid. These activities will be provided through mobile facilities. Each mobile facility consists of a paired-up

mobile clinic and mobile computer lab, staffed by 1 primary care nurse, 4 health counselors, 1 health

educator, and 1 computer educator. Each mobile facility will visit a participating secondary school one week

per month for eight months per year. This allows each mobile facility to serve 4 secondary schools per

school year. The project will have three mobile facilities, allowing them to serve 12 secondary schools in

total. Six of the 12 schools have been pre-selected. The remaining six schools and the 24 community sites

will be determined with the Mayors of Umkhanyakude District, Mtubatuba Municipality, and Hlabisa

Municipality and with local officers of the DOE.

ACTIVITY 1: Health screening

A health counselor will provide students with an annual individualized health screening that includes VCT;

individualized AB-counseling for HIV prevention and behavior change; counseling or referral to further

services for PMTCT, ART, TB and psychosocial support; and referral to a staff social worker for assistance

with accessing government grants and assistance with legal matters. School principals, local Department of

Education officials, District and Municipal mayors, and focus groups of teachers and students have

expressed the community acceptability of schools-based VCT. This activity provides support for OVC in the

form of improving their access to health care.

ACTIVITY 2: Health education

A Mpilonhle health educator will provide students with four 90 minute small-group HIV, health and life-skills

education sessions per year that will discuss the basic facts about HIV, VCT, STIs, TB, ART, PMTCT;

reducing stigma and discrimination against PLHIV; and promoting respect between men and women. An

age-appropriate curriculum on these topics will be developed by the Educational Development Center

(EDC) and the South African Democratic Teacher's Union (SADTU), drawing on material developed by the

EDC in collaboration with SADTU, and the World Health Organization (WHO). This curriculum emphasizes

the tradition of improving Knowledge, Attitudes, and Practice (KAP), skill-building methods in topics such as

risk reduction, being faithful, decision making, and social responsibility, as a way of preventing HIV

infection, providing support to those infected and affected by HIV, respect for women, fighting stigma and

discrimination, and dealing effectively with the challenges of everyday life. Group health education provides

supportive social care in the form of efforts to reduce stigma and efforts to increase community awareness

of care, prevention, and treatment. This activity will provide support to OVC in the form of psychosocial

support and HIV prevention messages.

ACTIVITY 3: Computer-assisted learning

An Mpilonhle computer educator will provide students in participating schools with four 90 minute small-

group computer education sessions per year that will provide training on how to use computers, basic

software, and the internet; and computer-assisted learning for improved school performance, HIV

prevention, and general health promotion. This activity is expected to improve student learning, raise

graduation rates, self-confidence and employability. This in turn increases self-reliance, self-confidence and

self-sufficiency and the socio-economic status of the females, thus reduces their vulnerability to coercive,

cross-generational, and transactional sex. This activity will improve educational development of OVC

through computer-assisted learning and will encourage OVC to stay in school and complete their education.

In addition, having computer skills will improve the market skills and employability of OVC that head

households.

Sustainability of activities is facilitated by building human capacity in remote rural areas. Mpilonhle

maximize the capacities and skills of relatively abundant lay health workers to enable them to perform

critical yet currently scarce services such as VCT, health screening and personalized risk assessment, and

health education, shifting the burden of these activities away from relatively scares professional health

workers like nurses and doctors. Mpilonhle will build the technical expertise and capacities of lay health

Activity Narrative: workers through rigorous training and regular refresher courses. Sustainability is also facilitated by political

commitment from District and Municipal governments and the local Department of Education to scale-up

and fund-raise for this activity.

Gender issues will be addressed in the provision of care and support to in-school OVC with special

emphasis on the girl child. The emphasis areas for this program are Human Resources in the form of

salaries for health counselors, health educators, and computer educators, Information, Education and

Communication in the form of resources for health education and computer education, Infrastructure in the

form of deployment of mobile clinics and computer laboratories and Development of

Network/Linkages/Referral Systems through the referral of OVC to the staff social worker.

The Mpilonhle OVC activities outlined above contribute to PEPFAR 2-7-10 goals of providing care and

support to 10 million people, including OVC, in the form of supporting access to health services,

psychosocial support and increasing access to with economic opportunities.

SUMMARY:

Mpilonhle is a new South African community-based organization (CBO). It was registered in 2007 with the

South African Directorate Non-Profit Organisations. Mpilonhle is dedicated to improving the health and well-

being of adolescents in high schools in Umkhanyakude District Municipality, KwaZulu-Natal through its

"Mpilonhle Mobile Health and Education Project". Operations will begin in late 2007 with a single counseling

and testing (CT) mobile unit funded by Oprah's Angel Network, and later, will expand with two further mobile

units funded by PEPFAR. The organization is currently recruiting and employing staff, which is expected to

grow to 40. Staff will be based in the Mpilonhle office in Mtubatuba in KwaZulu-Natal.

Mpilonhle's counseling and testing (CT) activities include (1) schools-based health screening, and (2)

community-based health screening. These services will be delivered through mobile clinics and mobile

computer laboratory facilities to 12 secondary schools and 24 community (non-school) sites at

Umkhanyakude District in rural KwaZulu-Natal province.

Emphasis areas include gender, human capacity development, and strategic information. Target

populations include adolescents aged 10-24 years and adults.

BACKGROUND:

This is a new activity that will be implemented by the prime partner, Mpilonhle, a newly established non-

governmental organization (NGO). The program has broad support from district and provincial South

African government leadership. PEPFAR funds will be used to establish the infrastructure, to purchase

mobile vans, equipment and operational costs to run the program. Mpilonhle will implement activities in

Umkhanyakude District, the poorest and most rural district in KwaZulu-Natal province, and one with high

HIV prevalence. Activities will take place in 12 representative rural secondary schools that are affected by

physical remoteness, poor health conditions, and inadequate resources, and in 24 community (non-school)

sites. Partners include the Department of Education, the South African Democratic Teachers' Union, district

health services, and district and municipal leadership.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Schools-based Health Screening

A health counselor will provide secondary school students with (a) an annual individualized health screening

that includes CT, screening and referral for common health problems; (b) counseling or referral to further

services for prevention of mother-to-child transmission (PMTCT), antiretroviral treatment (ART), TB and

psychosocial support; and (c) referral to a social worker for assistance with accessing government grants

and support for people living with HIV (PLHIV). School principals, local Department of Education officials,

district and municipal mayors and focus groups of teachers and students have expressed the community's

acceptance of schools-based CT.

ACTIVITY 2: Community-Based Health Screenings

This activity will be conducted by health counselors at 24 community-based sites outside schools.

Community-based health screenings will consist of a core of HIV preventive services including

individualized CT; personalized ABC counseling, and condom provision to sexually active individuals;

referrals to other community-based services for PMTCT, ART, TB and psychosocial support; referrals to a

social worker for assistance with accessing government grants and support for orphans and vulnerable

children (OVC) or PLHIV; general health screening and referral for care and other services as required;

basic computer training to community members; and group HIV and health education sessions.

ACTIVITY 3: Mobile Facilities

These counseling activities will be provided through mobile facilities. Each mobile facility will consist of a

paired-up mobile clinic and mobile computer laboratory, staffed by one primary care nurse, four health

counselors, one health educator, and one computer educator. Each mobile facility will visit a participating

secondary school one week per month for eight months per year. This will allow each mobile facility to serve

four secondary schools per school year. The project will have three mobile facilities, allowing Mpilonhle to

serve 12 secondary schools in total. Each participating secondary school has an average of 800 students,

and will offer the first three activities described above. Six of the 12 schools have been pre-selected.

ACTIVITY 4: Counseling and Testing

CT will be conducted using South African Government (SAG) approved algorithms, test kits and guidelines

and procedures. Health counselors will be trained in SAG-approved CT programs and will use SAG-

approved HIV CT protocols. External Quality Assurance methods will be used to check the service quality.

Health screening will use an Electronic Medical Record (EMR) system implemented on handheld

computers, programmed with health screening guidelines, algorithms, and series of questions that must be

followed by the counselors. These will save individual screening results into a medical record. EMRs

facilitate collection of timely, high quality and easily analyzable data. EMRs also contribute to quality control

by minimizing missing data, and by enforcing and monitoring conformity to protocols and guidelines. The

data collected by the EMR system will include indicators of acceptance of pre-test counseling, testing,

results, post-test counseling, data on HIV status, and on sexual behavior.

Persons who are HIV-infected will be referred to the program nurse for further evaluation, including CD4

testing, which will be done at Department of Health laboratories. People who meet initial screening criteria

for antiretroviral treatment (ART) will be referred to the Hlabisa Health sub-district ART program at one of

the DOH clinics. Persons screened for TB will also be referred for TB management at district clinics.

ACTIVITY 5: Human Capacity Development

Sustainability of activities is facilitated by building human capacity in remote rural areas. Mpilonhle will

maximize the capacities and skills of relatively abundant lay health workers to enable them to perform

Activity Narrative: critical yet currently scarce services such as HIV counseling, health screening and personalized risk

assessment, and health education. This skills development in lay health workers will shift the burden of

these activities away from relatively scarce professional health workers like nurses and doctors. Mpilonhle

will build the technical expertise and capacities of lay health workers through rigorous training and regular

refresher courses and through the technological support provided by the information technology

components of the program. Sustainability is facilitated by political commitment from district and municipal

governments, and the local Department of Education to scaling-up and to fund-raising in support of such

scaling-up.

These activities will contribute to PEPFAR 2-7-10 goals of promoting counseling and testing for HIV among

secondary school students and adults in the general population.