PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
The Aurum Institute for Health Research (Aurum) will increase support for the public sector sites and
decrease support for non-governmental organization and general practitioner (GP) programs in FY 2009. In
FY 2008 Aurum amended its policy in line with the new South African PMTCT guidelines of dual therapy,
and this will continue in FY 2009. A focus on couple counseling and integration of a family-centered
approach will be undertaken. This will include integration of other services at the community health center
and primary health care levels such as linkages to family planning services, prevention with positives, and
increased linkage with the community.
The prevention of mother-to-child transmission (PMTCT) support will be provided to eight of the Aurum
down-referral sites that have antenatal services in Ekurhuleni Northern district (Gauteng province), the
current GP project, the currently supported public sector sites including Tshepong hospital and Orkney clinic
in the North West, Chris Hani Bara hospital, Tembisa hospital, Tembisa main clinic in Gauteng, and
Madwaleni hospital in the Eastern Cape. The Aurum-supported PMTCT sites will be provided with a nurse
and/or lay counselor as required from individual sites and training is to be conducted for each of the
geographical areas. The program will also include routine counseling and testing; strengthening the tracing
of the babies from the PMTCT program in collaboration with the existing home-based care system;
strengthening of TB screening amongst expectant mothers; and staging and provision of highly active
antiretroviral therapy (HAART) to those women eligible. Training will be given for couple counseling,
prevention with positives, and engagement of the male partner for health staff in the clinical setting of
PMTCT.
The program will also link with the integrated management of childhood illnesses (IMCI) and the expanded
program on immunization programs and include them in the trainings for better follow-up of children.
Emphasis will also be on the early screening of HIV-exposed babies by polymerase chain reaction testing
and provision of cotrimoxazole.
Training is to be provided to lay counselors on sexuality, including empowering pregnant women to use
condoms consistently during their pregnancy and lactation periods to avoid new and reinfection.
Another gender activity is to encourage the involvement of fathers during the antenatal period, promote HIV
testing among fathers, and provide advice on the use of condoms during pregnancy. Specific training and
mentoring of health staff in prevention with positives, couple counseling and testing and gender issues will
target these issues. A gender module will be developed for health-care staff, patients and their partners that
will seek to identify and prevent gender-based violence.
-----------------------------
SUMMARY:Aurum will provide PMTCT services to patients in South African government clinics, GP
practices and non-governmental sites. Emphasis will include the implementation of the PMTCT diagnosis
and treatment protocols at the service outlets, early counseling and testing of pregnant mothers, provision
of antiretroviral prophylaxis to HIV infected mothers both during the pregnancy and during delivery.
Emphasis will also include provision of ARV to infants born to HIV mothers according to protocols and PCR
of infants born to HIV-infected mothers. Also included in this activity is counseling on safe infant feeding
practices and prevention of STI and HIV infection during pregnancy and while breast feeding. The primary
target populations are HIV-infected pregnant women and their infants.BACKGROUND: Aurum Institute for
Health Research (Aurum) is a not-for-profit, public benefit organization that is committed to improving the
health of disadvantaged individuals and communities through transformational research (the research
programs are not PEPFAR-funded), management of TB and HIV programs and provision of HIV testing,
treatment and care. Aurum has received PEPFAR funding since October 2004. The main focus of the
Aurum program in the public, private and non-governmental sector is to provide HIV care and treatment to a
large number of persons in a cost-effective standardized manner ensuring a high quality of counseling,
patient care and patient monitoring. The model is centrally coordinated and designed to be implemented on
a large scale in peripheral sites that are resource-constrained and lacking basic resources such as HIV
specialists, information technology (IT) infrastructure, and laboratory and pharmacy capacity. Aurum has
established a centralized system of support which includes the following: (1) training of all levels of
healthcare workers to ensure capacity building of clinicians to manage patients in resource limited settings
with remote HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive therapy
(including INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child
transmission and VCT; (3) clinical and administrative support through site visits by staff involved in
psychological support, training, clinical support and monitoring data management systems; and (4)
centralized distribution of medication and laboratory testing. This program will supplement the South African
government's ARV rollout and therefore the program adheres to national guidelines and
protocols.ACTIVITIES AND EXPECTED RESULTS: Aurum will carry out five activities in this Program Area.
All of the activities are aimed at the provision of quality PMTCT service delivery.ACTIVITY 1. Establishing
Capacity for PMTCT at Service Outlets This activity will include the dissemination of information on the
importance of PMTCT and the application of PMTCT protocols to all South African government clinics, GP
and NGO sites funded supported through the Aurum grant. This is also linked to the training of health
workers (activity 7 below).ACTIVITY 2: Counseling and Testing of Pregnant women Pregnant women will
receive provider-initiated counseling and testing as soon as they present to the health care service outlet.
Women who test negative during the initial testing will be encouraged to repeat testing during the pregnancy
to detect early HIV infection and ensure proper clinical care for the mother and infant. ACTIVITY 3:
Provision of Prophylactic ART Women who are HIV-infected and pregnant will be provided with prophylactic
ARVs to prevent transmission of HIV from the mother to the unborn child. As part of the minimum service
package, newborn infants will receive the recommended prophylactic ART. Following pregnancy women will
be enrolled onto the HIV care program.ACTIVITY 4: Early infant diagnosis using PCRTraining will be given
to health care providers at South African government clinics, GP sites and NGO sites on the importance of
early infant HIV diagnosis and the correct use of the PCR test. Data collection will include a compilation of
results of all PCR tests performed.ACTIVITY 5: Prevention of STI and HIV in pregnancy and during breast-
feeding periodCounseling given to pregnant mothers will emphasize the risk of contracting STI and new HIV
Activity Narrative: infections during pregnancy and how that increases the risk of transmission to the unborn child. ACTIVITY
6: Promotion of safe infant feeding practicesAurum will provide education and counseling to support
mothers to make correct choices around infant feeding practices to ensure reduced risk of HIV transmission
in the post-partum period while safeguarding the health of the infant.ACTIVITY 7: Training of Health Care
Workers to provide PMTCTAurum will incorporate training around the provision of PMTCT into its existing
training curriculum for doctors and professional nurses and counselors. This training will include counseling
of pregnant women to encourage them to test for HIV, the prophylactic antiretroviral therapy, the
modification and continuation of antiretroviral therapy in mothers already receiving therapy the use of PCR
for early infant diagnosis and counseling around other prevention methods for STI and HIV and safe infant
feeding practices. Aurum's PMTCT activities contribute to the achievement of the PEPFAR 2-7-10 goals.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13689
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13689 13689.08 HHS/Centers for Aurum Health 6574 190.08 $242,500
Disease Control & Research
Prevention
Emphasis Areas
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $121,250
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Aurum will continue programs described in the FY 2008 COP, but the following enhancements have been
made:
Some programs will be provided to parents on how to deal with adolescents and young people. The parents
will be targeted in workplaces and community organizations such as churches. More emphasis will be
placed on empowering girls in dealing with peer pressure and the ability to say no. Recreational activities
will be supported through community organizations.
Partnerships with youth organizations will be established and strengthened. Training on peer education will
be provided to youth organizations and other organizations in the communities. Community mobilization
officers and counselors will undergo in-service trainings and debriefing sessions on a regular basis. The
Aurum social worker will be responsible for debriefing the project team. Two team-building activities will be
conducted during the year. These will be conducted to promote staff wellness and better integration of
activities across the Aurum project. Managers, human resources managers and trade union officials of
small and medium enterprises (SME) will be trained on policy development, stigma and discrimination. The
project will continue to expand its services to private nursing schools targeting student nurses and tutors.
The HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011(NSP) prevention target is to reduce the
national HIV incidence by 50% by 2011. Aurum's abstinence and being faithful (AB) activities aim to
contribute to the reduction of HIV incidence among young people. Objective 1.2 under Goal 1 of the NSP is
to accelerate programs to empower women and educate men and women (including boys and girls) on
human rights in general and women rights in particular. The AB activities will specifically run educational
and information sessions on gender issues with the aim of empowering women and girls. Women need to
be empowered in order to be able to say no to gender violence and be able to negotiate safe sex. At the
same time men and boys must be able to deal with empowered women and girls, and reduce gender
stereotypes.
Objective 1.7 aims is to build AIDS competent communities through tailored competency processes. The
SME project continues to provide HIV and AIDS services to SMEs in the workplace. These services are
tailored to meet the needs of SME employees, and aim to promote HIV prevention among the workers.
Goal 2, objective 2.4 aims to increase the rollout of workplace prevention programs for workplace
interventions. More SMEs will be targeted in FY 2009. Partnerships with trade unions and employer
organizations will be strengthened in order to reach as many SMEs as possible. There will be greater
emphasis on the construction industry.
Objective 2.7 of the NSP aims to develop a comprehensive package that promotes male sexual health. The
sexually transmitted infections clinic that will be established in FY 2008 at the Bree Street taxi rank targeting
taxi operators will be strengthened.
Gender-focused information sessions will be conducted in the communities. The HIV education currently
provided to employees of SMEs will include gender and HIV sessions. Specific gender-focused training
material will be developed. Refresher training for trained peer educators will be conducted.
Education of parents will also be prioritized. This will aim to empower parents to deal with gender
SUMMARY: The Aurum SME Project commenced in September 2007. The project seeks to extend access
of HIV related services such as prevention, counseling, testing and treatment to people that currently are
not accessing services through the existing health care system. The project specifically targets employees
of small, micro and medium sized (SME) companies as well as their partners and dependents. In the
second year of this project, the focus will be on strengthening service provision at the existing service points
as well as extending the service offering to four additional fixed sites in Mpumalanga, Limpopo and Gauteng
provinces.
BACKGROUND: Aurum provides services to SMEs at the workplace, through the use of mobile vehicles
and through a fixed testing site at the Bree Street Taxi Rank which is the busiest taxi rank in Johannesburg,
catering for an estimated 400,000 commuters a day in addition to 500 traders and 2000 taxi drivers.
ACTIVITIES AND EXPECTED RESULTS: Prevention activities will comprise prevention messaging
targeting youth and young adults that utilize the fixed Bree centre as well as a campaign that will involve the
use of counselors visiting educational institutions, sports facilities and entertainment venues within the
targeted areas. In FY 2008 these activities will be expanded through the employment and training of
additional counselors. It is anticipated that 7000 people will be reached with specific abstinence and be
faithful messaging. Messaging that specifically targets the young men and young women will encourage
abstinence, delayed sexual debut, avoidance of risk taking behavior and reduction in the number of sexual
partners. All the messaging will be provided in languages understood by the targeted group and the project
will involve an ongoing conversation with the community as opposed to short-term information blitzes. In
addition 300 individuals from the targeted companies and communities will be trained as peer educators to
use A/B focused materials.
ACTIVITY 1: Recruitment and training of youth community mobilization counselors.
Aurum intends to recruit additional youth counselors who will be trained and then tasked with the provision
of youth focused messaging and education to students at educational institutions within the targeted areas,
mainly high schools and tertiary educational colleges. Young commuters that frequent the taxi ranks will
also be targeted with the specific A/B message. The training provided to the youth counselors will include
basic counseling skills, sexuality, modes of HIV transmission, gender as related to the HIV epidemic,
Activity Narrative: prevention methods, counseling for behavioral change, group and individual counseling.
ACTIVITY 2: Delivery of specific AB message to targeted youth.
An ongoing activity under this grant will be the delivery of targeted messaging to youth, attending
educational institutions in the targeted areas. Youth will also be targeted at sports venues and other
entertainment venues and the abstinence, be faithful and delay in sexual dbut will be delivered in one on
one and small group information and education sessions. Messaging will specifically targets young men and
young women and will encourage abstinence, delayed sexual debut, avoidance of risk taking behavior and
reduction in the number of sexual partners. All the messaging will be provided in languages understood by
the targeted group and the project will involve an ongoing conversation with the targeted communities.
Continuing Activity: 19444
19444 19444.08 HHS/Centers for Aurum Health 6574 190.08 $100,000
* Increasing women's legal rights
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.02:
Qualitative work will be done on population-specific behavioral, gender and structural risks in the target
populations. This will inform interventions to address norms and identified high-risk behavior. HIV education
programs will address these issues in detail. Targeted and gender focused activities will be run for men as a
way to address stereotypes and gender imbalances. Partnership with Alcoholics Anonymous (AA) and other
interventions for alcohol abuse will be established to address risk between alcohol and HIV. The Bree street
taxi rank center will expand alcohol and HIV services to taxi operators. The construction industry will also be
specifically targeted as part of group of people most at risk population.
Partners and families of these high-risk populations will be engaged and included where possible through
structured interventions. Counselors and nurses will be provided with necessary training and information
sessions to equip them to deal with these issues. A basic program evaluation will be implemented in the
screening for substance abuse, offering referral to services to quantify the contribution of substance abuse
to HIV risk in these populations.
The sexual prevention program will mainly be provided in the workplace and in partnership with trade
unions, employer organizations and other community organizations. Training on peer education will be
provided to employees of small and medium enterprises (SMEs) and other organizations in the
communities. Nurses and counselors will undergo in-service trainings and debriefing sessions on a regular
basis. The Aurum social worker will be responsible for debriefing the project team. Two team building
activities will be conducted during the year. These will be done to promote staff wellness and better
integration of activities across the Aurum project. Managers, human resources managers and trade union
officials of SMEs will be trained on policy development, stigma, gender and discrimination. The Aurum
project will further expand its services to private nursing schools targeting student nurses and tutors.
The HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 prevention target is to reduce the
national HIV incidence by 50% by 2011. Aurum's other sexual prevention activities are intended to
contribute to the reduction of HIV incidence among young people. Objective 1.2 under Goal 1 of the HIV &
AIDS and STI Strategic Plan is to accelerate programs to empower women and educate men and women
(including boys and girls) on human rights in general and women rights in particular. The other prevention
activities will specifically provide educational and information sessions on gender issues with the aim of
empowering women in the workplace. Women need to be empowered in order to be able to say no to
gender violence and be able to negotiate safe sex. At the same time men must be able to deal with
empowered women and reduce gender stereotypes. Objective 1.7 is to build AIDS competent communities
through tailored competency processes. The SME project continues to provide HIV and AIDS services to
SMEs in the workplace. These services are tailored for the employees of SMEs and aim to promote HIV
prevention. Goal 2, objective 2.4 is to increase the rollout of workplace prevention programs for workplace
Objective 2.7 is to develop a comprehensive package that promotes male sexual health. The STI clinic that
will be established in FY 2008 at Bree street taxi rank will be strengthened to include activities to promote
gender specific sexual health for males. The clinic is intended for taxi operators and associated staff. A
targeted gender specific intervention for the taxi operators will be initiated. The majority of people in the
workplaces that the Aurum project supports provide services to men. This has allowed men to access HIV
services. Employed men normally find it difficult to access HIV services especially in the public sector. The
HIV education is being strengthened to specifically address gender issues and empower men to deal with
empowered women. Qualitative work on male norms and risk behavior will inform these interventions.
----------------------------
SUMMARY:
This activity will building on the existing program components (care, treatment and TB-HIV) to include a
prevention activity, integrated into existing services. Aurum currently provides services in three sectors:
public, private and NGO. This funding will allow Aurum to address prevention awareness and promote
behavior change among the target populations, many of whom are at high risk (prisoners, refugees, miners
and other mobile populations), including prevention messaging for people in the care and treatment
program.
As per the South African Government ABC strategy, Aurum will address all these aspects, including
messaging and training that promotes the correct and consistent use of condoms at South African
government clinics, GP clinics and NGO sites. Aurum will continue to develop messaging for specific target
groups such as young males, young women, pregnant women, mobile populations, and other target groups
identified as being at risk in conjunction with other expert organizations. Aurum will emphasize messages
that promote healthy choices regarding sexual behaviors and avoiding risky behaviors, especially
concurrent multiple partnerships. Emphasis will be placed on avoidance of drug and alcohol abuse, delaying
sexual debut and addressing transactional sex. One of the focus areas of this program is gender with a
particular focus on addressing male norms and behaviors. Male circumcision will be encouraged within the
context of local policy and guidelines. Aurum is working with one corrections facility and aim to be working
with approximately four additional prison facilities in the next year. In one of the supported NGO facilities,
based in central Hillbrow, Aurum is targeting homeless populations and street youth. The primary target
populations are men, women, youth, prisoners and other most at risk populations (MARPs). For patients
currently enrolled on the program (HIV-infected patients) messages about HIV prevention are continuously
emphasized.
FY 2008 represents the second year of activity of the SME project which has a significant focus on
prevention activities. The partnership with City of Johannesburg has enabled the establishment of a fixed
site within the Bree Street Taxi Rank. In FY 2008, Aurum plans to undertake targeted prevention activities
Activity Narrative: involving taxi drivers at a number of taxi ranks in the three targeted provinces. Attention will be paid to
intensifying prevention activities in these groups through the syndromic management of STIs, peer
education and active screening and counseling for substance use/abuse. This will include venue-based
interventions aimed at targeting substance abuse and other risk behavior.
BACKGROUND:
Aurum supports activities which reduce the transmission of HIV through engaging target populations to
provide messaging that encourages positive choices around sexual behaviors. The target population
currently services with HIV care and treatment services are poor, underserved, and mobile. In partnership
with ReAction! Consulting, another PEPFAR partner, community messaging is delivered to communities in
the vicinity of NGO clinics in Mpumalanga through door-to-door campaigns. Utilizing the experience and
tools from this facility, Aurum will expand its prevention activities in the other settings currently supported by
Aurum. Health care workers that work in government clinics, GP clinics and NGOs will receive training from
ReAction! Consulting in order to provide support in these activities.
The mining sector is a key platform to reach men. Stepping Stones is a workshop series designed to
promote sexual and reproductive health. It addresses questions of gender, sexual health, HIV and AIDS,
gender violence, communication and relationship skills. Stepping Stones has been shown to reduce high
risk behavior and HIV incidence in a program in Africa. Aurum intends using this program in both the mining
setting and in the prison population.
The SME Project targets workers in small, micro and medium sized companies, including market traders
and taxi drivers who previously did not have access to HIV prevention, counseling and testing and treatment
services due to incompatibility of their working hours with the operating hours of the public health facilities
and the fact that the majority of SME employees do not have private health insurance. In placing services
within taxi ranks and markets, partners and dependents of SME employees will also have access to these
services.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Targeted Training to Specific Groups
Men will be targeted, especially the large prison populations supported by Aurum, and in mining settings.
Messages to men will be developed and training provided promoting behavior change, and addressing
cultural norms of manhood and masculinity. This will be done in partnership with other PEPFAR partners.
This includes messages to young men encouraging them to use condoms, reduce the number of sexual
partners and avoid risky behavior. Messaging to young women, who make up the bulk of the current
population served with Aurum's care and treatment services, will empower them to be involved in decision-
making regarding sexual choices, requiring their partners to use condoms, empowering them to use female
condoms, delaying sexual debut and avoiding gender violence. Young women will be encouraged to
develop a positive self-image.
Aurum currently offers a number of courses that cover positive living and information on HIV prevention.
The training, provided by Aurum social workers and a psychologist, will be offered to incarcerated
communities, nurses, lay counselors and peers. The trainees will become implementers and peer
educators. The training curriculum includes understanding the challenges of disclosure, how to help clients
disclose safely, and how to address HIV and AIDS stigma, and is offered twice a year. In addition a module
on Prevention with Positives will be included in the training provided to the counselors in the SME fixed and
mobile sites as well as the health care workers and peer educators.
ACTIVITY 2: Promotion of Male Circumcision as a Method of Reducing Transmission
Based on existing evidence, male circumcision has been show to have an effect on the rate of HIV
transmission. Aurum plans to undertake a situational analysis to understand the beliefs, attitudes and
practices of male circumcision to understand the barriers for widespread circumcision implementation in
limited a number of industrial and community sites. In settings where it is possible to provide circumcision,
Aurum will provide training to ensure safe methods and encourage males to opt for this procedure. Activities
will not be conducted without consent from the National Department of Health.
ACTIVITY 3: Prevention and Treatment of Sexually Transmitted Infections (STIs)
Aurum will continue to provide training to health care workers on the syndromic management of STIs as a
means of preventing the transmission of HIV, as many of the populations currently served with HIV care and
treatment services are at high risk. Aurum will encourage the use of male and female condoms to prevent
the spread of STIs. In FY 2008 the SME Project will focus on the issue of identification and treatment of
STIs in taxi drivers and will provide these services within the Bree Street taxi rank.
ACTIVITY 4: Education to Prisoners and Miners on Gender
Various organizations that are involved in gender issues and a framework will be established to provide
education and programs to males based at the corrections facility and a company within the mining industry.
One of these is the Stepping Stones workshops to be implemented with peer groups. The 14 sessions for
the separate peer groups cover the following topics: introduction for the group and development of group
skills; Images of Men and Women: Exploration of Ideals and Realities; Images of Sex and Sexual Health
Problems; Exploration of Love: What We Look for and Expect to Give; Exploring our Sexuality: Problems
and Concerns about Sex and Reproductive Health; Conception and Contraception; STDs and HIV; Safer
Sex; Gender-based Violence; Let's Look Deeper: Why we Behave in the Ways We Do; Assertiveness Skills:
Part 1; Assertiveness Skills: Part 2; Dealing with Loss; Let's Prepare for the Future: Future Decisions and
Changes.
Activity 5: Prevention with Positives
People that are identified as being HIV-infected through counseling or testing will be rapidly assessed for
additional risk behaviors. Once these have been identified the counselor will negotiate with the HIV-infected
Activity Narrative: client around methods of reducing the risk of transmitting the infection to other people or of becoming
infected with additional strains of the virus. The session will end with the client either being referred for
additional support or arranging a follow-up session with the counselor. This service will be provided at all
fixed and mobile sites as well as within the workplace and in occupational clinics within the SME project.
Activity 6: Venue-based Interventions targeted at reducing substance abuse and other risky behavior.
In FY 2008, Aurum will commence venue-based interventions that will target nightclubs, shebeens, taxi
ranks and sports venues and will involve one on one encounters where a rapid assessment will be made of
an individuals risk behavior such as substance and alcohol abuse. The counseling session will aim to
identify the risk that that behavior places the individual in terms for transmission of HIV and other STIs and
will involve referral of the individual for further assistance.
Continuing Activity: 13690
13690 13690.08 HHS/Centers for Aurum Health 6574 190.08 $447,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Estimated amount of funding that is planned for Education $5,000
Table 3.3.03:
Aurum's program will mainstream gender in FY 2009 and focus on a family-centered approach. Aurum will
strengthen links to communities in four provinces (Gauteng, North West, Eastern Cape and Limpopo)
through devolution of care to lower level facilities. The care program will be closely linked to TB-HIV
initiatives and many of the activities in that area will be integrated here.
There is a need to continue with the appointed trained human resources and to appoint additional staff to
meet the demands of the growing program. The staff will cover the program comprehensively and be multi-
skilled to provide for continuum of care and the family approach. The staff will receive ongoing training as
part of their development and Aurum will also appoint new staff to be trained.
The Department of Health and Correctional Services staff will also be trained in the entire program to
ensure the sustainability of program when the current PEPFAR-funded staff is no longer available.
The program will continue to have mentorship from both the PEPFAR-appointed staff and the South African
Government (SAG) staff.
The lay counselors will also be offered continuous training and update on new developments. Their stipend
will also be augmented to provide for motivation and continued volunteering. They will be trained in all the
counseling programs including the adherence training in both HIV and TB.
Mentoring and training of health care staff on prevention with positives, treatment literacy approaches and
engagement of couples and partners will be undertaken.
Under the small and medium enterprises (SME) project, training is provided to lay counselors, peer
educators, managers and representatives of taxi drivers and traders to develop and implement a workplace
HIV policy. Technical assistance on SME management and leadership development will continue to be
provided to targeted companies to decrease stigma and discrimination of HIV-infected employees in the
workplace. In addition training and capacity building of the City of Johannesburg staff, the Metropolitan
Trading Company, and small traders within taxi ranks is undertaken.
--------------------------
Aurum's palliative care program provides care to patients infected with HIV following HIV counseling and
testing, and screening for treatment eligibility in accordance with South African Government (SAG)
guidelines. The facilities where palliative care is provided include general practitioners' clinics, non-
governmental clinics and public sector sites. These sites are located mainly in the Gauteng, North West
Mpumalanga and KwaZulu-Natal. Patients are also assessed for opportunistic infections and eligibility for
ART and provided with preventive therapy i.e. INH and cotrimoxazole. Emphasis areas include human
resources, commodity procurement, logistics, quality assurance and training. The primary target populations
are people living with HIV (PLHIV), HIV-infected children, prisoners, homeless people and street youth.
This is an ongoing program funded by PEPFAR since October 2004. The PEPFAR-funded project aims to
rapidly expand access to HIV care and treatment to South Africans living with HIV, and especially in areas
(such as mining areas) where Aurum is familiar and other partners are less likely to work. Aurum has
established a number of general practitioner (GP) clinics which are capable of providing care to large
numbers of HIV-infected individuals and achieving high quality results. In order to ensure sustainability of
this model, Aurum has partnered with Faranani Solutions, a network of general practitioners from a
previously disadvantaged population. Advantages of this model, now termed the Auranani model, are that
Aurum has been able to secure lower consultation rates for GPs and GPs are encouraged to provide
assistance at their local hospital clinics. The presence of trained individuals in these public health facilities
will enable the transfer of knowledge to nurses and doctors in the public sector. It is hoped that this model
can be used to rapidly scale up delivery of HIV services in South Africa, in partnership with government
efforts. Sites are located throughout the country, but are concentrated in Gauteng, North West province and
KwaZulu-Natal. There is only one site each in the Northern Cape and the Western Cape. A further
extension of Aurum's program is to include care and treatment services in HIV prevention trial sites of the
Aurum Institute in the North West and KwaZulu-Natal. Thus patients are being diagnosed in early stages of
their disease and are being counseled and prepared for antiretroviral therapy (ART) and palliative care. In
both these provinces there is a close collaboration with SAG, and patients are referred to public sector
facilities for ART initiation. These clinics are will be used in the future as down referral facilities In FY 2006
Aurum fostered new relationships with non-governmental organizations (NGOs) and public sector sites. A
number of primary healthcare clinics attached to NGO and faith-based organizations (FBOs) have been
established. Metro Evangelical Services, a sub-partner, is a FBO providing training, housing and health
services for the homeless and street youth of Hillbrow, Johannesburg. An HIV center has been established
to provide CT and HIV services to this population. In Gauteng, a contract has been concluded with Chris
Hani-Baragwanath hospital for support and a contract for extension of these services to other parts of
Gauteng is being negotiated with the provincial health departments. In the North West, Aurum supports the
provision of HIV Care at Tshepong Hospital through the provision of medical and nursing staff. In addition,
through the establishment of a walk-in clinic at Jade Square in Klerksdorp Aurum provides care for HIV
patients that are not able to currently access care through the public hospital. Aurum has met with the
KwaZulu-Natal Department of Health about sites attached to the Medical Research Council. Furthermore, in
Mpumalanga, one of Aurum's sub-partners, Reaction Consulting, has worked with the provincial health
department to strengthen support for Ermelo Hospital, and in the Northern Cape, Aurum's public-private
partnership with De Beers Consolidated Mines in the Danielskuil area has been discussed. In the Limpopo
area, discussions are underway with Anglo Platinum and the Limpopo Department of Health to provide
support to a down-referral clinic based in the Capricorn district close to one of the Anglo Platinum mines.
Aurum intends to continue to support the Department of Correctional Services in Johannesburg but also to
expand activities to other Gauteng-based correctional facilities, namely Pretoria. A number of Aurum's sites,
Caritas Care, MES and Duff Scott collaborate with the local health departments that provide funding for
Activity Narrative: inpatient care to palliative care patients. In FY 2008, the SME project will commence the provision of care
and support services to HIV positive SME employees including market traders and taxi drivers and their
partners and dependents in targeted sites in Gauteng, Mpumalanga and Limpopo provinces.
PEPFAR funding will be used to fund all central staff responsible for monitoring and evaluation of the
program. FY 2008 funds will also be used to provide training and human resources at the sites. Focus areas
of training include how to run support groups, disclosure and stigma, special counseling situations such as
couples and children, and the prevention of mother-to-child transmission. Care will be provided through
occupational health care clinics, the mobile vehicles, the GP network and at the fixed service points such as
Bree Street site.
ACTIVITY 1: Monitoring for Opportunistic Infections
At each of the patient visits, a full physical examination including pain and symptom management of the
patient is conducted to exclude the existence of opportunistic infections (OI). If a client presents with an OI,
further investigations and management of the infection including the provision of cotrimoxazole may occur
at the site, or the patient may be referred to another healthcare service. Adherence to OI medications
(including cotrimoxazole prophylaxis and TB treatment) is also part of the package of services. Effort will be
made to ensure equitable access to care services for both males and females.
ACTIVITY 2: Provision of Prophylactic Medication
Patients with CD4 below 200 will receive elements of the preventive care package including cotrimoxazole
preventative therapy. It is expected that 30% of all patients receiving palliative care will be receiving
cotrimoxazole preventive therapy.
ACTIVITY 3: Psychosocial and Spiritual Support As part of a holistic approach to palliative care, patients
receive counseling by trained staff member at each clinic visit. A psychologist, a dietician and a social
worker based within the central office is responsible for education, training and support of site staff. Some of
the sites have established psychological and spiritual support groups. The Basic Package of Care including
acceptance of status, disclosure, prevention with positives, opportunistic infections, adherence counseling,
treatment literacy and nutrition counseling will be included at all Aurum funded sites (private sector).
ACTIVITY 4: Work with prisons
Aurum provides technical assistance to the Department of Corrections in Gauteng province in three areas:
1) assist in the development of the ART and care delivery system, 2) training health care workers on ART
and holistic palliative care, and; 3) development of a data management system to track prisoners who are
receiving ART and care support. Patients will be encouraged to bring family members in the facilities.
Training on couple counseling and counseling for children is given to the health providers. Family members
will be encouraged to test for HIV and will be provided education and counseling on HIV and TB. Those
family members that test HIV positive will be enrolled into Aurum's care program and will be provided with
all the services as already described above. In all of the above activities, PLHIV will receive at least one
clinical and one other category of palliative care service. Palliative care to family members of PLHIV or OVC
will be provided in at least two or the five categories of palliative care services. Aurum's palliative care
services contribute to the PEPFAR goals of 10 million people in care by increasing the quality of care.
ACTIVITY 5: Work with SME Employees
Aurum has established a project that strengthens the provision of services to SME employees, their
partners and dependents initially within the Johannesburg CBD. The project will be expanded to an
additional site in Gauteng as well as to Witbank and Polokwane. Aurum has developed partnerships with
the Johannesburg City Council and with individual companies that have existing occupational health care
clinics. Utilizing these partnerships and the mobile vehicles and GP network, HIV positive clients will be
screened for the presence of opportunistic infections, provided prophylactic therapy and provided education
on nutrition.
Continuing Activity: 13684
13684 3323.08 HHS/Centers for Aurum Health 6574 190.08 $1,150,000
7300 3323.07 HHS/Centers for Aurum Health 4369 190.07 $1,000,000
3323 3323.06 HHS/Centers for Aurum Health 2626 190.06 $900,000
Table 3.3.08:
Activities from FY 2008 will continue, and in addition, in FY 2009 Aurum intends to scale up prevention with
positives, retention in treatment and a focus on public sector consolidation with down referral.
The prevention with positives approach will include risk stratification, risk reduction counseling, substance
abuse screening and intervention, condom access (female and male), and couple counseling. Aurum will
undertake the evaluation of the effect of these on the sexual behavior of populations at public sector sites.
With regards to down referral, Aurum will focus on the referral of stable patients from district level services
to lower levels and develop networks of referral linked to the TB-HIV activities defined elsewhere in the
COP.
Networks will be developed in Gauteng, Eastern Cape and Limpopo provinces. Support will include human
resources, training and mentoring, pharmacy and data collection support, monitoring and evaluation.
In the general practitioner (GP) and non-governmental organization (NGO) program, Aurum will continue
the process of devolvement of patients to alternative means of support primarily within the public system
and enroll new patients only at public sector sites. The GP and NGO network will be incrementally
downsized from Aurum support to this alternative and strategies as accreditation of NGO sites will be
completed.
Retention will be addressed through the development of down referral to clinics closer to patient's homes
and linkage to community support from the community health centers and primary health care clinics.
A further activity in the public sector will be surveillance of primary resistance at the Tembisa site to allow
for rational drug use and choice. This will be done in cooperation with the Department of Health and local
government.
This activity provides support services at public facilities providing antiretroviral therapy as part of the
national ARV rollout and HIV care and treatment at primary health centers, clinical trial sites and general
practitioner (GP) practices. ART is provided in accordance with the National Department of Health (NDOH)
guidelines. The emphasis areas are renovation, human capacity development, and local organization
capacity building. The primary target populations are people affected by HIV and AIDS, HIV-infected
children, prisoners, homeless people and street youth. The SME Project will provide treatment to targeted
SME employees, taxi drivers, market traders and their partners and dependents.
This is an ongoing activity funded since FY 2004, providing access to HIV care and treatment in the public,
private and NGO sector. This activity takes place in the following NDOH ARV sites: (1) Madwaleni Hospital,
Eastern Cape; (2) Tshepong Hospital, North West; and (3) Chris Hani-Baragwanath Hospital, Gauteng. In
addition Aurum intends to provide ARV services in FY 2008 to sites added in FY 2007: (4) Ermelo Hospital,
Mpumalanga, and (5) Thembisa Hospital, Gauteng. In FY 2008, Aurum intends to provide support to a
further two public sector hospitals. Aurum plans to provide support for down referral in the following areas:
North West province (Kanana clinic), Limpopo province (Mathe-bathe clinic), Madwaleni-linked primary
health centers, Gauteng down referral program and Northern Cape (Danielskuil clinic).
A number of sub-partners are involved in implementation of this activity:
1. Faranani Network is described in the Basic Health Care and Support activity and this network supports
treatment of people without medical insurance in general practitioner (GP) sites.
2. Reaction Consulting is based in the Mpumalanga Area. This is a public-private partnership with X-Strata
which provides the clinics. This organization received direct PEPFAR funding in FY 2007.
3. MES Impilo, a faith-based organization based in Hillbrow, Johannesburg, functions as a home-based
care center for the homeless population of Hillbrow, including street youth.
4. Medical Research Council (MRC) site based in KwaZulu-Natal, provides HIV services to prevention trial
participants (microbicides, diaphragms) who are found on screening to be HIV-infected.
5. De Beers Consolidated Diamond Mines has developed a public-private partnership in the town of
Danielskuil, Northern Cape where contractors and partners of employees are treated for HIV.
In addition, new sub-partners are envisaged as follows:
8. Department of Correctional Services: Aurum will provide support for HIV services including HIV
counseling, laboratory monitoring and preventive therapy in two correctional facilities - the Johannesburg
Correctional Facility and one other facility. The drug and laboratory costs would be funded by the South
Africa Government (SAG).
Additional sub-partners involved in the implementation of central activities include:
9. S Buys will be involved with procurement, dispensing and distribution of medications and will provide
pharmacy support at the Chris Hani-Baragwanath Hospital.
Activity Narrative: 10. Toga Laboratories will assist with laboratory testing. Toga has negotiated with Bayer to secure reduced
pricing for viral load testing for the Aurum program. Toga is piloting a new initiative to place point-of-care
lactate tests at some of Aurum facilities to facilitate early recognition of ART adverse events.
11. Kimera Solutions will provide specialist HIV clinical support to doctors in the form of training and onsite
mentoring with regular site visits.
The program activities include:
ACTIVITY 1: Wellness of HIV-infected Individuals
Human resources, laboratory monitoring and counseling services for patients who are enrolled into HIV care
are included (described in other sections of the COP). Aurum provides a continuum of care from provision
of counseling, preventive therapy and preparation for ART. In some sites (MRC, Reaction) patients are
referred to public health facilities for initiation of ART.
ACTIVITY 2: Provision of ARVs to Children
Provision of ARVs to children is a recent focus of the program. Aurum has partnered with Wits Pediatrics
(sub-partner of Reproductive Health Research Unit) to provide training for two Aurum clinicians. These
clinicians attend a pediatric clinic once a week to gain experience in pediatric care. This will help capacitate
Aurum to provide ARV services at pediatric units. Aurum is actively encouraging partners to provide
services to children and have provided for HIV PCR testing for children in this COP. One of the Aurum GPs
is involved in routine treatment of orphans and vulnerable children and has enrolled onto the Aurum
program as a provider. Also, Metro Evangelical Services and Caritas Care Centre have a few orphans
enrolled onto their hospice. We will attempt to expand to other partners who provide care to orphans and
vulnerable children.
ACTIVITY 3: M&E
M&E is a central component of the Aurum program. Every patient contact is recorded on a standardized
form and a unique patient identifier is allocated by the central Aurum office. The information is then
couriered or faxed to the central office where the data is captured in a database. Monitoring visits take place
at the sites to ensure adherence to guidelines and completeness of data collection. Quarterly reports are
produced for all stakeholders. Aurum also provides a data management system for the Adult ARV clinic at
Chris Hani-Baragwanath and Tshepong hospital in North West program. This system will also be
implemented at Thembisa hospital.
ACTIVITY 4: Provision of ARVS to SME employees
People identified as HIV-infected through Aurum activities within the workplace, mobile clinics or taxi ranks
will be offered ARV treatment within the GP network if they do not have immediate alternate access to
treatment
Provision of laboratory services is per a standardized schedule of follow-up in accordance with SAG
guidelines.
The program started in March 2005 and has established 60 treatment sites where about 7000 patients are
receiving ART and 80% achieve virological success at 6 months.
Aurum will contribute to the PEPFAR 2-7-10 goals by providing quality HIV care and treatment services in
the public, private and NGO sector.
Continuing Activity: 13688
29129 29129.05 U.S. Agency for Fresh Ministries 11875 11875.05 $230,971
International
Development
29128 29128.05 U.S. Agency for Africare 11874 11874.05 $351,851
29127 29127.05 U.S. Agency for Project HOPE 11873 11873.05 $228,005
29126 29126.05 U.S. Agency for Samaritan's Purse 11872 11872.05 $303,393
29125 29125.05 U.S. Agency for Catholic Relief 551 551.05 7 Dioceses $0
International Services
29124 29124.05 Department of Harvard University 1581 1581.05 APIN $12,410,577
Health & Human School of Public
Services Health
29123 29123.05 Department of Harvard University 544 544.05 HRSA Track 1.0 $0
29122 29122.05 U.S. Agency for Children's AIDS 11871 11871.05 $717,127
International Fund
29121 29121.05 Department of American 193 193.05 $676,438
Health & Human Association of
Services Blood Banks
29120 29120.05 U.S. Agency for Adventist 11869 11869.05 $387,800
International Development &
Development Relief Agency
13688 2912.08 HHS/Centers for Aurum Health 6574 190.08 $11,857,412
7296 2912.07 HHS/Centers for Aurum Health 4369 190.07 $7,850,000
2912 2912.06 HHS/Centers for Aurum Health 2626 190.06 $2,300,000
Estimated amount of funding that is planned for Human Capacity Development $528,000
Estimated amount of funding that is planned for Public Health Evaluation $0
Table 3.3.09:
FY 2008 COP activities will be expanded to include:
-Adding adolescents to training programs related to couple counseling and family engagement;
-Strengthening the training of the current human resources; and
-Improving the human resource capacity for pediatrics by seconding skilled staff in public sector facilities.
This is a new program area in FY 2009. Aurum's pediatric care and support program provides care to
children infected with HIV following HIV counseling and testing, and screening for treatment eligibility in
accordance with South African government (SAG) guidelines. The facilities where pediatric care is provided
include general practitioners (GP) clinics, non-governmental organization (NGO) clinics and public sector
sites. These sites are located mainly in the Gauteng, North West, Mpumalanga and KwaZulu-Natal
provinces. Children are also assessed for opportunistic infections and eligibility for ART and provided with
preventive therapy i.e. INH and cotrimoxazole.
This is an ongoing program funded by PEPFAR since October 2004. The PEPFAR-funded Aurum project
aims to rapidly expand access to HIV care and treatment to South Africans living with HIV, and especially in
areas (such as mining areas) where Aurum is familiar and other partners are less likely to work. Aurum has
established a number of GP clinics which are capable of providing care to large numbers of HIV-infected
individuals and achieving high quality results. In order to ensure sustainability of this model, Aurum has
partnered with Faranani Solutions, a network of general practitioners from a previously disadvantaged
population. Advantages of this model, now termed the Auranani model, are that Aurum has been able to
secure lower consultation rates for GPs and GPs are encouraged to provide assistance at their local
hospital clinics. The presence of trained individuals in these public health facilities will enable the transfer of
knowledge to nurses and doctors in the public sector. It is hoped that this model can be used to rapidly
scale up delivery of HIV services in South Africa, in partnership with government efforts. Sites are located
throughout the country, but are concentrated in Gauteng, North West province and KwaZulu-Natal. There is
only one site each in the Northern Cape and the Western Cape. A number of primary healthcare clinics
attached to NGO and faith-based organizations (FBOs) have been established. Metro Evangelical Services,
a sub-partner, is a FBO providing training, housing and health services for the homeless and street youth of
Hillbrow, Johannesburg. An HIV center has been established to provide CT and HIV services to this
population. In Gauteng, a contract has been concluded with Chris Hani-Baragwanath hospital for support
and a contract for extension of these services to other parts of Gauteng is being negotiated with the
provincial health departments. In the North West, Aurum supports the provision of HIV Care at Tshepong
Hospital through the provision of medical and nursing staff. In addition, through the establishment of a walk-
in clinic at Jade Square in Klerksdorp Aurum provides care for HIV patients that are not able to currently
access care through the public hospital. In the Northern Cape, Aurum's public-private partnership with De
Beers Consolidated Mines in the Danielskuil area has been discussed. In the Limpopo area, discussions
are underway with Anglo Platinum and the Limpopo Department of Health to provide support to a down-
referral clinic based in the Capricorn district close to one of the Anglo Platinum mines. A number of Aurum's
sites, Caritas Care, MES and Duff Scott collaborate with the local health departments that provide funding
for inpatient care to palliative care patients.
ACTIVITY 1:
Aurum will focus on a family centered approach with gender being mainstreamed in the program. This will
include training on couple counseling and family engagement. In addition Aurum intends on adding an
adolescent focus so that this age group receives appropriate services in the public sector.
ACTIVITY 2:
The number of children accessing the South Africa Comprehensive Care, Management and Treatment
(CCMT) program remains low in South Africa. Aurum will strengthen the training of the current human
resources in order to multi-skill and encourage the family approach to CCMT which includes pediatrics.
There is also a need to source pediatric expertise to improve access for children. The program will provide
for pediatrics management onsite support especially to primary health care including integrated
management of childhood illnesses (IMCI). There is also a need to integrate the PMTCT, IMCI and
expanded program on immunization (EPI) with the Comprehensive Care, Management and Treatment
Aurum will ensure that both parents, especially the male parent, are involved in the management of the
child by including the topic in the counseling training curriculum. This will also encourage men to participate
in the HIV care program themselves and to test and be managed as a family. A gender module will be used
for training all staff and mainstreaming gender into the program.
ACTIVITY 3:
Aurum supports human capacity development by seconding skilled staff in public sector facilities, who will
be leveraged to encourage a family approach to HIV and TB management. Aurum will support community-
based staff at four public sector sites to improve linkage to the community and four clinical staff at these
sites to improve the human resource capacity for pediatrics. These sites will be in Gauteng, North West,
Eastern Cape and Limpopo.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.10:
This is a new program area for Aurum in FY 2009. This activity provides support services at public facilities
providing antiretroviral therapy (ART) as part of the national roll-out of HIV care and treatment at primary
health centers, clinical trial sites and general practitioner (GP) practices. ART is provided in accordance with
the National Department of Health (NDOH) guidelines. The primary target populations are HIV-infected
children. The Small and Medium Enterprises (SME) Project will provide treatment to targeted SME
employees, taxi drivers, market traders and their partners and dependents.
Aurum has received PEPFAR funding since FY 2004, providing access to HIV care and treatment in the
public, private and NGO sector. This activity takes place in the following NDOH ARV sites: (1) Madwaleni
Hospital, Eastern Cape; (2) Tshepong Hospital, North West; (3) Chris Hani-Baragwanath Hospital, Gauteng;
and (4) Thembisa Hospital, Gauteng. Aurum plans to provide support for down referral in the following
areas: North West province (Kanana clinic), Limpopo province (Mathe-bathe clinic), Madwaleni-linked
primary health centers, Gauteng down referral program and Northern Cape (Danielskuil clinic).
1. Auranani Network: this network supports treatment of people without medical insurance in general
practitioner (GP) sites.
2. MES Impilo, a faith-based organization based in Hillbrow, Johannesburg, functions as a home-based
3. Medical Research Council (MRC) site based in KwaZulu-Natal provides HIV services to prevention trial
4. De Beers Consolidated Diamond Mines has developed a public-private partnership in the town of
5. S Buys will be involved with procurement, dispensing and distribution of medications and will provide
6. Toga Laboratories will assist with laboratory testing. Toga has negotiated with Bayer to secure reduced
7. Kimera Solutions will provide specialist HIV clinical support to doctors in the form of training and on-site
The Aurum program provides the majority of its support in settings that do not provide for easy access to
children (e.g. workplaces and prisons), but in FY 2009 will make concerted efforts to scale up support for
pediatric care and treatment. These activities will complement the already strong adult care and treatment
program, and will utilize many of the same strategies described in the Adult Treatment COP section as it
relates to drug and laboratory services, monitoring and evaluation, and quality improvement.
ACTIVITY 1: Provision of ARVs to Children
Aurum aims to increase the number of pediatric patients receiving treatment and encourage support from
both parents. Additionally, Aurum will incorporate a family-centered approach to care and treatment
through integrated care, support and treatment. This will be linked to closer community-level linkages and
the development of different levels of services from the primary health care (PHC) level to district and the
integration of services such as EPI (expanded program on immunization), IMCI (integrated management of
childhood illnesses) and family planning.
Aurum is actively encouraging partners to provide services to children, which includes HIV PCR testing for
children born to HIV-infected mothers at 6 weeks. All HIV-exposed infants will also at this point be provided
with cotrimoxazole prophylaxis in line with South African Government pediatric treatment guidelines.
A focus is to ensure that general practitioners are providing outreach and support to orphaned and
vulnerable children to ensure early access to HIV care and treatment.
ACTIVITY 2: Monitoring and Evaluation (M&E)
produced for all stakeholders.
ACTIVITY 3: Human Capacity Development
The number of children accessing the Comprehensive HIV Care, Management and Treatment (CCMT)
public sector ART program remains low in South Africa. Aurum will strengthen the training of the current
human resource in order to multi skill and encourage the family approach to CCMT which includes
pediatrics. There is a need to source pediatric expertise to improve access for children. The program will
provide for pediatrics management on site support especially to primary health care including integrated
management of childhood illnesses (IMCI).
To ensure that both parents are involved in the management of the child, this topic will be included in the
counseling training curriculum. This will also encourage men to participate in the HIV care program
themselves and to test and be managed as a family. This will include training of staff including community
Activity Narrative: members on gender.
Some elements of pediatric treatment are also addressed in more details in other linked areas of the COP,
including Pediatric Care and Support, Counseling and Testing, ARV Drugs, and Adult Treatment.
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.11:
This is a new PHE for FY09 that has been approved for $499,937.
PHE tracking number: ZA.09.0256
Title: Evaluating the impact of a systematic, policy-endorsed, integrated TB/HIV intervention vs. current
standard of care piloted at the sub-district level
Estimated amount of funding that is planned for Public Health Evaluation $499,937
Table 3.3.12:
Aurum will scale up integrated TB/HIV services in the Tembisa sub-district in Gauteng. Tembisa Hospital
will be the central activity, but Winnie Mandela Clinic and Tembisa Main Clinic will also receive support.
Aurum will focus on linkage of services between HIV/TB, intensive case finding, INH provision and infection
control. Aurum will develop networks of care in Gauteng, North West, Eastern Cape and Limpopo,
supporting the down-referral process for ART and linkages among levels of TB/HIV services. This will
include training and mentoring health-care staff on co-infection, the use of INH and infection control.
Aurum will support testing health-care workers for TB and HIV. At the site level, Aurum will support
community-based staff for TB/HIV activities and staff at district, community health center (CHC) and primary
health care (PHC) levels. Infection control will be assessed at health-care provision sites accompanied by,
where necessary, training and infrastructural support. TB/HIV coordinators will be trained and supported to
strengthen linkages from the district level to PHC. These positions will be supported in collaboration with the
Department of Health (DOH) and be placed within the DOH to support TB-HIV integration. In addition, at the
site level Aurum will support the TB/HIV focal points in developing appropriate training and resources to
manage TB/HIV integration more effectively. Aurum will support laboratory staff so that the increased
burden of smears and TB diagnostics will be absorbed in the scale-up. Staff at the site level will be trained
in intensive case finding and recognition of TB suspects. INH will be provided at the clinic level and will be
linked to the current down-referral sites in the four provinces. A provider- and client-centered model linked
to training, patient education and improved management will be used. This will be linked to the TB/HIV focal
points and the proposed TB/HIV coordinators at the managerial level.
The linkage to directly observed therapy (DOT) will be facilitated by the down-referral networks that this
program will develop and has developed. The existing DOT program will be supported through managerial
support and staff training.
TB/HIV activities will focus on human capacity development at four tertiary and secondary sites with TB/HIV
focal points and 14 CHC sites, including four prisons. Training and mentoring of public sector staff will be
provided at supported public sector sites including Tshepong Hospital and Orkney Clinic (North West), Chris
Hani Bara Hospital, Tembisa Hospital, Tembisa Main Clinic (Gauteng) and Madwaleni Hospital (Eastern
Cape). These activities will also be conducted at eight of the down-referral sites in Ekurhuleni Northern
district, the current general practitioner project and three down-referral sites in the Eastern Cape linked to
Madwaleni Hospital.
Support for staffing plans and task shifting will be initiated at all sites and levels of service. Mentoring and
training will include TB/HIV integration, infection control, staff TB testing, INH provision, and intensive case
finding. SME employees, peer educators, managers and owners will receive education and training on the
identification and management of TB. Occupational health nurses in the SME program will be trained to
become treatment supporters and directly observed therapy short course (DOTS) monitors for HIV-infected
employees who are receiving anti-TB treatment supporting existing DOH DOTS programs.
Linking TB screening and CT aim to bring services closer to populations at risk. This will be achieved
through mobile testing and fixed site services. Individuals who test positive for TB will be referred to Aurum-
supported public sector centers.
In terms of the National TB Strategic Plan, Aurum will support (a) political and managerial efforts, where
Aurum and the chairs of District Health Councils, clinic staff and community will prioritize TB and TB/HIV
interventions through focused planning, improvement of data feedback and responsiveness; (b) resource
mobilization; (c) effective program management of the TB and TB/HIV program at the district, sub-district
and health facility levels; (d) improved case detection through smear microscopy and cultures by developing
the capacity of the sub-district and district levels, maintaining sputum smear microscopy as the diagnostic
mainstay, and ensuring that lab and health-care staff are trained in diagnoses, and in addition, Aurum will
consider models of devolving lab services to lower levels of service and support the DOH in this effort; (e)
supervision and patient support; (f) standardized reporting and recording system, including the paper-based
revised TB data collection tools, TB register, suspect registers, patient cards, facility cards and referral
forms that include HIV and their implementation at the clinic level; (g) strengthening the health system's
existing processes and systems to function and deliver district level targets, while training and capacity
building of staff and systems that will directly affect related health outputs for the district; and (h) advocacy,
communication and social mobilization efforts through development of gender module to train healthcare
staff and to incorporate gender into programming at all levels of care, including linkage to partner testing
and TB screening, involving families in the TB HIV continuum.
Providing TB identification, prophylaxis and treatment support services to selected mobile male populations
that drive taxis within commercial hubs in Gauteng, Mpumalanga and Limpopo will enable increased
identification of TB cases, prevent the spread of TB within taxis, and allow taxi drivers to continue to work
while taking medication. All data will be disaggregated by gender. Formative assessment on gender and
TB/HIV will be done and gender-specific interventions will be operationalized based on findings.
--------------
Aurum's TB/HIV program aims to integrate HIV care with TB prevention and treatment. This integration is
planned at all the HIV treatment sites which include general practitioners' clinics and community clinics
throughout the country. In addition, Aurum plans to improve TB/HIV integration at Chris Hani-Baragwanath
Hospital in Gauteng by providing support to the TB clinic in the form of nursing staff and data management
support. In addition, Aurum plans to work with the Platinum mining industry to insure TB/HIV integration
within the mining health services and to provide mobile services to contacts of miners who are treated with
TB. In the Eastern Cape, Aurum intends to provide support to Themba TB hospital to ensure they receive
accreditation to provide HIV services. TB/HIV Care is a new activity under the SME Project. The screening
and identification of TB cases among the employed sector and taxi drivers is of particular importance as
Activity Narrative: they come into contact with a large number of people each day and successful treatment will result in the
prevention of several new infections. In addition, successful identification and treatment of TB in the
employed sector, including Traders and Taxi drivers will ensure they continue to be economically active and
are able to support themselves and their dependents and continue to run a viable business. SMEs
contribute half of the total employment in South Africa and 75% of the employed people in Johannesburg
utilize Taxis to commute to and from work.
The main focus of the Aurum program in the public, private and NGO sector is to provide HIV care and
treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality of
counseling, patient care and patient monitoring. The model is centrally coordinated and designed to be
implemented on a large scale where the peripheral sites are in resource-constrained settings and lack HIV
developed a centralized system of support which includes the following: (1) training of all levels of
healthcare workers to ensure capacity building of clinicians to manage patients in resource-poor settings
transmission and voluntary counseling and testing; (3) clinical and administrative support through site visits
by staff involved in psychological support, training, clinical support and monitoring data management
system; and (4) centralized distribution of medication and laboratory testing.
In most areas, clients are referred to the public health clinics for definitive diagnosis and treatment of TB.
Aurum is initiating a program where healthcare workers at sites are able to diagnose TB patients using
algorithms and guidelines that are in line with the NDOH. Healthcare workers then refer patients to public
sector clinics for treatment. In addition, patients who test HIV-infected under the counseling and testing
program will be screened for TB.
There are seven main activities in this program area.
ACTIVITY 1: TB Preventive Therapy for HIV-infected Individuals
CD4 count testing is done 6-monthly or 3-monthly in patients with CD4 above or below 350 respectively.
Patients are given TB preventive therapy with 300mg isoniazid taken daily for 6 months after exclusion of
TB, repeated every 2 years. Aurum expects that a minimum of 10% of all palliative care patients will require
TB preventive therapy. This integration will be implemented at all the HIV treatment sites run by general
practitioners and community clinics throughout the country. Sites include the Metro Evangelical Services
Clinic, which provides services for the homeless population and street youth of Hillbrow, Johannesburg, and
the Medical Research Council (MRC) sites, providing care primarily to women. Aurum's sites are located
primarily in Gauteng, North West and KwaZulu-Natal. There are sites in all the other provinces but only one
site in each of Northern Cape and Western Cape
ACTIVITY 2: Diagnosis and Treatment of TB in the HIV-infected
When initiating the ARV program or the palliative care program, a symptom screen and a chest radiograph
will be done on each patient. At each clinic visit, there is symptom screening by trained nurses. Guidelines
for screening tuberculosis will be followed and monitored. An evaluation of current screening practices is
currently underway and this will be used to ensure improved monitoring of screening and standardization of
the TB screening process. At Tshepong hospital the project will be enrolling new patients who are started
on treatment onto a TB screening process (including symptom screening, sputum testing and chest
radiography) to identify the most appropriate screening methods.
ACTIVITY 3: Support for HIV-TB integration services at Chris Hani-Baragwanath hospital
Aurum will provide support to provide TB/HIV integration services at the Chris Hani-Baragwanath hospital, a
large government hospital in Gauteng. Aurum will employ a nurse and counselor who will provide HIV
counseling and testing to all TB patients and ensure referral of those who test positive to the HIV clinic. In
addition, Aurum will develop a data system that will assist in ensuring successful incorporation of these
patients in the HIV care program.
ACTIVITY 4: Public-Private Partnership within Platinum Mining Industry
Aurum is establishing a partnership with Anglo Platinum and other platinum mining companies to strengthen
their TB/HIV integration activities within their mining facilities. In addition, a program to trace dependents
and household contacts of miners diagnosed with TB will be introduced. This program will include
household visits with HIV education and counseling, HIV testing, TB screening and referral for TB and HIV
services. Aurum aims to visit around 800 households with approximately 5 persons per household. In
addition, public TB services in the communities will be strengthened to cope with the increased workload.
Originally support to the platinum mining industry was to include a PHE, but as this PHE was not approved,
the funding is reprogrammed back into the TB-HIV services to support service delivery in this industry.
ACTIVITY 5: Support at Eastern Cape Themba TB hospital
Aurum will provide support to the Eastern Cape Themba hospital to assist them to obtain accreditation for
the national CCMT program. This support will include provision of limited renovation, staff and technical
support.
ACTIVITY 6: TB screening at Johannesburg Correctional Facility
Activity Narrative: Aurum will be undertaking a TB and HIV screening project at Johannesburg Correctional Facility. This will
determine HIV and TB prevalence and appropriateness of various screening methods. In addition it will
determine yield and cost-effectiveness of routine screening within the prison. This will be started with FY
2007 funding and completed in FY 2008. The project is expected to provide information that may lead to
routine screening in other facilities.
ACTIVITY 7: TB Activities in the SME Project
People identified as HIV infected through the counselling and testing process performed by the SME Project
will be screened for the presence of TB symptoms and referred for treatment to the nearest TB centre for
follow-up. At some sites, sputum collection will be performed according to South African government
protocols and the clients will then be informed of the results and referred for treatment. All HIV positive
clients who do not have active TB will be offered IPT and training on the use of IPT will be provided to
Aurum clinical staff, counselors, peer educators and staff at occupational health clinics. Education sessions
to SME employees will include the simple identification of TB symptoms, importance of treatment and
importance of IPT in HIV and their contacts.
ACTIVITY 8: Tembisa HIV-TB Integration
Aurum will implement an integrated TB-HIV model for Tembisa (outside Johannesburg) that will utilize the
principles of intensive case finding, isoniazid prophylaxis and infection control to improve TB-HIV services at
Tembisa hospital, Tembisa Main Clinic and Winnie Mandela Clinic. Additional clinics in the sub-district will
also be identified for strengthening activities. This activity would aim to engage private and civil society
partners to ensure horizontal integration at the household level, utilizing mobile services and capacity
development of clinics.
Continuing Activity: 19451
19451 19451.08 HHS/Centers for Aurum Health 6574 190.08 $109,000
Estimated amount of funding that is planned for Human Capacity Development $481,000
This PHE activity, "A preliminary study of screening for tuberculosis in a South African correctional facility
' was approved for inclusion in the COP. The PHE tracking ID associated with this activity is ZA.07.0114.
Estimated amount of funding that is planned for Public Health Evaluation $58,000
This is a new PHE for FY09 that has been approved for $447,883.
PHE tracking number: ZA.09.0262
Title: Screening for tuberculosis in primary health care and other outpatient health care clinic
Estimated amount of funding that is planned for Public Health Evaluation $447,883
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $49,058,658
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
South Africa's HIV pandemic continues to create a rapidly growing number of vulnerable children who are without adult protection
and have uncertain futures. Of South Africa's 18.2 million children (38% of the population), about 3.8 million children have lost one
or both parents (21% percent of all children). (SA Child Gauge 2007/2008, Children Institute, University of Cape Town.) The
burden of HIV and AIDS on children has greatly increased in the last five years with the number of orphans increasing
substantially by 750,000 due to the effects of the HIV epidemic. While it is estimated that 1.4 million children have been orphaned
by AIDS, a much larger number are considered to be highly vulnerable to the pandemic that surrounds them, according to 2007
Actuarial Society of South Africa estimates using a 2003 model.
Working in all nine provinces, the United States government (USG) approach supports programs that are firmly aligned with and
in support of the South African strategies that include the "Policy Framework for Orphans and Vulnerable Children made
Vulnerable by HIV and AIDS in South Africa" , (July 2005), the "National Action Plan for Orphans and Vulnerable Children and
Other Children Made Vulnerable by HIV and AIDS ((NAPOVC)," the "National Guidelines for Social Services to Children Infected
and Affected by HIV/AIDS," and the "South Africa National Strategic Plan for HIV & AIDS and STI, 2007 -2011." In November
2007, the Children's Amendment Act no. 41 of 2007 was passed, which provides a framework for a comprehensive range of
social services needed to support vulnerable children and their families. At the core of the Children's Act is the South African
government's commitment to delivering social services that will strengthen and support families and communities to care for and
protect children.
The USG provides direct assistance to the Department of Social Development (DOSD) and works together with both local and
international partners to improve and scale-up existing, effective OVC programs to provide protection, care and support services
to orphans and other vulnerable children (OVC). At the end of March 2008, 23 PEPFAR partners had reached 215,056 OVC with
primary and supplementary direct services. In addition, 10,978 OVC were reached indirectly and 17,418 individual caregivers
were trained to provide quality services to OVC.
USG programs in support of the DOSD maintain a focus on the child through the family and the household. Families are the most
influential force in the lives of children and adolescents. This is central to the USG program in South Africa and to the activities
supported by Hands at Work, Child Welfare, World Vision, and other PEPFAR-funded OVC partners. These OVC programs aim to
strengthen the capacity of the family and the community. This family focus is a critical opportunity to expand reach to other
members of the family and the community and is an opportunity to integrate the OVC programs with other prevention, treatment,
and care interventions. In FY 2009, care for the caregivers continues to be a central area of focus for USG partners, in addition to
continued training of volunteers, caregivers, and community-based organizations to address service delivery issues. The National
Association of Child Care Workers (NACCW) "Isibindi" Child and Youth Care workers model of care ensures that antiretroviral
treatment (ART) is available for adults and children as part of their delaying orphanhood program. Child and youth care workers
are trained to identify households and families that require clinical services and through a system of referrals to a network of
clinical care services specifically linked to Isibindi. Ensure that mothers and caregivers get tested early and access ART. This
intervention has resulted in mothers accessing ART and 294 children (October-March) being assisted to access pediatric ART
and their households receiving home-based care and adherence support. USG-supported OVC programs continue to link with
pediatric and adult treatment programs. Initially this is done through voluntary counseling and testing (VCT) programs to
encourage HIV testing of OVC and their caregivers to ensure that both HIV-infected OVC and their caregivers have access to
treatment and palliative care services. In FY 2009 The USG will continue to work with OVC partners like Children in Distress
(CINDI) to highlight the scale-up and integration of OVC interventions in prevention of mother-to-child transmission (PMTCT),
VCT, treatment, and wrap around programs.
To ensure quality, the USG has defined direct service provision as each child receiving a minimum of three services from a menu
of eight services. These include targeted, short-term food and nutritional support; shelter and care; child protection; assistance in
accessing healthcare; psychosocial support; increased access to education and vocational training (including school fees,
uniforms, tutoring etc.); assistance in accessing economic support (accessing social grants, income-generation projects, etc.); and
community mobilization. In FY 2009, the USG will support the DOSD to review and develop quality standards for these basic
services. Once developed and shared with stakeholders, these standards will reflect an expected level of service delivery and
performance and will be used to assess the overall impact of services provided to each child. These standards will be used by
DOSD and partners to define quality and to measure and improve services provided to children to ensure a positive impact. Save
the Children UK is currently field-testing a quality assessment tool using a modified version of the Child Well Being Assessment
tool, which has now been simplified and translated into one of the local languages.
Better data and increased understanding of the multi-faceted needs of adolescent OVC and identification of OVC interventions
that are effective in addressing these needs are critical to the scale-up of service delivery for OVC in South Africa. The scale-up of
services for OVC is desperately needed to maximize impact and minimize wasted expense. Program design and resource
allocation needs to be guided by a base of documented evidence. To fully implement National Plans of Action for OVC,
governments, donors, and program managers need information on how to reach more OVC more cost effectively with services
that improve their well-being. Working hand in hand with the DOSD, the USG will participate in a public health evaluation that will
evaluate programs for adolescent OVC with the overall goal of improving the impact of service delivery for this highly vulnerable
and underserved population. This activity will enhance USG and DOSD programmatic efforts by providing a better understanding
of the situation of adolescent OVC, identifying best practices for meeting their needs, and documenting promising practices.
Working with the DOSD, the USG will provide documented evidence of the effectiveness of the DOSD recommended models of
care for vulnerable children. The USG will support the DOSD in documenting the Child Care Forum (CCF) model to respond to
the increasing needs of children and to provide support to OVC at the community level. CCFs are a mechanism to build capacity
in community-based systems for sustaining care and support to OVC and households over the long term. Prior to the scale-up
and replication of this model, the USG will assist the DOSD in providing evidence of the effects and effectiveness of this model of
care. The same process will also be used for the NACCW Isibindi model, which is implemented as a social franchise with the
NACCW entering into formal partnerships with implementing organizations linking DOSD, the donor, the community, and
implementing partner in a network of social delivery. This model has encouraged the private sector to fund Isibindi projects, often
co-funding them with DOSD. Initial documented evidence on the model shows the impact of the activities undertaken and the
multi-disciplinary approach that allows resources to be accessed from multiple sources (both government and non-government).
The Isibindi model is an award-winning best practice model of care that the DOSD would like to scale-up and replicate.
USG partners will focus on improving the quality of OVC program interventions, strengthening coordination of care especially at
the district level, and expanding initiatives that reach especially vulnerable children (e.g., under fives, disabled children).
Several USG-funded programs have developed focused interventions to reach the especially vulnerable child. For example,
NACCW has been working to reach disabled children and has trained disability facilitators to identify, refer and provide ongoing
therapeutic services to disabled children. Several USG partners in FY 2009, e.g., South African Catholic Bishop Conference and
Woz'obona Childhood Community Service Group, will replicate this intervention. In addition, USG assistance has and will
continue to focus on reaching especially vulnerable populations through Early Childhood Development Interventions with
Nurturing Orphans for Humanity (NOAH), CARE-South Africa's local sub partners, Hands at Work, and Woz'obona Childhood
Community Service Group.
In collaboration with DOSD, USG has begun the development of a vulnerable children service directory and web database, which
will be completed in FY 2009. The directory will increase the level and effectiveness of referrals for vulnerable children to receive
comprehensive services. As part of this activity, service delivery mapping will be done, which will provide information that the USG
and DOSD will utilize in strategic positioning of expanded or new service sites for OVC.
The USG supports programs that focus on supporting child-headed households, such as safe parks and other safety zones for
providing young girls with sustained interaction from a trusted adult; and providing information on life skills and HIV prevention
education. The USG continues to support the Vhutshilo (Tshivenda, meaning "life") peer education program, a structured 13-
session curriculum based peer led prevention and support group intervention for vulnerable 10 - 13 years olds using 16-19 year
old peer educators. This program has been replicated in several other OVC programs. The program promotes resilience in
vulnerable children by building or strengthening social structures through which young vulnerable children learn new skills, receive
and provide support from their peers in similar circumstances and build trust to maintain strong social connections. In FY 2009,
the USG will assess the impact of this peer education intervention in terms of its psychological and HIV prevention education
effects on vulnerable children. This activity will be a basic programmatic evaluation and to the extent possible, threats to internal
validity will be managed.
In FY 2009, USG will continue to bring OVC partners and the DOSD together in annual meetings to disseminate and share
promising practices and innovations. This provides an opportunity for partners to build their knowledge base, hear innovative
interventions, share lessons learned and emerging good practices, and note the results from research in the OVC arena. In 2008,
the USG documented the successful voluntary savings and loan methodology that allows poor rural women to save and make
small loans in a closed savings environment in video format to allow for widespread sharing between partners. With technical
assistance from MEASURE Evaluation, the USG developed and documented 32 case studies on the various OVC program
models within South Africa. A synthesis report considering results from all 32 case studies will help to identify various strategies in
meeting the needs of OVC and their guardians, highlight gaps in service delivery, and identify best practices relating to improving
the effectiveness and increasing the scale of OVC interventions. The USG and the DOSD hosted the Nigeria OVC team both
Government and USG), providing a learning opportunity for south-to-south sharing that resulted in strong links and learning
between the two programs.
In South Africa, the USAID Prevention and OVC Team lead serves as the OVC program focal point and is supported by a two-
person OVC technical team with a small OVC working group to monitor and review USG OVC activities in South Africa.
In FY 2009, USG assistance will continue to build local capacity, encourage coordination, and support DOSD strategic
programming. While several OVC partners have developed innovative gender and child participation interventions (e.g.,
NACCW's girl child program and World Vision's The Courage to Become Me program) most partners still face a challenge in
incorporating gender into their day-to-day implementation of activities. In FY 2009, the USG will focus on providing technical skills
and training in gender integration to enable the partners to integrate gender into all their activities (especially in the area of
vocational training). Working to shift gender roles, OVC partners will be encouraged to include gender equality into
implementation of their program and working in communities, to have discussions and take action for a more gender equitable
community. Having adequate systems and processes in place to measure progress and quality in the area of monitoring and
evaluation is critical in assuring that positive impact is being made in improving the well being of OVC. Increased human capacity
development efforts are needed in this area. USG will continue training to build the human resource capacity of both the partners
as well DOSD in the area of monitoring and evaluation.
The USG continues to work closely with UNICEF, including sharing information and assessment results. The USG program in
South Africa continues to complement the efforts of the DOSD and other donors to leverage resources and to ensure that there is
no duplication of effort.
Table 3.3.13:
Activities started in FY 2008 will continue in FY 2009, with the modifications detailed below.
The program will focus on couple counseling and accessing youth and men. All the PEPFAR-supported
sites will be supported to improve access. Other activities will be performed to provide access to those
healthy people for early diagnosis and to keep the negative population as such.
The Small and Medium Enterprises (SME) project will not provide counseling and testing (CT) training to
persons not eligible to provide this service. Instead, the project has been approached by a number of
nursing colleges to provide nursing students with training on CT.
CT sessions will be linked to tuberculosis (TB) symptom screening and this will be incorporated into routine
CT assessments.
The CT support will be provided to eight primary health care down referral sites in the Ekurhuleni district
(Gauteng province) that provide HIV/AIDS, TB and HIV services, the general practitioner (GP) project, the
currently supported public sector sites including Orkney clinic in the North West, Tembisa hospital, Tembisa
main and Winnie Mandela clinics in Gauteng and Madwaleni hospital in the Eastern Cape. The PEPFAR
supported CT sites will be provided with a nurse and/or lay counselor as required from individual sites, with
training to be conducted for each of the geographical areas.
The program will also link up with the integrated management of childhood illnesses (IMCI), TB, and family
planning programs and the general outpatient clinic and the staff members will be included in the trainings
for better access for patients, increasing the numbers counseled and those tested, and those enrolled in
care and treatment programs.
Emphasis will also be on the early screening of HIV-exposed babies by an Enzyme-Linked
Immunoadsorbent Assay (ELISA) rapid testing for those children above 18 months and provision of
cotrimoxazole for both adults and children. All Aurum staff that provide CT services receive in-house
training on the basics of CT as well as specialized training on couple counseling, post-rape counseling and
post exposure counseling. The City of Johannesburg staff at Metro Transport Company (MTC), lay
counselors and SME managers receives training and mentoring on aspects of HIV including prevention,
referral for treatment and other issues related to HIV/AIDS. In addition market traders in Johannesburg
receive training and capacity building on HIV/AIDS issues.
The counseling training will include and encourage men to assume a positive in health and well-being of
their partners, families and communities in order to increase HIV preventive behaviors, with a focus on:
a) Behavior change programs that promote the positive role men can play in the health and well-being of
their partners, families and their communities to increase HIV preventive behaviors.
b) Programs targeting partners of pregnant women and providing information to men on prevention of
mother-to-child transmission (PMTCT), CT, prevention and other health issues and encouraging couples
counseling and testing in an attempt to increase men's involvement in HIV/AIDS treatment and care
programs and to reduce stigma and violence against women.
c) Couple counseling and testing at CT and PMTCT sites to promote testing of men and to build support for
their female partners.
Couples counseling will continue to be provided at the mobile and fixed service delivery sites. The SME
project targets males, both in SMEs and at taxi ranks, and provides them with easy access to CT which they
currently are reluctant or unable to access through the formal health care delivery points. The majority of
market traders within the taxi rank are women. Provision of free CT services within their workplace
overcomes barriers such as cost of transport and the presence of female health care workers.
A gender module for training will be operationalized in CT to better address gender issues and provide
targeted and appropriate services to both genders. Formative work on male norms will be done to inform
the interventions. All data collected will be gender disaggregated to better inform program deliverables
around gender.
The Aurum program provides HIV counseling and testing (CT) for patients in private general practitioner
(GP) practices and non-governmental sites. Where Aurum provides support in the public sector, the
voluntary counseling and testing (CT) human resources and commodities are provided by the South African
government. Emphasis areas include human resources, commodity procurement and quality assurance.
The primary target populations are people living with HIV (PLHIV), HIV-infected children, prisoners,
homeless people and street youth. The SME Project will continue and expand counseling and testing
services offered to SME employees, their partners and dependents through fixed and mobile sites located
within targeted workplaces, mobile clinics and sites located within taxi ranks.
Aurum Institute for Health Research (Aurum) is a not-for-profit, public benefit organization that is committed
to improving the health of disadvantaged individuals and communities through transformational research
(the research programs are not PEPFAR-funded), management of TB and HIV programs and provision of
HIV testing, treatment and care. The main focus of the Aurum program in the public, private and non-
governmental sector is to provide HIV care and treatment to a large number of persons in a cost-effective
standardized manner ensuring a high quality of counseling, patient care and patient monitoring. The model
Activity Narrative: is centrally coordinated and designed to be implemented on a large scale in peripheral sites that are
resource-constrained and lacking basic resources such as HIV specialists, information technology (IT)
infrastructure, and laboratory and pharmacy capacity. Aurum has established a centralized system of
support which includes (1) training of all levels of healthcare workers to ensure capacity building of
clinicians to manage patients in resource limited settings with remote HIV specialist support; (2) providing
and maintaining guidelines for HIV preventive therapy (including INH and cotrimoxazole), treatment of
adults and children, prevention of mother-to-child transmission and CT; (3) providing clinical and
administrative support through site visits by staff involved in psychological support, training, clinical support
and monitoring data management systems; and (4) maintaining a centralized distribution of medication and
laboratory testing. This program will supplement the South African government's antiretroviral rollout and
therefore the program adheres to national guidelines and protocols. This is an ongoing program funded by
PEPFAR since October 2004. It is a facility-based program in which Aurum works with general practitioners,
a faith-based organization (FBO) and within the public sector. In addition the SME Project will expand its
services to three additional fixed sites and two additional mobile clinics within Gauteng, Mpumalanga and
Limpopo.
ACTIVITY 1: Establishing Capacity for CT
This activity will take place in two primary health clinics and two prison clinics. This activity will include the
provision of and training of staff in these clinics as well as provision of running expenses for these clinics.
ACTIVITY 2: Counseling and Testing
HIV counseling and testing is conducted at selected GP sites, primary health centers and mobile units. The
counseling and testing includes pre- and post -test counseling and rapid finger prick testing with a screening
and a confirmatory test. Provision has been made for the mobile units.
ACTIVITY 3: Quality Control of HIV Testing
External Quality control is done at Aurum CT sites. Specimens are supplied on a monthly basis to the CT
sites and each staff member on site tests these. This is reported to Aurum by Thistle. Feedback on these
results is given at the quarterly refresher training.
ACTIVITY 4: Training on Voluntary Counseling and Testing
A five-day course is given to all new personnel involved in CT. In addition, an annual meeting is held and
new findings, discussions on counseling, running of support groups are covered. Training includes a focus
on stigma and discrimination.
ACTIVITY 5: Data Management
All encounters are recorded on a standardized form and then captured onto a centralized database that is
used for reporting.
ACTIVITY 6: Supply and Distribution of Testing Kits
Kits are ordered using a form that is faxed to, and authorized at, Aurum. The supplier then delivers the kits
to the sites.
ACTIVITY 7: Marketing and Promotion
Educational pamphlets and campaigns are provided. Various methods are being used to market and
encourage counseling and testing. Some sites (MES and Aurum Klerksdorp) run CT campaigns over short
periods of time. Other sites run activities on commemorative days such as Valentine's Day and World AIDS
Day. Marketing material is developed locally by the site according to their needs.
ACTIVITY 8: Expansion of Counseling and Testing in SME Sector
Activities in FY 2008 will include the expansion of counseling and testing services to additional sites in
SMES in Witbank Central Business District and Polokwane Central Business District. In addition an
additional fixed site will be established in partnership with the City of Johannesburg. This will enable market
traders, taxi drivers, commuters and SME employees and their dependents to access counseling and
testing. Partnerships will continue to be to be developed with individual SMEs to provide counseling and
testing onsite, within occupational health clinics where they exist or within Aurum's mobile vehicles.
Additional staff will be hired and trained to provide these services. In addition, occupational health staff will
also be trained and supplied with testing kits. As yet there remain restrictions of the use of rapid test kits by
persons not registered with the Health Professions Council but in the event of a change in the regulations,
Aurum will be in apposition to test and equip a number of lay counselors to also perform rapid testing.
Aurum will contribute to the PEPFAR 2-7-10 goals by promoting and providing counseling and testing
services to allow for entry into HIV care and treatment programs.
Continuing Activity: 13686
29159 29159.06 HHS/Health Catholic Relief 11895 11895.06 $3,094,749
Resources Services
Services
Administration
29158 29158.06 U.S. Agency for Children's AIDS 11894 11894.06 $291,025
29157 29157.06 HHS/Health Harvard University 11893 11893.06 $3,696,000
Resources School of Public
29156 29156.06 HHS/Health Harvard University 11893 11893.06 $2,904,000
29154 29154.06 HHS/Centers for American 11892 11892.06 $676,440
Disease Control & Association of
Prevention Blood Banks
29152 29152.06 HHS/Centers for American 11891 11891.06 $676,440
29151 29151.06 HHS/Centers for American 11890 11890.06 $676,440
29150 29150.06 U.S. Agency for Hope Worldwide 11889 11889.06 $163,869
International Nigeria
13686 2915.08 HHS/Centers for Aurum Health 6574 190.08 $1,340,000
7299 2915.07 HHS/Centers for Aurum Health 4369 190.07 $2,200,000
2915 2915.06 HHS/Centers for Aurum Health 2626 190.06 $400,000
Table 3.3.14:
ACTIVITY UNCHANGED FROM FY 2008
Aurum Health Research (Aurum) will use FY 2008 PEPFAR funding to continue an ongoing clinical program
that works through general practitioners and community clinics throughout the country, and to expand the
program to three public hospitals in the Eastern Cape, North West and Gauteng provinces. The emphasis
areas for this activity are human capacity development, local organization capacity building, and strategic
information. Target populations include infants, children and youth; adults, including men and women of
childbearing age; and people living with HIV (PLHIV), including HIV-infected pregnant women, infants and
children.
The focus of the Aurum program in the public, private, and non-governmental sector is to provide HIV care
and treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality
of counseling, patient care and patient monitoring. The model is centrally coordinated and implemented on
a large scale in peripheral sites that are resource-constrained and lacking in HIV specialists, information
technology (IT) infrastructure, and laboratory and pharmacy capacity. Aurum achieves this by having a
centralized system of support which includes the following: (1) training of all levels of healthcare workers to
ensure capacity building of clinicians to be able to manage patients in resource-poor settings with remote
HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive therapy (including
INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child transmission and
voluntary counseling and testing; (3) clinical and administrative support through site visits by staff involved
in psychological support, training, clinical support and monitoring data management system; and (4)
centralized distribution of medication and laboratory testing.
The S Buys group (a private company) is responsible for the centralized procurement and distribution of
antiretroviral and preventive therapy. Negotiations with research-based pharmaceutical companies have
ensured that GlaxoSmithKline (GSK) drugs are available at access prices and members of the community
without medical insurance are able to access these medications.
PEPFAR funds will be used in this program area to purchase, store and distribute ARV drugs. Patients who
are medically eligible for, but cannot afford, antiretroviral therapy will receive the drugs at no cost from
enrolled sites. The drugs will be prescribed using the South African Government's (SAG) eligibility criteria
and drug regimens. Generic medications purchased comply with the USG PEPFAR Task Force requirement
of U.S. Federal Drug Administration approval as well as approval from the Medicines Control Council of
South Africa.
The pharmacy plan comprises:
(1) Warehousing and stock control of drugs: A computerized system of stock control will ensure an audit
trail and batching abilities from the warehouse to patients.
(2) National distribution of medication: Through a courier service, S Buys is able to distribute medication
anywhere in South Africa within 24 hours of receiving the request. ARV drugs are dispensed centrally on a
monthly basis, and Aurum has not experienced any stock-outs.
(3) Named patient dispensing: Dispensing centrally at the pharmacy ensures that medication is controlled
and it facilitates a strict audit trail to the patient.
(4) S Buys pharmacy has in place stock control, pricing based on volume purchasing (where possible) and
has a process for checking compliance with ART guidelines.
(5) Integration with the Aurum Health Research (AHR) Project: This integration will help ensure adherence
to protocols, as well as communication between pharmacists and AHR. It will also allow for the integration
of data from drug dispensing sites.
(6) Aurum is working with sub-partners to ensure Department of Health accreditation for a number of sites,
allowing drugs to be provided by the government. A number of sites have already been accredited.
(7) Aurum will participate in the training of professional nurses in pharmacy skills. The SME Project will
utilize the existing drug supply chain to provide medications for patients registered on the project. Funding
allocated to SME Project will be directed to support and enhance the above mentioned activities.
Continuing Activity: 13687
29138 29138.06 U.S. Agency for World Vision 11881 11881.06 $187,504
International International
29137 29137.06 U.S. Agency for Catholic Relief 11880 11880.06 $479,867
29136 29136.06 U.S. Agency for American 11879 11879.06 $676,440
International Association of
Development Blood Banks
29135 29135.06 U.S. Agency for American Red 11878 11878.06 $335,754
International Cross
29134 29134.06 U.S. Agency for Save the Children 11877 11877.06 $1,180,778
International US
29133 29133.06 HHS/Centers for John Snow, Inc. 11904 11904.06 $2,115,000
Disease Control &
29132 29132.06 HHS/Centers for Federal Ministry of 3756 496.06 $0
Disease Control & Health, Ethiopia
29131 29131.06 HHS/Centers for Federal Ministry of 3756 496.06 $0
29130 29130.05 U.S. Agency for Food for the 11876 11876.05 $120,715
International Hungry
13687 2913.08 HHS/Centers for Aurum Health 6574 190.08 $3,651,000
7297 2913.07 HHS/Centers for Aurum Health 4369 190.07 $2,750,000
2913 2913.06 HHS/Centers for Aurum Health 2626 190.06 $1,400,000
Table 3.3.15:
