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:
In FY 2009, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) plans to increase prevention of
mother-to-child HIV transmission (PMTCT) coverage in the supported provinces. The following activities are
prioritized:
- With the introduction of the new PMTCT guidelines in February 2008 (i.e., dual therapy) EGPAF has had
to scale up training of Department of Health (DOH) staff on the new guidelines and will continue to do so in
FY 2009 to ensure that PMTCT services are in line with the new guidelines.
- EGPAF will continue to participate in the review of the PMTCT indicators to ensure alignment with new
PMTCT guidelines.
- Repeat HIV testing at 32 -34 weeks for initial negative status or testing in labor for unknown status is of
high priority.
- Quality improvement (QI) activities will continue in an effort to ensure quality PMTCT services.
- A Chronic Care Model that emphasizes community linkages, self-patient management support, optimum
service delivery system design, efficient health information and referral systems, is being rolled out in
supported districts.
- Effective referrals to child survival interventions will be implemented. EGPAF plans to strengthen
community integrated management of childhood illnesses (IMCI) in home- and community-based care.
- EGPAF will assist the DOH to improve follow-up of mother/infant pairs and polymerase chain reaction
(PCR) testing six weeks post weaning. Women will be supported with their infant feeding options and it will
be determined if it is acceptable, feasible, affordable, sustainable and safe (AFASS) for all mothers who
choose to exclusively formula feed.
- Women and their partners will be screened for sexually transmitted infections (STI) in the PMTCT setting
and referred to other sexual reproductive health service points (e.g., family planning, STI clinic) where
required.
- TB infection control and the integration of TB/HIV services in the PMTCT setting is an area of focus in FY
2009. Women will be screened for TB at antenatal clinics.
As at 30 June 2008, EGPAF-SA is supporting 136 DOH PMTCT sites. A trained and motivated health
workforce is essential for the sustainability of the PMTCT program. In an effort to address human resources
(HR) gaps and in consultation with the DOH, EGPAF hires additional staff where required, at all levels of
service delivery (i.e., site, district, provincial and national level). Categories of staff provided depend on the
HR needs (e.g., nurses, counselors, data capturers, etc.). EGPAF adheres to DOH salary scales. Additional
staff seconded to DOH has fixed term contracts of employment with EGPAF and where applicable, DOH
absorbs them into the DOH payroll at the end of the contract. As a recruitment and retention strategy, DOH
has recently introduced the Occupational Specific Dispensation (OSD).
In addition to human resources provision, EGPAF strengthens DOH human capacity development (HCD)
efforts by providing training using various training methodologies, namely, didactic training, preceptorship,
onsite mentoring, coaching and supportive supervision. Health-care workers are trained on comprehensive
PMTCT, early infant diagnosis (including PCR testing), clinical staging in infants and children, infant feeding
as well as community IMCI. To strengthen the monitoring and evaluation (M&E) capacity, staff is trained on
basic M&E including data quality and analysis as well as encouraged to use data for quality improvement.
EGPAF has and will continue to train health-care workers on the new PMTCT guidelines to ensure
compliance and improve the quality of care.
PMTCT is an important entry point for gender programming. EGPAF will promote partner testing and male
participation to improve PMTCT uptake. Support groups for HIV-infected pregnant women and mothers will
be established or strengthened to provide psychosocial support as well as support for safe disclosure. As
part of strengthening community linkages, EGPAF plans to work with communities to promote human rights,
women rights in general, address gender-based violence, strengthen social cohesion and support the
institution of the family, and promote male sexual health. Specific needs of pregnant women and children,
including follow-up, infant feeding support and prevention with positives will be addressed.
EGPAF's overall PMTCT support is provided in line with the National DOH PMTCT policies and guidelines
and the HIV & AIDS and STI Strategic Plan for South Africa, 2008-2011 (NSP). NSP Priority area 1, goal 3,
is to reduce mother-to-child transmission of HIV. All EGPAF support is aimed at assisting DOH to scale up
coverage and improve quality of PMTCT to reduce MTCT to less than 5%, as well as to broaden existing
PMTCT services to include other related services and target groups (e.g., family planning and male
involvement).
--------------------------
SUMMARY:EGPAF will use FY 2008 PEPFAR funds to continue prevention of mother-to-child transmission
(PMTCT) support for its existing partners which include National Department of Heath (NDOH) and
provincial DOH Kwazulu-Natal and Gauteng. The Foundation will expand its geographic coverage during
FY 2008 to include direct support to provincial and district health departments in the Free State and North
West province. The key objective is to expand the coverage of PMTCT services, and thus ensure provision
of quality PMTCT services, and increase the uptake of PMTCT services. The primary emphasis area is
human capacity development and expansion of services through training and task-shifting, quality
improvement, development of networks, linkages, referral systems and strengthening M&E and health
systems, and strengthening of local organizations. Primary populations to be targeted include infants, men
and women, pregnant women, HIV-infected pregnant women, people living with HIV (PLHIV), and public
Activity Narrative: and private healthcare providers.BACKGROUND:The long-term goal of the EGPAF Project HEART PMTCT
program in South Africa is to decrease transmission of HIV from mother-to-child. This is to be achieved
through an intensive focus on increasing: the capacity of health facilities to deliver high quality PMTCT
services in antenatal care (ANC), including screening and staging of HIV-infected pregnant women; the
uptake of voluntary counseling and testing (VCT) through the implementation of the opt-out policy; and the
referral of eligible HIV-infected pregnant women to care and treatment.USG support for the PMTCT
program was initiated in 2003. This support was provided to McCord Hospital in KwaZulu-Natal, Hlabisa sub
-district through the Africa Centre in KwaZulu-Natal, mothers to mothers (m2m) in KwaZulu-Natal and
Mpumalanga, and the Johannesburg Metro District through the Perinatal HIV Research Unit (PHRU) in
Gauteng. The Africa Centre, M2M and PHRU programs have been transitioned to the KwaZulu-Natal
Department of Health (KZNDOH) and to direct USAID support, respectively.McCord Hospital implements
best practices for PMTCT through highly active antiretroviral therapy (HAART) for prevention/treatment,
AZT from 28 weeks and nevirapine in labor, nevirapine for pregnant women who first present in labor, as
well as a stat dose of nevirapine and AZT seven days post delivery to the HIV-exposed infant. This is
different from the national protocol. This resulted in a vertical transmission of 4.25% in 2006. McCord uses a
family-centered approach for PMTCT.New partnerships created at the end of FY 2006 and implemented in
FY 2007 include working directly with the Tshwane-Metsweding Region in Gauteng, and the Free State,
North West and KwaZulu-Natal provincial health departments. To improve quality of PMTCT service
delivery, EGPAF will continue to support the national and provincial Departments of Health by providing
technical support, human capacity development, and infrastructure rehabilitation, where applicable.Priority
areas for the South Africa program that are implemented through the activities include: (a) Follow-up of HIV-
exposed infants and referrals to care and treatment for HIV-infected infants. (b) Develop referral and
integration strategies for fast-tracking pregnant women to treatment services.(c) Improve partner (i.e.,
couple) testing and increase male and mothers-in-law involvement in the PMTCT program.(d) Work directly
with Government sites to strengthen PMTCT services.(e) Strengthen monitoring and evaluation (M&E)
activities.(f) Encourage provider-initiated testing and counseling, counseling for HIV negative to stay
negative, repeat HIV test at 36 weeks(g) Tuberculosis (TB) screening, identification of eligible pregnant
women for HAART and referral to care and treatment sites.(h) Integrating PMTCT into existing maternal and
child health and family planning services including pap smears.(i) Infrastructure rehabilitation, e.g.,
renovations to existing structures, acquisition of park homes.(j) Encourage support groups for pregnant
women(k) Community and facility-based strategies to support infant feeding choices madeACTIVITIES AND
EXPECTED RESULTS: ACTIVITY 1: McCord PMTCT Program Activities(a) Implement the family-centered
model encouraging couple counseling, providing partner testing and testing of other siblings.(b) Use the
both provider-initiated and voluntary "opt-out" approach in the counseling and testing (CT) program (c)
Provide polymerase chain reaction (PCR) testing at six weeks for early infant diagnosis and thus improve
HIV-exposed infant testing and follow-up.(d) Strengthen the referral system between PMTCT and the
wellness clinic or care and treatment services. This is achieved by offering routine CD4 testing to HIV-
infected pregnant women and HIV-infected infants to identify those eligible for HAART.(e) Provide TB
screening for HIV-infected pregnant women.(f) Offer complex ARV regimens depending on the clinical and
immunological (CD4) staging.(g) Provide HIV and AIDS training to local community-based organizations
such as churches and youth organizations to raise community awareness.(h) Provide cotrimoxazole
prophylaxis for mothers and children.ACTIVITY 2: Free State, Gauteng, KwaZulu-Natal and North West
Provincial Departments of Health(a) Conduct needs and site assessments to identify gaps and address the
needs of human resources, infrastructure, training of healthcare workers (HCW), technical support,
monitoring and evaluation, commodity, and ways to strengthen PMTCT services.(b) Provide training in early
infant diagnosis (PCR) to improve follow-up of HIV-exposed infants.(c) Incorporate CD4 testing of HIV-
infected pregnant women and HIV-infected infants in the PMTCT program, and fast-track those eligible to
care and treatment sites or wellness clinics.(d) Facilitate the provision of antiretroviral treatment for eligible
HIV-infected women within the PMTCT program.(e) Develop comprehensive referral systems to care and
treatment sites.(f) EGPAF respects Provincial Policy on Nutrition. The nutritional advise is provided through
health education to all pregnant women (HIV infected or not).ACTIVITY 3: Support to National PMTCT Staff
Capacity and Training; Participate in the National Pediatric AIDS Working Group(a) Provide training to the
nine provinces on early infant diagnosis, antiretrovirals in pregnancy, clinical and immunological staging of
HIV and AIDS in infants and children, and clinical manifestations of HIV and AIDS in infants and children.(b)
Place a technical advisor within the National Department of Health.(c) Participate in the National Pediatric
Working Group to discuss and advise policy with regard to pediatric treatment guidelines and access to
pediatric treatment services. With FY08 reprogramming funding, EGPAF will provide support to the National
Department of Health and three provinces (KwaZulu-Natal, North West and Free State) in training and
mentoring of health workers to implement the new (2008) PMTCT dual therapy guidelines. Tools to
measure compliance to these new guidelines are being developed and will be rolled out to facilities in the
three targeted provinces, and beyond.
With FY08 reprogramming funding, EGPAF will provide support to the national Department of Health and 3
provinces (KwaZulu-Natal, North West and Free State) in training and mentoring of health workers to
implement the new (2008) PMTCT dual therapy guidelines. Tools to measure compliance to these new
guidelines are being developed and will be rolled out to facilities in the three targeted provinces, and
beyond.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13763
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13763 7969.08 HHS/Centers for Elizabeth Glaser 6600 193.08 $2,925,000
Disease Control & Pediatric AIDS
Prevention Foundation
7969 7969.07 HHS/Centers for Elizabeth Glaser 4505 193.07 $1,500,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $780,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
With FY 2009 funding, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will continue to improve
the quality of the adult care and support services, and activities started in FY 2008 will continue. With the
expansion of the HIV treatment program, EGPAF assists the Department of Health (DOH) in preparing
primary health care (PHC) facilities to become down referral sites as well as assists selected facilities to
prepare for DOH accreditation. EGPAF will continue to work closely with community-based organizations
(CBOs) and faith-based organizations (FBOs) in the various EGPAF-supported communities to improve
wellness defaulter tracing, early identification of HIV patients, as well as community HIV care and support
awareness. Where applicable, community health care workers (CHCW) will be trained on various aspects of
the care and support approaches. EGPAF will work closely with DOH in building human capacity within
various DOH-funded community-based NGOs. Other activities planned for FY 2009 will include training in
infection control within communities and in the TB/HIV context. Prevention with positives, which includes
effective referrals to family planning, couple counseling for discordant couples and encouragement of
disclosure, will be of priority.
The adult care and support program is well established at EGPAF-supported sites. EGPAF provides
additional staff where required. Health care workers are trained on comprehensive care and support
including clinical staging, management of opportunistic infections and sexually transmitted infections (STIs),
TB/HIV and infection control. Onsite mentoring and coaching is provided to ensure the quality of care and
compliance with national protocols and guidelines. At service delivery level, EGPAF employs dieticians and
nutrition advisors to provide comprehensive nutritional support based on needs identified. Community
linkages with community-based care and support services and organizations will be strengthened by
providing training and technical assistance where required.
Gender is a critical issue in care and support, with implications for the quality and effectiveness of the care
provided and, the disproportionate burden on women and girls to provide care. EGPAF will work with the
DOH to ensure equitable access for both women and men to medicines and other care and support
services and resources. Linkages with reproductive health programs for female-headed households and
caregivers will be strengthened. Programs for older women caregivers that provided support networks and
access to productive resources will be targeted. Programs that target men and boys and encourage their
participation and responsibility in care-giving and household functions, their support for female caregivers
and their recognition of the burden of care as well as programs that reduce gender-based violence and
promote human rights will be implemented. Specific needs of women will be addressed.
EGPAF overall adult care and support is provided in line with the National DOH policies and guidelines and
National Strategic Plan (NSP) 2007-2011 Priority Area 2, i.e. Treatment, Care and Support, goals 5, 6, 7,
and 8 and their objectives are taken into account. All EGPAF support is aimed at assisting the DOH to scale
up coverage of the comprehensive care and treatment package, increase retention of patients in care, and
decrease HIV and AIDS related morbidity and mortality.
-----------------------------
SUMMARY:Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will use FY 2008 PEPFAR funds to
continue palliative care support for its existing partners in KwaZulu-Natal. The Foundation is also expanding
its program activities to the Free State, North West, and Gauteng provinces. EGPAF aims to improve the
quality of life for people living with HIV (PLHIV) by strengthening care and support services at facility as well
as community level. The primary emphasis areas are human capacity development and expansion of
services through training and task shifting, quality improvement, development of networks, linkages, referral
systems and strengthening local organization, development of infrastructure, development of policies and
guidelines, and health information systems strengthening. Primary populations to be targeted include
PLHIV, pregnant women, OVC, and family members.BACKGROUND:The long-term goal of EGPAF care
and support program in South Africa is to achieve optimal quality of life for PLHIV. Ongoing care and
support of HIV infected individuals and their families are pivotal to their long-term wellbeing. Sites supported
by EGPAF will expand their activities and partnerships with community-based leaders and organizations
providing care and support to communities thus ensuring sustainable community-based care and support of
HIV infected and their families. Strategies to identify family members who may or may not be infected and
are in need of care and support will be explored. Project Help Expand Antiretroviral Treatment (HEART)
care and support services will expand with increased geographic coverage during FY 2008. The program
will focus on routine screening and treatment of opportunistic infections (OIs) such as tuberculosis (TB),
ongoing adherence counseling and support, general HIV prevention, prevention with positives, nutrition and
infant feeding options support, psychosocial support, as well as strengthen linkages with home-based care,
orphans and vulnerable children (OVC), legal, and social welfare support systems or organizations. In their
regular reporting, sites will be required to demonstrate functional networks/ linkages with existing
governmental and non-governmental support services, especially (OVC), home-based care services.
EGPAF utilizes Project HEART resources to complement those of the Department of Health (DOH) and
private partners, such as faith-based organizations (FBOs) and other non-governmental organizations
(NGOs) providing health care services. EGPAF will expand/strengthen care and support service delivery
through training and task-shifting. A syndromic approach to the most common adult illnesses including
sexually transmitted infections (STIs) and most opportunistic infections will be emphasized in training.
EGPAF will also provide additional health care providers e.g. nurses, counselors, based on staffing needs.
The provision of additional staff ensures that ongoing clinical monitoring and assessments viz. laboratory
tests, nutritional assessment, screening for TB and, other OIs, cotrimoxazole prophylaxis, are conducted at
all times. PLHIV as well as family members will also be utilized in treatment support to achieve optimal
compliance and adherence to ART The existing sites are: 1. McCord Hospital, Durban2. Aids Healthcare
Foundation (AHF), Umlazi, Durban3. KwaZulu-Natal Department of Health (KZNDOH), Umgungundlovu
District (Edendale and Northdale Hospitals and their feeder clinics), 4. KZNDOH, Zululand District, Vryheid,
Benedictine Hospital and their feeder clinics, as well as eDumbe Community Health Centre (CHC) and its
feeder clinicsNew HEART partners include the remaining St Francis, Nkonjeni, Ceza, Itshelejuba, and
Activity Narrative: Thulasizwe TB Hospitals and their feeder PHC clinics, in the Zululand District in KZN; all five districts in the
Free State Province; two sub-districts in North West Province, as well as Eastern Ekurhuleni sub-district in
Ekurhuleni District and Lesedi sub-district in the Sedibeng District in Gauteng Province.ACTIVITIES AND
EXPECTED RESULTS:Project HEART aims to improve the quality, availability, and accessibility of care
and support services. Activities undertaken in order to achieve the program objectives include:1.
Conducting site assessments to identify gaps or needs to be addressed to increase the number of patients
on palliative care. This could include minor renovations to address space constraints.2. Improving the
quality of counseling and testing by providing ongoing support to lay counselors and health care
professionals.3. Assessing quality of the program and supportive supervision to staff.4. Providing technical
assistance to enhance family-centered approach to clinical screening and opportunistic infection prophylaxis
in community settings. 5. Human capacity development through training and task-shifting to improve the
quality of palliative care services. This includes a syndromic approach to the most common adult illnesses
including sexually transmitted infections (STIs) and most opportunistic infections will be emphasized in
training. Clear instructions will be provided according to the DOH guidelines so that health worker knows
which patients can be managed at the first-level facility and which require referral to the district hospital or
further assessment by a more senior clinician. Preparing health workers to treat the common, less severe
opportunistic infections will allow them to stabilize many clinical stage 3 and 4 patients prior to ARV therapy
without referral to hospital. All patients are asked/observed for cough (to improve TB case detection) and
asked about genital ulcers or sore or (in men) a urethral discharge. These trainings enable HCW to offer
appropriate prophylaxis and treatment of opportunistic infections for adults and children. They will also
cover Integrated Management of Childhood Illness (IMCI). Trainings will also cover appropriate referral to
and linkages with provision of antiretroviral therapy for eligible patients, including both adults and children.6.
Providing M&E support with a focus on strengthening data management systems to enhance routine
program monitoring, improve data quality and facilitate data use.7. Developing/ strengthening linkages and
referral systems with community-based government and non-government support services namely, home-
based care, OVC, social welfare and support groups, or other primary health care services like PMTCT and
TB care. 8. Screening and treatment of opportunistic infections e.g. TB screening, INH and cotrimoxazole
prophylaxis).9. Nutritional support including infant feeding options supportIn FY 2008, the HEART program
will increase the percentage of HIV-infected patients with palliative care by 30%. EGPAF plans to embark
on a growth strategy - building on the experience and success achieved in FY 2007. This growth in patient
numbers will be achieved through a combination of expanding the efforts of existing HEART programs,
forming alliances with new sub-partners, and supporting the efforts of South African Government
Departments of Health at provincial and district level.
With FY08 reprogramming finds, EGPAF will scale up, raise awareness and champion the need for early
initiation of HAART, especially for those babies that are coming out of the PMTCT program, 50% of whom
should be on HAART by the first birthday; support the implementation of community IMCI; strengthen adult
care at the community level; and create pediatric-friendly family clinics and adolescent services.
Continuing Activity: 13764
13764 3805.08 HHS/Centers for Elizabeth Glaser 6600 193.08 $1,825,000
7654 3805.07 HHS/Centers for Elizabeth Glaser 4505 193.07 $600,000
3805 3805.06 HHS/Centers for Elizabeth Glaser 2628 193.06 $200,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $800,000
Table 3.3.08:
This PHE activity, 'Antiretroviral Pregnancy Registry ' was approved for inclusion in the COP. The PHE
tracking ID associated with this activity is ZA.08.0133."
However, note that OGAC will have to enter the approved budget amount at a later date. The PHE
committee on 13 November noted "Approve for continuation and use of FY08 funds. Determination of FY09
funding level contingent on submission of a detailed and satisfactory budget. Please communicate with the
PMTCT Evaluation Team."
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Public Health Evaluation $0
Table 3.3.09:
In FY 2009, EGPAF will continue to assist the Department of Health (DOH) with its down referral process
and accreditation of more primary health care (PHC) facilities in an effort to ensure adequate and
appropriate geographic and epidemiologic treatment coverage. EGAPF will train PHC-level staff on
comprehensive HIV and AIDS prevention, care, management and treatment and, ensure that didactic
training translates to good clinical practice. Facility-based quality improvement (QI) teams will be
established and service gaps identified will be addressed to ensure quality service delivery. Testing and
counseling will be offered at all possible entry points to ensure that HIV-infected people eligible for
treatment are identified early. Patients not eligible for antiretroviral therapy will be enrolled into wellness
programs. Coordinated linkages will other care and support services within facilities and in communities will
be established or strengthened. Prevention interventions will be integrated in care and treatment settings.
All HIV-infected patients will be screened for TB, and all TB patients will be offered HIV testing. Tracing or
tracking of patients that do not return for results will be strengthened. Monitoring and evaluation systems to
track patient progress and outcomes in the care and treatment setting will be put in place. The family-
centered approach will be standard practice. After McCord was accredited as a DOH rollout site in 2006
and the DOH provided antiretroviral drugs (ARVs) and HIV-related lab tests it was decided that the funds be
reprogrammed for the ARV drug and lab portion. This resulted in funding of McCord and six other sites.
In an effort to strengthen human capacity, task shifting will be explored where nurses will be supported to
manage stable patients on treatment thus preparing them for adult treatment initiation in the future. EGPAF
will provide support in the form of ongoing didactic training, onsite mentoring, preceptorship and supportive
supervision. An integrated training approach will be implemented thus the trainings will cover the following
areas, basic and advanced HIV and AIDS training, TB/HIV, sexually transmitted infection (STI) and
opportunistic infection (OI) management, QI, monitoring and evaluation (M&E), and general infection control
practices.
Gender is a critical issue in treatment, care and support, with implications for the quality and effectiveness
of the care provided and, the disproportionate burden on women and girls to provide care. EGPAF will work
with DOH to ensure equitable access for both women and men to medicines and other care and support
access to productive resources will be targeted. Programs that target men/ boys and encourage their
promote human rights will be implemented. Specific needs of women will addressed. Generally, more
females than males access treatment services and the ratio is 60:40.
EGPAF overall support is in line with National DOH adult treatment policies and guidelines. The National
Strategic Plan (NSP) 2007-2011 Priority Area 2, Treatment, Care and Support, goals 6 and 7 are taken into
consideration. All patients will be managed according to government guidelines and standards to ensure
quality, including CD4 percentage increases, viral load, disease stage, side effects, adverse events and
outcomes at 12 and 24 months.
---------------------------
BACKGROUND:
The long-term goal of the EGPAF care and treatment program in South Africa is to increase life expectancy
amongst HIV-infected persons by increasing access to care and treatment services and service utilization.
Primary emphasis areas are human capacity development and expansion of services through training and
task shifting, local organization capacity building, development of infrastructure, policy and guidelines, and
strategic information. Primary populations to be targeted include infants, men and women, pregnant women,
people living with HIV (PLHIV), and public and private healthcare providers.
Project Help Expand ART (HEART) will expand geographic coverage of services in FY 2008. HEART/South
Africa is part of a larger worldwide initiative by EGPAF to support care and treatment services, and receives
both Track 1 and in-country PEPFAR funding. The program's focus is on integrating PMTCT services to
provide a family-centered model of care that includes access to treatment for HIV-infected pregnant women,
couple counseling, partner testing and screening for TB.
EGPAF utilizes PEPFAR resources to complement those of the KwaZulu-Natal (KZN) Department of Health
(DOH) and private partners, such as faith-based organizations (FBOs) and other non-governmental
organizations (NGOs). These resources fund staff, infrastructure, drugs, laboratory testing and provide
technical support. EGPAF will identify gaps in the program at the site level and implement activities to
address the needs. The intent is to facilitate national and provincial plans and work with the government and
partners to transition programs to South Africa government (SAG) support.
EGPAF has a partnership with a private NGO, the AIDS Health Care Foundation (AHF); this is a cost-
sharing relationship (drugs and staff) to support the AHF care and treatment program. McCord Hospital, a
faith-based organization, is a sub-grantee of EGPAF. The EGPAF partnership with the DOH includes
support for human capacity development, infrastructure rehabilitation and technical support for sites in KZN.
The existing sites are:
(1) McCord Hospital, Durban
(2) AHF (Ithembalabantu Clinic), Umlazi, Durban
(3) KZNDOH, Pietermaritzburg Up/Down referral program (Edendale Hospital and four referral clinics,
Northdale Hospital and five referral clinics),
(4) KZNDOH, Vryheid Hospital plus three referral clinics, Benedictine Hospital and three referral clinics, and
Edumbe Community Health Centre (CHC) plus one referral clinic, in Zululand district.
Activity Narrative: This partnership with the DOH will be expanded to the whole Free State province, to Ramotshere Moiloa
(Zeerust) and Tswaing (Delareyville) sub-districts in the North West, to all of the Umgungundlovu and
Zululand districts in KZN, and the Eastern Ekurhuleni and Lesedi sub-districts in Gauteng.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Human Capacity Development
EGPAF will support training of healthcare providers on the following:
1. Screening and treatment of TB/HIV and opportunistic infections, ART in pregnancy, and referral systems
(between PMTCT and ART);
2. Supporting systems to improve access to care and treatment of children (including early infant diagnosis);
3. Capacity building at sites for implementation and management of the comprehensive care, management
and treatment support program;
4. M&E;
5. Project management; and
6. Funding health workers to complete a HIV and AIDS Diploma at the University of KwaZulu-Natal.
In addition EGPAF will provide technical assistance for the creation of outreach programs to build capacity
at primary healthcare (PHC) clinics for downward and upward referral in order to maintain patients on ART,
initiate new patients on therapy, and decongest treatment sites that have reached capacity.
ACTIVITY 2: Down Referral Process
The KwaZulu-Natal Health Department (KZNDOH) started providing comprehensive care and treatment
services to HIV-infected patients in May 2004 at hospital level. PHC clinics will be capacitated so that they
are able to manage stable patients on ART referred down from the hospitals or community health centers
(CHCs), and also up refer those that are eligible for initiation of ART to hospital or CHCs that are ARV
accredited sites.
The KZNDOH aims to make ART accessible to all by expanding and strengthening existing HIV and AIDS
care and treatment service delivery. A number of CHCs have been accredited by the national and provincial
health departments and will initiate ART. The PHC clinics conduct rapid HIV testing, CD4 testing and
provide the first, second and third adherence counseling sessions, which is also done at CHC and hospital
level, and then refer patients to accredited CHCs or hospitals for initiation. The KZNDOH has identified the
Pietermaritzburg and Zululand districts as areas needing immediate support as they are poorly resourced
with high HIV seroprevalence rates. The KZNDOH has requested that EGPAF support be extended to these
districts. The districts have identified clinics where stable patients on treatment can be referred to continue
ART management.
ACTIVITY 3: Pediatric Care and Treatment
EGPAF's goal is to ensure that 10 percent of all patients on treatment are children, which has not been
achieved in the Zululand district. To strengthen pediatric HIV care and treatment, EGPAF will provide
training on early infant diagnosis, pediatric HIV clinical staging and diagnosis and ART in children, in
addition to provision of staff, strengthening the linkages between PMTCT and care and treatment.
The Edendale and Northdale pediatric HIV clinic has the largest cohort of pediatrics in the province on ART.
The hospital down refers stable patients to the care of the PHC clinics to free up space for new pediatric
patients.
EGPAF aims to:
1. Increase the rate of down referral of stable children on ART;
2. Increase the up referral of new eligible children for initiation of therapy; and
3. Improve linkages between PMTCT programs and care and treatment programs.
EGPAF will provide financial and technical support to eight PHC clinics in the catchment area of the
Edendale and Northdale hospital in Pietermaritzburg, thus capacitating them to: (1) receive and manage
transferred stable pediatric patients on ART from the pediatric HIV clinic; and (2) provide screening and
preparation of eligible HIV-infected patients at three PHC facilities for up referral and initiation of ART at
Edendale Hospital Pediatric HIV clinic. The same approach will be applied as we expand to other provinces,
namely Free State, North West and Gauteng provinces.
ACTIVITY 4: Counseling and Testing (CT)
The focus of this activity will be on strengthening comprehensive HIV and AIDS care and treatment services
using a family-centered approach to increase access to CT, by fast-tracking TB, STI, and family planning
patients to CT; to integrate PMTCT with HIV and AIDS care and treatment; to improve referral of eligible
pregnant mothers, partners, family members, and HIV-infected infants and children to treatment sites; to
screen for opportunistic infections. With this focus, EGPAF will increase pediatric care and treatment,
couple counseling, partner testing, and testing for siblings. For patients who test HIV-positive and are not
yet eligible for ART, they will be retained through wellness clinics, support groups, patient tracking, etc. The
overall goal is to expand coverage of HIV and AIDS care and treatment services to reach mothers, partners
and children who would not otherwise have access to these services.
The increase in funding in FY 2008 will be used to expand EGPAF program activities viz. human capacity
development, down referral process, pediatric care and treatment as well as counseling and testing
Activity Narrative: activities to the Free State, North West and Gauteng province. In addition, EGPAF will strengthen M&E
systems at all levels of service delivery.
The activities contribute to the PEPFAR 2-7-10 goals.
Continuing Activity: 13767
29179 29179.06 HHS/Health Catholic Relief 11903 11903.06 $80,658
Resources Services
Services
Administration
29178 29178.06 HHS/Health Catholic Relief 11903 11903.06 $1,042,789
29177 29177.06 HHS/Health Catholic Relief 11903 11903.06 $796,975
29176 29176.06 HHS/Centers for Columbia 3272 1432.06 $1,900,000
Disease Control & University
Prevention Mailman School of
Public Health
29175 29175.06 HHS/Health Catholic Relief 3730 3730.06 $2,077,346
29174 29174.06 HHS/Health Catholic Relief 3730 3730.06 $3,680,706
29173 29173.06 HHS/Health Catholic Relief 11902 11902.06 $5,449
29172 29172.06 HHS/Health Catholic Relief 11902 11902.06 $184,936
29171 29171.06 HHS/Health Catholic Relief 11902 11902.06 $112,294
29170 29170.06 HHS/Health Catholic Relief 11901 11901.06 $27,832
13767 2917.08 HHS/Centers for Elizabeth Glaser 6600 193.08 $5,510,000
7653 2917.07 HHS/Centers for Elizabeth Glaser 4505 193.07 $3,300,000
2917 2917.06 HHS/Centers for Elizabeth Glaser 2628 193.06 $1,220,000
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $200,000
FY 2008 COP activities will be expanded to include:
-Support Free State, Gauteng, KwaZulu-Natal and North West provincial Departments of Health scale up
pediatric care and support activities;
-Advocate for pediatric care and support services and engage more in policy, program, issue and
constituency advocacy activities at all levels; and
-Engage in human capacity development around pediatric care and support activities.
SUMMARY:
In line with its global strategic vision, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will advocate for
the provision of quality sustainable pediatric care and support programs at all levels including the
community. EGPAF will use FY 2009 PEPFAR funds to continue pediatric care and support to support its
existing partners namely, National Department of Heath (NDOH) and provincial DOH KwaZulu-Natal (KZN),
Free State, North West and Gauteng, as well as McCord Hospital and AIDS Healthcare Foundation (AHF)
in KZN. The key objectives are to expand the coverage of pediatric care services, increase the uptake of
pediatric care services and ensure provision of quality pediatric care services, including follow-up of HIV-
exposed infants, early infant diagnosis, and routine testing of children presenting at health care services.
The primary emphasis area is human capacity development and expansion of services through training and
task-shifting, quality improvement, development of networks, linkages, referral systems and strengthening
M&E and health systems, and strengthening of local organizations. Primary populations to be targeted
include infants, men and women, pregnant women, HIV-infected pregnant women, people living with HIV
(PLHIV), and public and private healthcare providers.
The long-term goal of the EGPAF Project HEART pediatric care and support program in South Africa is to
ensure that all health facility-based and community-based pediatric care and support is aimed at extending
and optimizing quality of life for HIV-infected children and their families throughout the continuum of illness
through the provision of clinical, psychological, spiritual, social and prevention services. To improve quality
of pediatric care and support service delivery, EGPAF will continue to support the national and provincial
DOH by providing technical support, human capacity development, and infrastructure rehabilitation, where
applicable. Priority areas include (a) Early infant diagnosis; (b) prevention and treatment of opportunistic
infections and other HIV and AIDS-related complications, as well as pain and symptom relief; (c) Nutritional
assessment and support; (d) Strengthening of links between facility-based and community-based care and
support services; (e) Psychological, social, spiritual and prevention services provision; and (f) Strengthen
monitoring and evaluation (M&E).
ACTIVITY 1: Support Free State, Gauteng, KwaZulu-Natal and North West Provincial Departments of
Health
(a) Scale-up pediatric care and support activities. EGPAF will support the provision of age-appropriate
services, using a family centered approach e.g. siblings of HIV-infected children will be tested.
(b) Functional linkages between related programs will be established or strengthened including PMTCT,
ART, maternal and child health (MCH), integrated management of childhood illnesses (IMCI), expanded
program on immunization (EPI), TB and community-based activities.
(c) Early identification of HIV exposed infants, PCR testing according to national PMTCT guidelines;
provider initiated testing and counseling at all entry points.
(d) Optimize provision of cotrimoxazole prophylaxis to HIV exposed and infected children from 4-6 weeks,
as per national pediatric treatment guidelines.
(e) Provision of a comprehensive prevention care package that includes nutritional assessment, counseling
and support.
(f) Diagnosis and clinical management of opportunistic infections (OIs) and co-morbidities as well as pain
and symptom relief management.
(g) TB case finding (for families), diagnosis, and treatment will be part of pediatric care and support
services.
(h) Support groups for children and their families will be strengthened/ established.
(i) Work with DOH and relevant community-based organizations/ stakeholders to establish school-based
programs that will educate learners and teachers about pediatric HIV and AIDS as well as care and support
service available in the communities
ACTIVITY 2: Advocacy
Pediatric HIV and AIDS care and support awareness is suboptimal. Globally, EGPAF advocates for
pediatric care and support and plans to engage more in policy, program, issue and constituency advocacy
activities at all levels.
ACTIVITY 3: Human capacity development
Activity Narrative: (a) Pediatric care and support technical assistance will be provided to care and support community-based
organizations (CBOs).
(b) Facility-based and community-based care and support personnel will be trained, mentored and coached
to ensure quality care and support service provision.
(c) Additional staff will be hired to address program needs e.g. Program Officer Linkages, Program Officer-
Nutrition.
Quality pediatric HIV care and support is essential and remains a challenge mainly due to inadequate
human capacity. There is limited pediatric care and support skills among health care workers, EGPAF will
train counselors, community health care workers, caregivers, and CBOs on pediatric care and support, with
a strong focus on community IMCI, TB/HIV, management of opportunistic infections (OIs), early
identification of infants and children and infant feeding. At service delivery level, EGPAF employs dieticians
and nutrition advisors to provide comprehensive nutritional support based on needs identified. In addition to
providing technical assistance, EGPAF will endeavor to strengthen CBOs and faith-based organizations
(FBOs) in management, leadership and policy development.
provided and, the disproportionate burden on women and girls to provide care. EGPAF will work with
relevant government departments and CBOs to identify child headed households, implement targeted
programs to meet needs including programs which keep girls in school, help them manage households,
address stigma and compensate for lost family income; programs that target men and boys and encourage
their participation and responsibility in care-giving and household functions, as well as programs that work
to reduce gender violence and promote human rights. Specific needs of children will be addressed.
All EGPAF supported pediatric care and support activities are in line with the National DOH policies and
guidelines and the National Strategic Plan (NSP) 2007-2011 Priority Area 2, i.e. Treatment, Care and
Support, goals 5,6, 7, and 8 and their objectives are taken into account. All EGPAF support is aimed at
assisting DOH to scale up pediatric care and support services, determining HIV status of infants and
children as early as possible and decreasing HIV and AIDS related pediatric morbidity and mortality.
Estimated amount of funding that is planned for Human Capacity Development $400,000
Table 3.3.10:
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will use FY 2009 PEPFAR funds to support its
existing care and treatment partners namely, National Department of Heath (NDOH) and provincial DOH
Kwazulu-Natal (KZN), Free State, North West and Gauteng, as well as McCord Hospital and AIDS
Healthcare Foundation (AHF) in KZN. EGPAF plans to scale up pediatric treatment services and ensure
access to those who need it. The emphasis areas for this activity are human capacity development and
strategic information. EGPAF will provide training on early infant diagnosis, pediatric HIV clinical staging,
diagnosis and ART in children as well as provide additional staff where required. Primary populations
include infants, young children, and adolescents. The geographic focus is on KwaZulu-Natal, Free State,
Gauteng and North West.
EGPAF pediatric treatment services will be closely linked to PMTCT, pediatric care and support, integrated
management of childhood illnesses (IMCI), well baby clinics, TB, adolescent services and other outpatient
services to optimize early identification of infants and children. EGPAF aims to have all eligible HIV-infected
children initiated on HAART in a timely manner, and improve their life expectancy and quality of life. EGPAF
recognizes the gap in the provision of pediatric treatment services and will support the DOH in ensuring that
pediatric care and treatment is prioritized. As part of the global EGPAF initiative, EGPAF is developing a
country-specific pediatric framework that articulates the major issues in scaling up pediatric treatment within
a family-centered approach as well as mobilizes resources to complement those provided by the DOH.
EGPAF will provide technical assistance and other resources to ensure the provision of comprehensive and
quality treatment services for all HIV-infected children.
ACTIVITIES AND EXPECTED RESULTS,
In general, pediatric treatment is still a hospital-based service. The skills limitations and lack of confidence
amongst health care professionals has resulted in the pediatric HIV and AIDS management being perceived
as difficult. Human capacity development activities will mainly focus on skills development or transfer, in an
effort to build confidence amongst health care professionals. Practical clinical skills, i.e. examination of
infants and children, clinical staging, and venesection, need to be strengthened. Didactic training, bedside
clinical training, preceptorship, on-site coaching, mentoring and supportive supervision will be provided. An
integrated training approach will be applied and thus the trainings will include adherence counseling,
TB/HIV and early infant diagnosis to ensure comprehensive and quality care.
with relevant government departments and community-based organizations (CBOs) to identify child-headed
households, implement targeted programs to meet needs including programs which keep girls in school,
help them manage households, address stigma and compensate for lost family income; programs that
target men and boys and encourage their participation and responsibility in care-giving and household
functions, as well as programs that work to reduce gender violence and promote human rights. Specific
needs of children will be addressed. The Project HEART South Africa male-to-female ratio of children on
treatment is 1:1.
ACTIVITY 1: Advocacy:
Media campaigns carried out by other organizations, including the DOH, have little or no pediatric focus,
hence suboptimal pediatric awareness. Globally, EGPAF advocates for pediatric treatment and engages in
technical policy activities at all levels of service delivery. Information on early identification, referral and
treatment of HIV-infected infants and children, treatment literacy and adherence support will be
communicated. The importance of cotrimoxazole prophylaxis in preventing opportunistic infections (OIs) will
be highlighted.
ACTIVITY 2: Set up Mobile Clinical Support Units (MCSUs):
In order to improve the pediatric treatment coverage, EGPAF will promote the establishment of MCSUs at
all EGPAF-supported antiretroviral (ART) initiation sites to ensure access and availability of pediatric
treatment services in rural and farming communities. The MCSU will be managed and coordinated within
the DOH treatment program.
ACTIVITY 3: Facility-based quality improvement (QI):
Multi-disciplinary teams that include clinical and non-clinical health care workers will be established at all
ART initiation sites to scale up and improve the quality of pediatric treatment services. Monthly QI meetings
that focus on improving the quality of pediatric treatment services will be conducted.
ACTIVITY 4: Down Referral Process and Accreditation.
EGPAF will assist DOH to down refer stable pediatric patients and their families to local primary health care
clinics.
ACTIVITY 5: Community linkages and referrals.
As part of the chronic care model, EGPAF will endeavor to strengthen community-based treatment support
services and ensure effective referrals between health establishments and community-based services.
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.
Activity Narrative: EGPAF overall support is in line with National DOH pediatric treatment policies and guidelines, The National
consideration
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.11:
Activities started in FY 2008 will continue in FY 2009, with the following additional emphases.
There are ongoing challenges with the delivery of TB and HIV services. TB and HIV services are usually
provided at different service points and it is difficult for people living with HIV co-infected with TB to receive
services in two different programs. As antiretroviral treatment (ART) services become more decentralized,
TB and HIV services may be co-located in the same facility or premises. Efforts to improve access to clinical
care must be linked to community and home-based care to ensure early detection, timely initiation and
completion of TB treatment. The integration of services together with TB infection control (IC) measures will
help decrease the transmission of TB and multi-drug resistant (MDR-TB). Elizabeth Glaser Pediatric AIDS
Foundation (EGPAF) will assist the Department of Health (DOH) at site level in developing and
implementing policies, plans and human capacity for TB IC based on international and national guidelines
on TB IC. Safe sputum collection will be ensured, cough etiquette and hygiene will be promoted, patient
flow assessed and TB suspects triaged for fast-tracking or separation from other patients. Room air
ventilation will be improved where required. EGPAF will collaborate with the DOH and other relevant
stakeholders in developing and implementing a TB IC training strategy.
Intensified case finding will be provided in all HIV infected patients. All clients receiving HIV services (i.e.,
prevention of mother-to-child transmission (PMTCT), voluntary counseling and testing (VCT), pediatric
services, etc.) will be routinely screened for TB disease. People with an initial positive TB screen will be
referred for TB diagnostic services and those diagnosed with TB, initiated on TB treatment using DOTS-
based national TB control strategy and international standards for TB care. Systems for tracking and patient
referrals and follow-up between TB and HIV services will be strengthened. Home-based care workers and
community healthcare workers community health-care workers will be trained so that they are able to
undertake early identification and referral of TB suspects, provision of directly observed treatment (DOT)
and patient support, defaulter tracing and coordination with TB and HIV programs. Supportive supervisory
systems linked with the health-care facilities will be strengthened.
Isoniazid preventive therapy (IPT) will be provided to all HIV-infected persons in whom TB has been ruled
out as per national guidelines, policies and protocols for IPT. Health-care workers will be appropriately
trained in the delivery of IPT, and the service will include clear messages to patients, family and caregivers.
The importance of completing prophylactic therapy and reporting any side effects will be reinforced. All
family members and close contacts of active TB patients, especially children under five will be screened for
TB and if active disease is rules out, IPT will be provided.
There will be a strong focus on capacity building around the management of TB/HIV in children to ensure
that children are identified early and managed accordingly. EGPAF will ensure that pediatric specific TB
diagnostic tools, treatment guidelines and protocols are in place at all sites. Ongoing technical support will
be provided to address challenges in service provision and strategies to improve TB/HIV documentation
and reporting will be explored.
Human capacity is critical in providing comprehensive TB/HIV services. TB/HIV human capacity
development activities will include task shifting, training on TB and HIV collaboration, MDR-TB and XDR-
TB, TB/HIV in children, TB IC, nutritional support, with a strong focus on quality improvement. EGPAF will
use an integrated training approach to reduce missed opportunities at both entry points. Community health-
care workers will be capacitated to provide comprehensive support to TB/HIV services through task shifting.
Expected outcomes include improved TB screening as part of the home and community based care,
defaulter tracing, adherence support, as well effective referrals and follow-up. Efforts to scale-up IPT will be
strengthened. Onsite mentoring, coaching and supportive supervision will continue.
EGPAF will work with DOH to ensure equitable access for both women and men to TB and HIV services.
TB screening will be offered to all HIV-infected pregnant women in the PMTCT setting. Linkages with
reproductive health programs for female-headed households and caregivers will be strengthened. Programs
for older women caregivers that provide support networks and access to productive resources will be
targeted. Programs that target men/ boys and encourage their participation and responsibility in care-giving
and household functions, their support for female caregivers and their recognition of the burden of care as
well as programs that reduce gender-based violence and promote human rights will be implemented.
Specific needs of men and women will addressed
EGPAF overall TB/ HIV support is provided in line the national DOH TB/HIV policies and guidelines as well
as the HIV & AIDS and STI Strategic Plan for South Africa, 2007 - 2011, Priority Area 2, Treatment, Care
and Support, goal 6, objective 6.3 which aims to ensure effective management of TB/HIV co-infection. All
EGPAF support is aimed at assisting DOH to reduce TB/HIV co-infection rate and comprehensively manage
TB/HIV co-infection.
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will support all of its care and treatment partners
in addressing the barriers to increasing case detection and cure rates in TB co-infected HIV-infected
patients. The program intends to strengthen collaboration between TB control initiatives and HIV and AIDS
programs at EGPAF supported sites in KwaZulu-Natal, Gauteng, Free State and North West. EGPAF
receives both Track 1 and Track 2 (South Africa) PEPFAR funding. The primary emphasis areas for
activities are human capacity development and expansion of services through training and task shifting,
quality improvement, development of networks, linkages, referral systems and strengthening local
organization, development of infrastructure, policy and guidelines, and health information systems
strengthening. Primary populations to be targeted include infants, men and women, both pregnant and not,
Activity Narrative: BACKGROUND:
Tuberculosis (TB) poses a serious threat to the public health and economic well-being of South Africans
and in the advent of HIV, affects the most productive segments of the population, as well as
disproportionately affects the poor. The HIV and AIDS epidemic in South Africa has further complicated
control and treatment of TB. Although the South Africa National TB Control Program (NTCP) has made
significant progress over the past several years, it still faces challenges in increasing case detection and
cure rates. Key barriers include a lack of community understanding about the disease, limited access to
services, inadequate provider knowledge and compliance with DOTS, and patient adherence to treatment.
The program's key focus will be at the district, municipal, and community levels. EGPAF will:
1. Assist stakeholders and partners to strengthen local capacity to detect, treat, and prevent TB.
2. Develop community-based strategies to identify potential TB cases and ensure early referrals for
diagnosis and treatment.
3. Assist sites to integrate TB services with HIV and other healthcare services.
4. Support and develop community-based approaches to ensure treatment adherence.
EGPAF will strengthen linkages between healthcare centers and community DOT supporters to reduce
treatment interruption rates and improve treatment adherence. EGPAF will establish mechanisms for
collaboration between TB and HIV services by providing counseling and testing within TB services, and
screening HIV-infected individuals for TB.
EGPAF will assist in strengthening the technical capacity at the sites where the comprehensive care
management and treatment programs are being supported. The key activities will involve the integration of
TB services, VCT services, and antiretroviral treatment (ART) services, at primary health care and hospital
level. These activities will be included in the site TB control and evaluation plans.
Mechanisms for integration are:
1. Support the district/site TB/HIV coordinator to expand and improve the referral linkages between TB and
CT.
For all TB patients, provider initiated HIV testing and counseling will be offered and HIV-infected patients
referred to CT. CD4 count and ART initiation will be carried at TB service points where possible.
Cotrimoxazole prophylaxis will also be made available. All HIV-infected patients will be screened for TB,
and referred to TB service points. Where possible, anti-TB treatment will be initiated in CT setting.
2. Assist in the development and implementation plan for TB/HIV at sites at which EGPAF will be providing
comprehensive HIV and AIDS services.
The plan will include human capacity development through training. Health care providers at TB and CT
service points will be trained in both TB and HIV management so that they can provide a comprehensive
package of care. Use of community-based care and support initiatives will be explored to improve
adherence and compliance
3. Assist in developing and strengthening monitoring and evaluation of referral systems for TB/HIV related
activities.
EGPAF promotes the use of referral registers between service points e.g. VCT register reflecting the
service point a patient was referred from e.g. TB, as well as TB and CT registers showing referrals between
the two service points. At TB service points, HIV tests and CD4 counts done are recorded in registers to
facilitate referral. All confirmed TB cases diagnosed at CT service points are recorded in registers and
immediately referred to TB service points. Where possible, electronic TB registers will be maintained
4. For monitoring and evaluation, a core set of indicators, based on national guidelines for monitoring and
evaluation of collaborative TB/HIV activities will be used to measure the success of the program.
EGPAF will support the following activities to reduce the burden of HIV in TB patients (adults and
pediatrics):
1. HIV counseling and testing for all TB cases
2. Increased screening rates of TB for all HIV-infected patients within existing care and treatment sites and
services. Intensified case finding methods include screening for symptoms and signs of TB i.e. cough for
more than 2 or 3 weeks, fever, night sweats, recent weight loss, lymphadenopathy, routine three sputum
samples for Acid-Fast Bacilli (AFB), chest x-ray, TB culture may be used to confirm smear-negative
pulmonary TB. When TB diagnosis is confirmed, TB notification is done. All HIV-infected patients with
confirmed TB are referred (referral given) to TB service points for initiation of anti-TB treatment according to
national ARV treatment guidelines. All TB referrals are recorded in the TB registers. In addition to the above
screening methods, primary health care (PHC) facilities are encouraged to use TB Suspect Registers,
which are in the form of a questionnaire, to screen for TB.
3. Provision of cotrimoxazole preventive therapy to TB patients with HIV infection as part of the
Activity Narrative: comprehensive care and treatment program.
4. Provision of antiretroviral therapy and anti-TB treatment to eligible TB patients with HIV infection, will be
carried out according to national ARV treatment guidelines. Staff will be trained on managing patients co-
infected with HIV and TB.
5. Provision of care and support services to TB patients with HIV infection. All TB patients diagnosed HIV-
infected are provided with cotrimoxazole prophylaxis. Prevention with positives activities are implemented
and nutritional support provided in the form nutritional supplements, education, and food parcels.
6. Provision of isoniazid preventive therapy as part of the package of care for PLHIV when active TB is
excluded. Currently, INH prophylaxis is mainly offered in the clinical setting. In its geographic areas of
support, EGPAF will facilitate the provision of INH prophylaxis under DOT, as well as through home-based
care programs, where possible.
EGPAF will assist the National TB Control Program to strengthen information systems, supervision, and
program management. EGPAF will work with provincial, district, municipal, and community health systems
to build or strengthen capacity to prevent, detect, and treat TB. Human capacity development through
training and task-shifting (e.g. DOT staff giving INH prophylaxis). Mentoring, coaching and preceptorships
will be used to ensure skills transfer in all areas including M&E, which will lead to a more sustainable
program
Emphasis will be put on strengthening linkages with home-based care organizations and community
healthcare workers to identify suspected TB cases, ensure early referrals for diagnosis and treatment, as
well as support treatment adherence through DOT.
With FY08 reprogramming funding, EGPAF will address infection control support (assessment, technical
assistance, training); and pediatric TB (training and mentoring) in the Free State and North West provinces.
By supporting HIV care and treatment services, EGPAF contributes to the 2-7-10 goals of PEPFAR and the
USG South Africa Five-Year Strategic Plan.
Continuing Activity: 13765
13765 7968.08 HHS/Centers for Elizabeth Glaser 6600 193.08 $1,070,000
7968 7968.07 HHS/Centers for Elizabeth Glaser 4505 193.07 $500,000
Estimated amount of funding that is planned for Human Capacity Development $970,000
Table 3.3.12:
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will make concerted efforts to improve
counseling and testing (CT) uptake and ensure good quality CT services at all possible entry points i.e.
prevention of mother to child (PMTCT), integrated management of childhood illnesses (IMCI), expanded
program of immunization (EPI), tuberculosis (TB), out-patients department (OPD) and in the wards. EGPAF
will use FY 2009 PEPFAR funds to support its existing CT activities and programs which include National
Department of Health (NDOH) and provincial DOHs in Kwazulu-Natal (KZN), Free State, North West and
Gauteng provinces, as well as McCord Hospital and the AIDS Healthcare Foundation (AHF) in KZN. The
primary emphasis area is human capacity development and expansion of services through training and
provision of additional staff. EGPAF will train and provide supportive supervision to counselors thus
ensuring good quality CT services.
The long-term goal of the EGPAF Project HEART CT program in South Africa is to ensure that CT is offered
at all possible entry points, including medical settings and non-medical CT service points. All CT methods
will be explored i.e. provider initiated testing and counseling (PITC), couple CT, home-based CT and
prevention CT. Support for disclosure will be strengthened through support groups and the family centered
approach will be used. EGPAF will continue to support national and provincial DOHs by providing CT
technical assistance and human capacity development.
Priority areas include: (a) PITC will be encouraged at all entry points; (b) couples CT; (c) home-based CT;
(d) psychological, social, spiritual and prevention services provision; (e) ongoing supportive supervision and
mentoring of counselors; (f) developing advanced CT skills i.e. couple, family and child counseling; (g)
strengthening referral systems to ensure HIV infected patients are linked to care and treatment services as
well as other prevention services; (h) ensuring adequate support for disclosure; and (i) ensuring that DOH
supported sites have adequate systems in place for quality assurance of testing services.
EGPAF will carry out the following five activities in this program area.
CT is an entry point into the continuum of care. Therefore, EGPAF will prioritize human capacity building to
improve CT uptake. EGPAF will train various categories of staff on CT and continue promote PITC at all
possible entry points. Where required, EGPAF will provide additional counselors and provide ongoing
supportive supervision, mentoring and coaching at sites.
EGPAF will continue to train staff on CT policies and protocols, provide onsite mentoring and coaching to
ensure didactic training translates to good quality CT practices. EGPAF will second staff to various service
points in-order to strengthen CT capacity. Non-medical CT e.g. home-based CT, voluntary counseling and
testing (VCT) campaigns with community-based organizations (CBOs) and faith-based organizations
(FBOs) will be implemented by capacitating CBOs and FBOs to offer CT in homes and communities, and
refer HIV infected patients to care and treatment services. Advanced CT skills i.e. couple, family and child
counseling training will be conducted.
ACTIVITY 2: Community Linkages
EGPAF will establish linkages and provide technical assistance to CBOs, in an effort to scale-up CT.
Community-based CT services will be linked to care and treatment sites and effective referral systems will
be implemented. Ongoing supportive supervision, mentoring and coaching will be provided to CBOs to
ensure good quality CT services. CT integration into other programs e.g. community integrated
management of childhood illnesses (IMCI), TB and directly observed therapy short-course (DOTS), TB/HIV
and functional referrals will be strengthened.
ACTIVITY 3: Quality Improvement
Facility and community-based multidisciplinary improvement teams will be established for ongoing CT
quality improvement activities. QI activities will assist in integrating CT in the medical and non-medical
settings. Compliance with CT policies will be monitored to ensure quality CT services.
ACTIVITY 4: Monitoring and Evaluation
EGPAF will assist facilities and districts in setting up CT targets in line with the HIV & AIDS and STI
Strategic Plan for South Africa 2007-2011 goal of increasing CT coverage. Staff will be trained on data
collection tools, indicators and reporting to ensure good quality data. Program sustainability; based on
programs staffing needs and funding availability, DOH seconded staff will be absorbed into the DOH payroll
system. Training, mentoring and coaching will result in the much needed skills transfer. Community
awareness, buy-in and ownership of CT services will be promoted in an effort to reduce stigma and ensure
sustainability of community-based CT services.
ACTIVITY 5: Couple Counseling and Testing
Couple CT will be promoted to reduce HIV transmission in discordant couples, and may encourage
faithfulness in concordant negative couples. Couple CT will be implemented through VCT, PMTCT, family
planning and home-based CT and active male participation will be promoted. Programs that reduce gender-
based violence and promote human rights will be implemented. In light of women vulnerability and financial
dependency on men, disclosure counseling should be routine part of CT services. Different approaches to
Activity Narrative: support partner disclosure e.g. couple CT, partner referrals will be encouraged. Specific needs of women
will addressed.
EGPAF overall CT support is in line with NDOH CT policies and guidelines as well as the HIV & AIDS and
STI Strategic Plan for South Africa 2007-2011 Priority Area 1, Prevention, goals 1, 2, 3, and 4, aimed at
reducing new HIV new infections by 50% by 2011. EGPAF support to DOH CT program aims to increase
testing uptake by ensuring CT services are offered at all possible medical and non-medical entry points.
Effective referral to care and treatment and other prevention services will be of priority.
Estimated amount of funding that is planned for Human Capacity Development $409,500
Table 3.3.14:
The ARV drugs funding will be used to supplement a Department of Health (DOH) ARV drugs budgetary
shortfall anticipated at McCord Hospital. While there have been promises by the Kwazulu-Natal DOH to
review the current insufficient budget, there has been no official revised budget to cover the anticipated
shortfall.
Gender is a critical issue in HIV treatment, care and support services, with implications for the quality and
effectiveness of the care provided and the disproportionate burden on women and girls to provide care.
EGPAF will work with the DOH to ensure equitable access for both women and men to medicines and other
care and support services and resources.
EGPAF overall support is in line with National DOH treatment policies and guidelines. National Strategic
Plan (NSP) 2007-2011 Priority Area 2, Treatment, Care and Support, goal 6 and 7 are taken into
consideration.
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by increasing access to antiretroviral treatment (ART) and care for those that need it. The emphasis areas
for this activity are renovation, human capacity development and strategic information. Primary populations
include infants, men and women, people living with HIV (PLHIV), and public and private healthcare
providers. The geographic focus is on KwaZulu-Natal, Free State, Gauteng and North West.
among HIV-infected persons. This will be achieved through an intensive focus on increasing access to care
and treatment services as well as the service utilization (demand). To achieve these goals and objectives,
project Help Expand ART (HEART) will expand the geographic coverage of services during FY 2008.
HEART/South Africa is part of a larger worldwide initiative by EGPAF to support care and treatment
services, and receives both Track 1 and in-country PEPFAR funding. The program has maintained a focus
on integrating PMTCT services so as to provide a family-centered model of care that includes access to
treatment for HIV-infected pregnant women, couple counseling, partner testing and screening for TB.
EGPAF utilizes PEPFAR resources to complement activities carried out by the KwaZulu-Natal Department
of Health (KZNDOH) and private partners, such as faith-based organizations (FBOs) and other non-
governmental organizations (NGOs). These resources are utilized to fund staff, infrastructure, drugs,
laboratory testing and provide technical support. EGPAF will identify gaps in the program at the individual
site level and implement activities to address the needs. The intent is to facilitate national and provincial
plans and work together with the government and other partners to ultimately transition programs to South
African government (SAG) support.
EGPAF will provide TA to strengthen quality improvement (QI) by developing or reinforcing Standard
Operating Procedures (SOP) and ensuring mentoring and ongoing supervision. HAART regimens used will
follow national guidelines. Patient monitoring will be based on immunological, clinical and virological
responses to HAART. These responses will be checked against the drug protocols and adherence
guidelines used, to dictate the most appropriate change in treatment regimen.
sharing relationship (drugs and staff) to support the AHF care and treatment program. In addition, McCord
Hospital, a faith-based organization, is a sub-grantee of EGPAF. The EGPAF partnership with the
Department of Health (DOH) includes support for human capacity development, infrastructure rehabilitation
and technical support for sites in KwaZulu-Natal.
(1) McCord Hospital, Durban;
(2) AHF (Ithembalabantu Clinic), Umlazi, Durban;
Northdale Hospital and five referral clinics); and
Edumbe Community Health Centre (CHC) plus one referral clinic, in Zululand District
The partnership with the Department of Health (DOH) has been expanded to the rest of Zululand district,
the whole Free State province, to Ramotshere Moiloa (Zeerust) and Tswaing (Delareyville) sub-districts in
the North West, and the Eastern Ekurhuleni and Lesedi sub-districts in Gauteng.
ACTIVIES AND EXPECTED RESULTS:
ACTIVITY 1: ARV Drug Procurement
ARV drug procurement will be undertaken for one Track 1 partner (McCord Hospital) and for one in-country
partner, AIDS Health Care Foundation. All DOH sites use the DOH ARV drug procurement systems.
Generic medications purchased comply with the USG PEPFAR Task Force requirement of FDA approval as
well as approval from the Medicines Control Council of South Africa.
ACTIVITY 2: Pharmacy
McCord and AHF are both national DOH accredited ARV sites, and each have a dedicated pharmacist for
Activity Narrative: the HIV and AIDS treatment program. This has resulted in uninterrupted supply of antiretrovirals and
individualized adherence counseling to the increasing number of patients.
Systems are in place to select, procure, store, track and distribute the drugs privately. Drugs can be
sourced at short notice from private suppliers. McCord Hospital has two purchasing systems currently in
operation. These include:
(1) Rolling Forecast System - GlaxoSmithKline access program drugs, that are purchased monthly
according to a three-month committed, and nine-month open forecast updated monthly. This forecast is
determined by the program batching systems.
(2) Demand Dependant System - 24 hour order to delivery system based on demand and maintained with
minimum and maximum stock levels.
Monitoring of purchases and distribution is done both manually and electronically (Pro-Clin and Trakhealth
Systems) and produce statistical and detailed reports. If stock-outs (less than five days) occur, stock can be
purchased from an alternative source.
As the AHF/Ithembalabantu clinic is a national DOH accredited ARV site, the KZNDOH provides the clinic
with two full-time counselors specializing in counseling and testing. AHF Ithembalabantu clinic has an onsite
pharmacy, and the clinic has the capacity to serve all of its clients pharmacy needs. AHF has developed
pharmaceutical and health commodities management systems to ensure a sustainable supply of ARVs and
other relevant supplies.
The clinical and psychosocial support staff at the Ithembalabantu clinic uses a locally developed, highly
effective treatment education and adherence program that has resulted in outstanding, sustained rates of
therapy success. Treatment adherence and education classes, social service support and counseling, as
well as skills development and capacity building classes are all provided onsite. Medication adherence
training and support is given before clients begin ART. Adherence counseling is also monitored by self-
reporting, pill counting, and follow-up with patients, dedicated family members or friends.
The EGPAF drug procurement program contributes to the PEPFAR 2-7-10 goals by ensuring adequate
supply of ARV drugs for patients in treatment.
Continuing Activity: 13766
13766 3806.08 HHS/Centers for Elizabeth Glaser 6600 193.08 $455,000
7655 3806.07 HHS/Centers for Elizabeth Glaser 4505 193.07 $1,800,000
3806 3806.06 HHS/Centers for Elizabeth Glaser 2628 193.06 $1,180,000
Table 3.3.15:
existing prevention, care and treatment partners, namely the National Department of Heath (NDOH) and
provincial DOHs in KwaZulu-Natal (KZN), Free State, North West and Gauteng provinces. EGPAF will also
support McCord Hospital and the AIDS Healthcare Foundation (AHF) in KZN. It will strengthen health
systems through supporting renovations to improve patient flow at supported sites and mobile clinics to
increase access to services in rural areas. It will also provide human capacity development support and
technical assistance at all levels of service delivery, including engagement in policy development and
reviews.
The key objective is to increase access to prevention of mother-to-child transmission (PMTCT), care, and
treatment services at supported sites, especially the most disadvantaged and rural sites. Primary
populations to be targeted include infants, men, women (especially pregnant women and HIV-infected
pregnant women), people living with HIV (PLHIV), and public and private healthcare providers.
EGPAF support is aimed at strengthening health systems to ensure long-term program sustainability. In
addition to limited human capacity, space to provide consulting and counseling services is a serious
challenge at some of the EGPAF-supported sites. Patient privacy and the quality of counseling are therefore
compromised. To address existing space constraints and maintain patient confidentiality, EGPAF will
provide additional consulting and counseling space in the form of minor renovations and purchasing of
prefabricated buildings. Mobile clinics will be procured to provide services to the resource limited,
disadvantaged rural and farming communities.
EGPAF will carry out the following three activities.
ACTIVITY 1: Renovations
Some EGPAF-supported sites are not able to incorporate care and treatment services into the existing
community health centers or hospitals due to lack of space. In these instances, when requested by the
Department of Health, EGPAF will conduct a site assessment to determine specific needs (providing
additional consulting space, partitioning rooms to provide patient confidentiality) and if needed, will provide
renovations, or temporary space through provision of prefabricated buildings.
ACTIVITY 2: Mobile clinics
In expanding to Free State and North West provinces, which have greater needs for services in the
agricultural and farming areas, EGPAF has been asked by the respective DOHs to support increasing
access to PMTCT, care and treatment services through mobile clinics. In partnership with the DOH, EGPAF
is exploring the feasibility of supporting mobile clinics and dedicated staff to reaching resource-limited rural
and farming communities. Because these activities would be supported in partnership with the DOHs under
the existing Memorandum of Understanding, these services would be sustainable because at the
conclusion of direct PEPFAR support, these activities could be maintained by the respective DOH.
ACTIVITY 3: EGPAF will support human capacity development by providing additional staff based on
staffing needs; training healthcare workers on comprehensive HIV/ AIDS prevention, care, management
and treatment based on training needs identified; and providing ongoing on-site coaching, mentoring,
preceptorship and supportive supervision. EGPAF will continue to provide technical assistance to the DOH
at the national, provincial, district and site levels. EGPAF will provide technical assistance on HIV-related
policy development and implementation to community-based organizations (CBOs) that provide care and
support services in an effort to build local capacity. The CBOs' personnel will be trained on stigma and
discrimination reduction as well as community mobilization for HIV prevention, care and treatment.
Overall EGPAF support aligns with national DOH health systems strengthening policies and guidelines
(Treatment, Care and Support) of the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011,
which aims to strengthen the health system and remove barriers to access is taken into consideration to
ensure long-term program sustainability.
Construction/Renovation
Table 3.3.18:
