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:
FY 2009 funding for the Foundation for Professional Development (FPD) will be used to support the
expansion of adult HIV care and support services and to strengthen adult human capacity development
(HCD) within all the provinces where FPD works. Activities in support of adult HIV care and support focus
on: strengthening and integrating public and civil society service delivery models for people living with HIV
(PLHIV); collaborating with the South African Government (SAG) to build sustainable human and
institutional capacity to support integrated adult HIV care and support services; promoting family-centered
services through the integration of pediatric and adult HIV care programs; promoting the basic care package
aimed at promoting early referral and retention in care; supporting surveillance activities monitoring
continuity of care and integration with counseling and testing (CT), TB and HIV care and support programs;
and expanding FPD's adult specialist mentoring and referral support to strengthen doctor and nurse
capacity to provide quality adult HIV care and support; expanding integrated preventive service,
psychological care, spiritual care and social care in all HIV care and support sites; implementing routine TB
screening and active TB case finding in all HIV care and support settings; improving the linkages with and
providing support to hospices whereby FPD-employed clinical staff does ward rounds in order to ensure a
continuum of care between treatment sites and hospices for all adult HIV patients.
The adult HIV care and support program will continue to expand a multi-sectoral model of care provision
that leverages diverse resources from within a geographical area; this model has proven to be extremely
cost-effective as it leverages substantial philanthropic and volunteer resources. FPD will work closely with
faith-based organization (FBO) and non-governmental organization (NGO) partners to expand access to
clinical care for populations whereby the public sector facilities are not able to provide such care. FBOs and
NGOs that enroll patients in care and support programs will be supported with access to CD4 counts and
cotrimoxazole prophylaxis.
All FPD-supported sites will ensure that patients have access to PLHIV-led patient support groups to
maximize patient retention. The work of these support groups will be directed to focus on: status
acceptance and disclosure; stigma and discrimination; violence and coercion; male norms and behaviors;
gender equity; partner counseling and testing; treatment literacy and adherence; prevention of positives;
nutrition; alcohol; and safe sex and family planning. Support groups will also serve to link the health facility
with the community to promote a continuum of care, as well as actively trace support group members.
New activities will target the promotion of family-centered HIV care services. Activities will include: piloting
booking systems that allow families to gain access to services on the same day as a unit; and supporting
promotional and awareness campaigns encouraging disclosure and CT services for all family members.
The antiretroviral therapy (ART) clinical quality assurance system that has been developed through
collaboration between FPD and JHPIEGO will be expanded to all facilities offering adult HIV care and
support. This system uses a standards based measurement and rating (SBMR) approach with an aim to
identify and respond to challenges to improve quality of adult HIV care. SBMR activities will be
implemented by facility staff on a routine basis and by external auditors periodically.
FPD will also start a course on pain assessment and management to be rolled out to health care
professionals country-wide. All FPD supported care sites staff will also receive such training to ensure that
pain is assessed appropriately and that there is no delay in referring patients in pain to medical services
where necessary.
The electronic medical record (EMR) that is utilized by FPD-partnered ART clinics will be expanded to
encompass general HIV care and wellness activities and be available at all ART sites and be piloted at five
adult HIV-palliative care sites which provide the basic package of care components (e.g. psychological care,
spiritual care and social care). The EMR was developed at the direct request of the Tshwane District of
Health in order to strengthen and harmonize facility-based monitoring systems while ensuring that data
quality and data use are integral components of the process. Key activities for the EMR include
strengthening the integration of various HIV service points (CT, TB, HIV-palliative care, ART) and optimizing
inter-connectivity with existing SA DOH systems (District Health Information Systems; National Health
Laboratory Systems). In support of these activities, FPD will place a strong emphasis on didactic training
and ongoing on-site mentorship to build sustainable, local monitoring and evaluation and HMIS systems.
The electronic medical record (EMR) is supported on an integrated virtual private network which allows for
the electronic transfer and/or access of data between different HIV service points. This inter-connectivity
holds great potential in terms of monitoring service integration and continuity of care within a district. In the
EMR, the electronic HIV and AIDS data will be held in a physically and technically secure environment with
minimum data repositories and limited individual access. Data access will be determined by designated
user roles and rights. The existing defaulter tracer module will support active tracing of missed
appointments, mitigate loss to HIV care and work in support of appropriate and early ART initiation for
PLHIV.
---------------------------
SUMMARY:
The Foundation for Professional Development (FPD) supports the expansion of access to comprehensive
HIV and AIDS palliative care by focusing on human capacity development with a view to increasing the
detection and treatment of patients with TB and HIV co-infection. The emphasis areas for these activities
are local organization capacity building and HCD. Target populations for these activities include people
living with HIV and AIDS (PLHIV) and most at risk populations.
BACKGROUND:
Activity Narrative: FPD is a South African Private Institution of Higher Education working exclusively in the health sector in
Southern Africa. With PEPFAR funding, FPD supports the public sector expansion of access to
comprehensive HIV and AIDS care by focusing on provision of antiretroviral therapy (ART) and increasingly
basic health care (wellness programs) for people living with HIV (PLHIV) who do not yet require ART. Due
to the acknowledged drop-off of patients who test positive for HIV between testing and actually entering
ART the basic care program attempts to provide a continuum of basic care at places of testing to ensure
retention of patients.
This approach allows patients to be enrolled in a care support program that allows regular contact with
health care providers, monitoring of CD4 counts and early referral of patients into ART programs. Activities
include supporting the establishment of such programs in public sector, NGO and FBO CT sites, through
the provision of staff, training, equipment purchase, technical assistance, mentoring, and refurbishment of
facilities. Care programs offer psychosocial support through support groups and individual counseling and
treatment of opportunistic infections. The program also includes dedicated staff (tracers) who follow-up on
any patients who drop out of the program to determine the reason and where possible attempt to convince
such patients to return to the program. The emphasis areas for this activity are human capacity
development, gender, local organization capacity development and construction and renovation.
Coordination with provincial Departments of Health (DOH) takes place through Memorandums of
Understanding (MOUs). FPD provides substantial assistance initially to public sector facilities and works
towards a diminished role over time, working towards sustainability at the sites. Sub-agreements are used
to partner with NGOs and FBOs to provide care support services where public sector facilities are either
overcrowded or not accessible. Gender issues are embedded in all aspects of the project and include
collecting gender-specific data in treatment programs, linkages with NGOs working in the gender field, CT
services that specifically focus on couple counseling, domestic violence and abuse detection. Other issues
addressed by this project are: 1) Male norms and behaviors that are addressed in the counseling provided
at basic care sites. All staff actively work towards reducing violence and coercion by identifying victims of
violence.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Support to Government ART, CT and PHC clinics
PEPFAR funds are used to respond to requests from provincial DOH to support South African Government
(SAG) ART, CT and Primary Health Care Clinics (PHC) through temporarily seconding clinical and
administrative staff, providing equipment, refurbishment and technical assistance. The FPD-supported staff
will play a critical role in introducing the provision of basic care programs at these sites as they will
supplement to government staff. Patients enrolled in such programs will be linked into the electronic patient
record system currently supporting patients on ARVs to allow patient tracking, mentoring by FPD specialists
and early referral to treatment facilities.
ACTIVITY 2: Support to NGOs and FBOs
Numerous NGOs and FBOs in the areas where FPD supports ART services are involved with CT activities
but seldom provide basic care, FPD will partner with these organizations to expand their services to include
a basic care component, including regular monitoring of CD4 counts at six month intervals, diagnosis and
treatment of opportunistic infections and psychosocial support. Patients enrolled in such programs will be
linked into the electronic patient record system currently supporting patients on ARVs to allow patient
tracking, mentoring by FPD specialists and early referral to government treatment facilities. It is anticipated
that this activity will also leverage existing resources in these organizations in support of basic care
programs and to expand the services provided to patients enrolled in the basic care program especially for
psychosocial support and income generation. FPD will also provide additional support through its Compass
Project, an organizational development project funded by the Dutch Government. This project provides
technical assistance to help develop and strengthen these local organizations in the areas of governance,
management, and M&E.
ACTIVITY 3: Referral and linkages
FPD will continue to strengthen and expand the referral networks and linkages of its partner NGOs and
CBOs with care and treatment services for clients identified to be HIV-infected. Linkages with community
mobilization and outreach activities will be initiated to promote the uptake of both HIV CT and basic care
services, including the regular monitoring of CD4 counts, treatment of opportunistic infections including the
provision of cotrimoxazole, and psychosocial support.
FY 2008 COP Activities: Although FPD has not in past years been funded for basic care activities such
activities were conducted at the ART sites that FPD supports. New activities will include expanding care
support activities to where CT takes place in both public and civil society facilities. This will help to ensure
that those who are HIV-infected but not yet eligible for treatment are enrolled in a care program. Where
feasible such programs will also be introduced at Primary Care facilities. A critical component will be
integrating patient data from basic care programs into the electronic record system that currently supports
patients on ART; this will allow better patient tracking and referral and allow the FPD clinical mentoring team
to also support patients on basic care.
FPD will contribute to the PEPFAR goals of 2-7-10 by developing the capacity of organizations to expand
access to ART services for adults and children, building capacity for monitoring ART service delivery and
reaching thousands of individuals with care and ART.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13753
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13753 13753.08 U.S. Agency for Foundation for 6591 226.08 $970,000
International Professional
Development Development
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $873,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
Activity 1: Support to South African Government (SAG) antiretroviral (ART) clinics is expanding to the
Eastern Cape (2008) and the Western Cape (2009) after conclusion of memorandums of understanding
(MOUs) with these provinces.
At the request of SAG, the Foundation for Professional Development (FPD) will continue to actively assist
the Department of Health (DOH) in the accreditation of Community Health Clinics (CHCs) and Primary
Health Clinics ( PHCs) and the expansion of down referral services. The primary goal of this COP is to build
capacity at the CHC and PHC levels in order to support nurse-initiated and -driven antiretroviral therapy
(ART). At primary- and community-level, FPD will collaborate with key stakeholders to strengthen scope of
non-ART services and coordinate linkages and delivery between these services.
A key focus area is to strengthen family friendly services; these activities will include: to strengthening
integration between HIV and AIDS services and Family Planning (FP)/ Reproductive Health (RH) clinics and
Safe Motherhood programs in order to facilitate women's access to services, and partner and family
member identification and testing to enroll more men and children.
FPD will work with facility Health Management Information Systems (HMIS) systems to track patient
progress and outcomes, support data use and program improvement at site and ensure compliance with
national HIV care and treatment patient monitoring systems. Activities in 2010 will focus on developing,
strengthening and harmonizing facility- and community-based monitoring systems while ensuring that data
quality and data use are integral components of the process. Key to HMIS will be integration and inter-
communication with other DOH systems (e.g. National Health Laboratory Service (NHLS) and District
Health Information System (DHIS)). In support of these activities, FPD will place a strong emphasis on
didactic training and ongoing on-site mentoring to build sustainable, local monitoring and evaluation (M&E)
and HMIS capacity.
Activity 2: Clinical training: FPD anticipates that the number of people trained will increase with around
1,000 additional people trained due to increasing need to train teachers on HIV-related issues in the context
of the AIDS outreach activities that involve schools. The mix of course will also be adjusted to meet the
current training needs of clients and could also include courses such as an advanced HIV course and a
course that integrates the latest developments on HIV/TB and sexually transmitted infections (STIs) for
health care professionals who have completed the existing AIDS training portfolio. Depending on demand,
this activity could also be used to absorb training requests for TB training on extensively drug resistant
(XDR) TB and multi-drug resistant (MDR) TB and counseling and testing (CT) if the dedicated funds in their
respective COPs are exhausted and surplus funding is available in this COP. The FPD training model is
based on a adult education model and does not extend to direct supportive supervision at the work site , the
numbers of people trained would render such follow-up prohibitively expensive (i.e workplace supervisory
visits for 7,000 students) The indirect support model will, however, be further strengthened. This includes
access to an alumni program that provides monthly continuing education meetings in all provinces in the
country, regular news letters, access to a free HIV clinical journal every quarter and access to two toll free
support lines: the HIV Hotline that provides treatment advice and the HIV911 line that provides advice about
accessing non-governmental organization (NGO) support services.
Activity 3: Management training: Due to the successes of the course and the increasing need from
managers for a ladder of learning that allows them to increase their managerial skills as they move up in
management seniority, an Advanced Health Care Management Course will be added for around 70 more
senior AIDS managers who have completed the Certificate in Advanced Health Management. This
qualification will be acquired through a work-based action research project. This cost for this activity will be
absorbed by reducing the intake on the Certificate in Advanced Management Course with 50 students.
Activity 4: Internship program: After two years of experience with the program, it was decided to extend the
placement period for some interns to 12 months rather than 6 months. This will allow FPD to recruit higher
quality interns and also secure the cooperation of some of the hosts who have requested this extended
period.
Activity 5: Placement Activity: Africa Health Placements addresses some of the priorities related to Health
Systems Strengthening, including recruitment and placement of qualified foreign health care professionals
in the public sector. This project currently is the only project of its kind in South Africa, and FPD is working
to understand the dynamics behind health professional migration in South Africa, including migration
between the public and private sector and also between South Africa and abroad.
Activity 6: Human Capacity Development/Call Center/Clinical mentoring support: This activity is slightly
modified to include the use of international infectious diseases specialists who will come on a voluntary
basis to provide clinical mentoring in rural parts of Limpopo. The call center activity was contracted to the
National Medicines Information Centre at the University of Cape Town, which already had substantial
resources in place for this activity with the requirement that they must expand their activities to all provinces.
------------------------------------
The Foundation for Professional Development (FPD) program supports the public sector expansion of
access to comprehensive HIV and AIDS care by focusing on provision of care, and through human capacity
development (HCD). Activities supporting improved and expanded service delivery in public sector ART
clinics include the provision of staff, clinical and management training, equipment, technical assistance,
mentoring, and refurbishment of facilities. Additional HCD activities include an international volunteer and
an intern program. The emphasis areas for these activities are Human Capacity Development, Local
Organization Capacity Building and Workplace Programs. Target populations for the activities include
people living with HIV (PLHIV) and the Business Community. The activities also target most at risk
Activity Narrative: populations.
FPD is a South African private institution of higher education working exclusively in the health sector in
Southern Africa. Since FY 2005, FPD has supported treatment for thousands of PLHIV and training for
thousands of healthcare providers and managers delivering ART and related services. Coordination with
provincial Departments of Health (DOH) takes place through Memorandums of Understanding (MOUs).
FPD provides substantial assistance initially to public sector facilities and works towards a diminished role
over time, working towards sustainability at the sites. Sub-agreements are used for supporting a national
HIV consumer line (HIV 911). Gender issues are embedded in all aspects of the project and include
collecting gender specific data in treatment programs, linkages with NGOs working in the gender field,
counseling and testing (CT) services that specifically focus on couple counseling, domestic violence and
abuse detection.
Other issues addressed by this project are: 1) Male norms and behaviors that are addressed in the
counseling provided at ART sites. All staff actively work towards reducing violence and coercion by
identifying victims of violence; 2) stigma and discrimination is addressed in counseling and training
programs; and 3) volunteers, including Peace Corps volunteers, will be involved at treatment sites.
ACTIVITY 1: Support to Government ARV Clinics
(SAG) ART sites through temporarily seconding clinical and administrative staff, providing equipment,
refurbishment and technical assistance. The FPD-supported staff play a critical role in service delivery and
have been able to reduce waiting times to less than a week at most facilities. FPD works with each public
sector site to determine the number of staff needed, and the timeframe for transferring them into SAG
employment. Most sites provide an integrated system of treatment and prevention, including CT and
wellness services. These services emphasize adherence and promote ART services among referral clinics
(TB, STI & Family Planning). All sites are also linked to a system of dedicated tracers who follow-up on any
patients who drop out of treatment to determine reasons and where possible try to encourage patients to
return to treatment. All sites are pediatric treatment sites and a minimum target is set at 10% of patients.
FPD's support to SAG ARV clinics will expand substantially to include increased numbers of patients.
ACTIVITY 2: Human Capacity Development (HCD)/Clinical Training
This activity ensures a cadre of skilled healthcare practitioners able to provide care to PLHIV. Healthcare
workers will be trained in various courses (clinical management of AIDS and TB, CT, palliative care,
adherence and workplace AIDS programs) using a proven short-course training methodology that provides
training close to where participants work. PLHIV form part of the faculty to help with stigma reduction among
participants and to articulate the needs of PLHIV. To update knowledge, an alumni program including
regular continuing medical education (CME) opportunities, meetings, journals, newsletters and mentorship
has been developed. This program provides alumni with membership in a relevant professional association,
the Southern African HIV Clinicians Society. Eskom (large power and utility company) and Discovery Health
(large health insurance company) are in a PPP with FPD to financially support this training.
Training takes place in all provinces for both public and civil society organizations. For public sector training
such training is coordinated with relevant human resources departments.
ACTIVITY 3: HCD/Management Training
This activity addresses the severe shortage of skilled managers within the public, NGO and FBO sector to
manage rapid scale-up of AIDS care through a one year management training program, offered in
association with Yale University, designed to develop local organizational capacity. Students are recruited
through a competitive scholarship program and graduates are enrolled with the SA Institute of Healthcare
Managers to provide them access to alumni services. Quality assurance mechanisms for Activities 2 and 3
are those currently prescribed by the Council for Higher Education for SA Universities. Impact studies and
participant surveys and external impact assessments are also conducted on a regular basis to assess
relevance quality and impact. Results of these surveys are used to make revisions to the management
training program. The management training program will be expanded in FY 2008 to introduce a lower level
operational management course geared at clinic rather than program managers. A need for such training
has been identified during the past two years of management training that has shown that the skills needed
at the clinic manager level is much more operational rather than strategic, the current management training
program does not meet the specific need of this more junior level managers.
ACTIVITY 4: HCD/Internship Program
There is a growing need for rapid expansion of the development of human capacity to support ARV
treatment programs. Based on the success of the current internship program that improves the skills of
graduate students by partnering them with implementing PEPFAR partners or public sector institutions, FPD
will continue to support a formalized HCD Program. FPD is well placed for this activity as training and HCD
activities are FPD's core business. The USG PEPFAR Task Force is developing a more robust HCD
strategy, and this activity will contribute to that strategy. FPD will coordinate with universities and other
institutions to recruit interns and will mentor both the intern and the recipient organization to ensure that
interns are optimally utilized to promote treatment initiatives.
ACTIVITY 5: HCD/Placement Project
Activity Narrative: This activity further expands FPD's role in HCD in the public sector by providing a user-friendly recruitment
mechanism that attempts to meet severe shortages of healthcare workers in the public sector by recruiting
local and internationally qualified professionals against public sector funded vacancies, on both a
remunerated and voluntary basis. Support provided includes matching applicants with vacancies, fast-
tracking the registration of international participants and mentoring international recruits. Atlantic
Philanthropies, a charitable organization, funded the startup of this activity in 2006 through a public-private
partnership (PPP) with FPD.
ACTIVITY 6: HCD/Call Center/Clinical mentoring support
The call center will provide access for healthcare workers to infectious disease specialists, pediatricians and
clinical pharmacologists through a toll-free line for queries related to treatment and post-exposure
prophylaxis. This call centre closely cooperates with the HIV 911 Call Centre that handles consumer queries
for referral to AIDS service organizations in both the public and the civil society sectors.
FPD will contribute to the PEPFAR 2-7-10 goals by expanding access to ART services for adults and
children, building capacity for ART service delivery, and increasing the demand for and acceptance of ARV
treatment.
Continuing Activity: 13745
29309 29309.08 HHS/Centers for US Centers for 8355 8355.08 $0
Disease Control & Disease Control
Prevention and Prevention
29308 29308.05 Department of Catholic Relief 11992 11992.05 HRSA/AIDS $269,550
Health & Human Services RELIEF
Services
29307 29307.07 HHS/Centers for Children in Need 11970 11970.07 CINI $20,000
Disease Control & Institute
Prevention
29306 29306.07 HHS/Centers for Children in Need 11970 11970.07 CINI $30,000
29305 29305.07 HHS/Centers for Share Mediciti 8624 8624.07 $44,169
Disease Control & (Umbrella)
29304 29304.07 HHS/Centers for Share Mediciti 8624 8624.07 $43,000
29303 29303.08 U.S. Agency for Elizabeth Glaser 7527 7089.08 EGPAF Bilateral $200,000
International Pediatric AIDS
Development Foundation
29302 29302.07 HHS/Centers for HHS/CDC 5612 3969.07 $20,000
Disease Control &
29301 29301.07 HHS/Centers for HHS/CDC 5612 3969.07 $25,000
29300 29300.07 HHS/Centers for HHS/CDC 5612 3969.07 $45,000
13745 2930.08 U.S. Agency for Foundation for 6591 226.08 $24,705,000
7593 2930.07 U.S. Agency for Foundation for 4481 226.07 $17,250,000
2930 2930.06 U.S. Agency for Foundation for 2634 226.06 $8,915,000
Estimated amount of funding that is planned for Human Capacity Development $21,465,226
Table 3.3.09:
FY 2008 COP activities will be expanded to include:
-Expansion of pediatric HIV care and support services;
-Promotion of family-centered services;
-Addressing the palliative care needs of pediatric PLHIV;
-Linking pediatric TB screening and treatment services; and
-Expansion of the ART clinical quality assurance system.
Funding will be used to support the expansion of pediatric HIV care and support services and to strengthen
pediatric HCD within all the provinces where FPD works.
This is a continuation and expansion of work started in the previous COPs. Activities in support of pediatric
HIV care and support focus on: strengthening and integrating public and civil society service delivery
models for People Living with HIV/AIDS (PLHIV); collaborating with SAG to build sustainable human and
institutional capacity to support integrated pediatric HIV care and support services; promoting age-
appropriate and family-centered services through the integration of infant, child, adolescent and parental
wellness programs; supporting surveillance activities monitoring continuity of care and integration with
PMTCT, ANC and MCH programs; and expanding FPD's pediatric specialist mentoring and referral support
to strengthen doctor and nurse capacity to provide quality pediatric HIV care and support.
ACTIVITES AND EXPECTED RESULTS:
ACTIVITY 1: Increase pediatric enrollment in HIV care
Activities to increase pediatric enrollment in HIV care aim to establish strong linkages between HIV-related
care sites and community-based CBOs, FBOs and NGOs with a focus on HIV-exposed and HIV-infected
children and caregivers; FPD will work with community-based partners to support community awareness
and mobilization campaigns in support of pediatric HIV care and treatment; the model has proven to be
extremely cost-effective as it leverages substantial philanthropic and volunteer resources.
ACTIVITY 2: Pediatric HIV care and support program
Key components of the pediatric HIV care and support program area include age-appropriate: integrated
preventive services, psychological care, spiritual care, social care, as well as quality HIV clinical care. All
FPD-supported pediatric HIV-related care sites provide a basic package of care including clinical care
services (clinical monitoring and staging, CD4 counts, Viral Load assessments, co-trimoxazole prophylactic
treatment, vitamins A and zinc supplementation, etc).
ACTIVITY 3: Promotion of family-centered services
New activities during the COP will target the promotion of family-centered services. Activities include:
piloting booking systems that allow families to gain access to services on the same day at the same time as
a family unit; encouraging CT services for all family members; strengthening integration of services between
different service partners within a site; and expanding the linkages between FPD and PMTCT partners,
such as Mothers to Mothers and Elizabeth Glazer, in order to ensure the seamless referral from PMTCT
programs to pediatric HIV care programs. FPD has a relationship with Mothers to Mothers and South to
South - South Africa. Mother to Mothers supports PMTCT programs in FPD-partnered SAG facilities in
North West Province; South to South provides technical assistance to FPD-partnered SAG facilities for
PMTCT and clinical pediatric HIV care where FPD and SAG have identified a need for additional
assistance.
ACTIVITY 4: Addressing palliative care needs of pediatric People Living with HIV/AIDS (PLHIV)
FPD will also focus on addressing the palliative care needs of pediatric PLHIV. FPD aims to link a dedicated
hospice to each treatment site and to establish a system whereby FPD-employed clinical staff does ward
rounds in order to ensure a continuum of care between treatment sites and hospices for all pediatric HIV
patients.
encompass general pediatric HIV care and wellness activities and be available at all ART sites and be
piloted at two pediatric HIV-palliative care sites which provide basic package of care components (e.g.
psychological care, spiritual care and social care). The EMR was developed at the direct request of the
Tshwane District of Health in order to strengthen and harmonize facility-based monitoring systems while
ensuring that data quality and data use are integral components of the process. Key activities for the EMR
include strengthening the integration of various HIV service points (CT, TB, HIV-palliative care, ART) and
optimizing inter-connectivity with existing SA DOH systems (District Health Information Systems; National
Health Laboratory Systems). In support of these activities, FPD will place a strong emphasis on didactic
training and ongoing on-site mentorship to build sustainable, local monitoring and evaluation (M&E) and
Health Management Information System (HMIS) systems.
The electronic medical record (EMR) is supported on an integrated virtual private network (VPN) which
allows for the electronic transfer and/or access of data between different HIV service points. This inter-
connectivity holds great potential in terms of monitoring service integration and continuity of care within a
district. In the EMR, the electronic HIV and AIDS data will be held in a physically and technically secure
environment with minimum data repositories and limited individual access. Data access will be determined
Activity Narrative: by designated user roles and rights. The existing defaulter tracer module will support active tracing of
missed appointments, mitigate loss to HIV care and work in support of appropriate and early ART initiation
of HIV-infected and HIV-exposed children. Additional steps to ensure retention include ensuring the
establishment of PLHIV-led support groups that will support pediatric patients and care-givers on issues
such as disclosure, nutrition, alcohol, safe sex and family planning, status acceptance, treatment literacy
and adherence counseling.
ACTIVITY 5: Link to pediatric TB screening and treatment services
Due to the high prevalence of Tuberculosis and infectious diseases in the community the following activities
will be supported in collaboration with DOH facilities: (1) routine TB screening and active case finding in all
pediatric HIV care settings; (2) implementation of the isoniazid (INH) prophylaxis program for HIV-exposed
and HIV-infected children; and (3) active monitoring of immunization status and ensuring that all children's
vaccination is up-to-date. There are a number of challenges associated with the management of TB-HIV
collaboration; FPD will focus on training and mentoring to improve the management of these systems,
including: the supply chain for INH prophylaxis, as well as data management for SAG TB registers.
ACTIVITY 6: Expansion of the ART clinical quality assurance system
The ART clinical quality assurance system that has been developed through collaboration between FPD
and JHPIEGO will be expanded to all facilities offering pediatric HIV care and support. This system uses a
standards-based measurement and rating (SBMR) approach with an aim to identify and respond to
challenges to improve quality of pediatric HIV care. SBMR activities will be implemented by facility staff on a
routine basis and by external auditors periodically.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $97,000
Table 3.3.10:
people living with HIV (PLHIV) and the business community. The activities also target most at risk
populations.
ACTIVITY 1:
FPD is implementing a comprehensive care and CT model that works to increase early infant diagnosis and
to increase the proportion of children on ART to 15%. This is a continuation of work started in previous
COPs. The current pediatric target will remain at 10%.
ACTIVITY 2:
Key pediatric care and treatment activities entail: providing adequate and appropriate human resources to
provide pediatric HIV care and treatment; improving early infant diagnosis of HIV and follow-up within all
appropriate settings; strengthening linkages with prevention of mother-to-child transmission (PMTCT),
antenatal care (ANC), maternal and child health (MCH), well-baby clinics, and pediatric wards; supporting
surveillance activities, monitoring continuity of care and integration with PMTCT and ANC programs;
identifying (through pediatric HIV testing services) and initiating HIV-infected children under two years of
age on ART; implementing routine TB screening and treatment for TB in HIV-infected children and families;
providing INH prevention therapy to HIV-infected children exposed to sputum smear-positive TB; ensuring
that all pediatric patients receive cotrimoxazole prophylaxis; providing nutrition support including multi-
micronutrient supplements and supplementary feeding, if indicated; promoting age-appropriate and family-
centered services through the integration of infant, child, adolescent and parental ART programs; piloting
booking systems to allow a family group to gain access to all service on the same day; supporting FPD
pediatric specialist mentoring and referral support to strengthen general practitioner and nurse capacity to
provide quality pediatric HIV care and support; supporting pediatric program monitoring by age groups (0-2,
2-4, 5-15 years of age).
ACTIVITY 3:
Another key activity area focuses on expanding the linkages between FPD and PMTCT partners such as
Mothers to Mothers and Elizabeth Glaser Pediatric AIDS Foundation in order to ensure the seamless
referral from PMTCT programs to pediatric HIV care and treatment programs. FPD has a relationship with
Mothers to Mothers and South to South - South Africa. Mother to Mothers supports PMTCT programs in
FPD-partnered SAG facilities in North West province; South to South provides technical assistance to FPD-
partnered South African Government (SAG) facilities for PMTCT and clinical pediatric treatment where FPD
and SAG have identified a need for additional assistance.
ACTIVITY 4:
encompass specialized pediatric treatment activities and be available at all ART sites. The EMR was
developed at the direct request of the Tshwane District of Health in order to strengthen and harmonize
facility-based monitoring systems while ensuring that data quality and data use are integral components of
the process. Key activities for the EMR include strengthening the integration of various HIV service points
(CT, TB, HIV-palliative care, ART) and optimize inter-connectivity with existing South African Department of
Health (DOH) systems (District Health Information Systems; National Health Laboratory Systems). In
support of these activities, FPD will place a strong emphasis on didactic training and ongoing on-site
mentorship to build sustainable, local monitoring and evaluation and HMIS systems.
by designated user roles and rights. The existing defaulter tracer module will support active tracing of
Activity Narrative: pediatric patients who missed appointments and mitigate loss to follow-up. Additional steps to ensure
retention include ensuring the establishment of PLHIV-led support groups that will support pediatric patients
and care-givers on issues such as disclosure, nutrition, alcohol, safe sex and family planning, status
acceptance, treatment literacy and adherence.
ACTIVITY 5:
and JHPIEGO will be expanded to all facilities offering pediatric treatment services. This system uses a
standards based measurement and rating (SBMR) approach with an aim to identify and respond to
challenges to improve quality of pediatric treatment. SBMR activities will be implemented by facility staff on
a routine basis and by external auditors periodically.
* Safe Motherhood
Estimated amount of funding that is planned for Human Capacity Development $1,775,313
Table 3.3.11:
The Foundation for Professional Development (FPD) aim to second TB nurses into antiretroviral treatment
(ART) clinics was not a realistic goal that could be implemented in FPD-partnered facilities. Following
lessons learned lay counselors and caregivers would be trained to do routine TB symptom screening and to
refer TB suspects to nurses, doctors and/or the TB focal point for further investigation. Screening for TB
symptoms is well established at FPD-supported counseling and testing (CT) and ART sites, and strong
referral linkages are in place between CT, ART, Outpatient Departments and the TB focal points. Lay
counselors will also be tasked to (1) manage CT and ART-based TB suspect registers; (2) verify the
number of TB suspects in CT and ART-based TB suspect registers against the number investigated for TB
in the TB focal point's daily patient register; and (3) follow up people living with HIV (PLHIV) identified as TB
suspects based on TB symptom screening to ensure completion of TB referral from the ART and CT entry
points. The same system used for TB referral at the aforementioned sites will be expanded to prevention of
mother-to-child transmission (PMTCT) sites. TB symptom screening will form part of the routine assessment
of all pregnant women at FPD-supported facilities. Pregnant TB suspects will be referred to the TB focal
point for investigation and further management.
Emphasis will be placed on constant in-service training and mentoring of staff on TB/HIV collaboration and
TB infection prevention and control. Nurses trained in TB/HIV collaboration and infection prevention and
control will be deployed to offer technical support and continuous on-site mentoring in the different districts
supported by FPD. These nurses will also comprise part of the in-service training program at the different
facilities.
Activities in support of TB/HIV collaboration include (a) ensuring that all nurses and doctors at HIV care
sites are trained in TB/HIV and are competent in the diagnosis, management and treatment of TB and the
appropriate referral processes; (b) improving infection control and exploring facility-specific ways of limiting
PLHIV exposure to TB; (c) supporting adherence counseling activities for ART and TB treatment; and (d)
strengthening linkages to family planning and reproductive health (FP/RH) and PMTCT services for
individuals on TB treatment and/or ART. Infection control is a priority. FPD will assist SAG to conduct facility
assessments, to develop and monitor facility infection control plans; and to facilitate in-service TB infection
control training of all staff. Funding will be used to improve ventilation, install UV lights, N95 respirators, kits
for fit-testing, smoke tubes and sputum collection booths, where indicated, as well as to develop
communication and social mobilization strategies around TB-HIV co-infection.
Efforts will also be made on a facility-by-facility basis to introduce an appointment system with patients at
block times to reduce the number of patients in waiting rooms. This complies with South African infection
guidelines. Patients will be screened for TB symptoms upon arrival and TB suspects will be fast-tracked to
avoid exposing other patients to TB bacilli. Patients will also be instructed about cough-etiquette. At ART
and CT sites, systems will be put in place to triage and fast track potential TB patients for assessment and
FPD will also extend support services to CT and TB focal points at the primary care level within an ART
clinic's catchment area in order to strengthen CT service provision for newly diagnosed TB patients.
The electronic medical record (EMR), already utilized at ART sites, will be expanded to include a TB
module, and rolled out at major TB treatment facilities. The EMR will improve TB/HIV patient management,
and FPD will work closely with provincial TB program in support of this activity. The EMR was developed at
the request of the Tshwane District of Health to strengthen and harmonize facility-based monitoring systems
while ensuring that data quality and data use are integral components of the process. The EMR is critical in
strengthening the integration of various HIV service points (CT, TB, HIV palliative care, ART) and optimizing
inter-connectivity with existing South African DOH systems (e.g., Electronic TB Register). In support of
these activities, FPD will place a strong emphasis on didactic training and ongoing on-site mentorship to
build sustainable, local monitoring and evaluation (M&E) and health management information systems
(HMIS). Key outputs include (a) in-systems alerts for HIV patients identified as TB suspects who do not
complete the referral to the TB focal point (e.g., TB investigation); (b) integration of ART clinic and TB focal
point data management systems onto a single electronic platform; (c) improved access to TB data for HIV
clinicians; (d) effective referral and cross-referral linkages among program areas; (e) utilization of the
defaulter tracing module to track TB patients regardless of HIV status; and (f) improved capacity to monitor
continuity of care and barriers of access between the HIV and TB service points.
The program supports the expansion of access to comprehensive HIV and AIDS care by focusing on
service delivery and Human Capacity Development with a view to increasing the detection and treatment of
patients with TB and HIV coinfection. The emphasis areas for these activities are construction/renovation
and HCD. The target populations for these activities include people living with HIV and AIDS (PLHIV), and
most at risk populations.
The Foundation for Professional Development (FPD) is a South African Private Institution of Higher
Education working exclusively in the health sector in Southern Africa. PEPFAR funding has allowed large
scale training and antiretroviral treatment to take place over the past year. FPD supports ART sites that are
in high TB prevalence areas with case rates ranging from 300-1500:100,000 and as such there is a need to
integrate TB and HIV services, improve the diagnosis and treatment of TB and provide training to health
care professionals on TB/HIV in FY 2008. FPD provided training to over 800 clinicians and nurses on the
management of TB/HIV during FY 06 and introduced programs in all the ARV clinics it supports to increase
the identification of TB/HIV co-infected individuals while in FY 2007 the emphasis is on strengthening TB
Activity Narrative: treatment sites with regard to identification of HIV co-infected individuals an initiation of ART at such sites.
Treatment related activities are closely coordinated with provincial Departments of Health (DOH) through
memorandums of understanding (MOUs) with provincial DOH and through close coordination with district
TB programs. National Department of Health (NDOH) guidelines are also incorporated in all activities and
training programs. A gender focus is built into all aspects of the project ranging from ensuring gender parity
in uptake of testing and treatment, including gender in data collection, all counselors will be trained on
aspects relating to male norms and behavior and equal access to training activities will be ensured. It is
envisaged that FPD will be the main project implementer; however, sub-agreements with CBOs and FBOs
may be used to increase community participation and to increase CT for TB and HIV. This project will place
specific emphasis on gender issues in the context of the CT activities. All CT staff will be trained and
provided with counseling tools in order to equip them to undertake couple counseling, identify, counsel and
refer victims of sexual abuse and violence, and reduction of stigma and discrimination. Most of these
activities will be aimed at strengthening the public healthcare system, promoting closer cooperation
between the public sector and civil society institutions, and developing human capacity. Activities will offer
sustainable and long-term benefits for the South African healthcare system.
FPD will continue to work with the national and provincial departments of health and specifically with the
HAST (HIV, AIDS STI, and TB) managers to prioritize interventions designed to address weaknesses
(identified by the departments of health) in the DOTS and TB/HIV programs. FPD will focus on improving
policy adherence and patient follow-up. Individuals will be hired for each site as tracers to track patients and
ensure that referrals are completed. FPD is setting aside funding to develop (with other relevant partners or
agreement counterparts) standardized tools to ensure that policies and guidelines recommended by NDOH
are followed, including guidelines for infection control. FPD will continue to integrate TB/HIV interventions
with existing agreement programs as they work seamlessly and side by side with government employees at
government facilities.
ACTIVITY 1: Support to South African Government
PEPFAR funds will be used for human resources at public sector ART sites and surrounding TB clinics.
Funds will be utilized predominantly and in the form of salary support for FPD staff seconded to these sites.
Sustainability will be ensured through strengthening systems and developing and supplementing capacity of
existing government staff to increase identification of TB/HIV co-infected individuals, through promoting
routine HIV CT for TB patients and routine TB screening of HIV patients at ART treatment sites. This will
allow in time withdrawal of FPD seconded staff. Emphasis will also be placed on strengthening systems and
developing and supplementing capacity to increase identification of TB/HIV co-infected individuals, through
promoting routine HIV counseling and testing (CT) for TB patients and routine TB screening of HIV patients
at TB treatment sites. Dedicated and cross-trained TB/HIV counselors will be placed at all TB sites who will
actively promote CT among TB patients. TB Nurses will be deployed to all ARV sites and tasked with
increasing the diagnosis of TB, especially sputum-infected TB in patients receiving ART. TB screening will
be done by nurses following a protocol of history taking, routine sputum specimens, and x-rays as needed,
and suspected smear-negative TB will be referred to an infectious disease clinician. These dedicated
nurses will also ensure a fast track for patients requiring TB therapy and will maintain contact with patients
to ensure they are not lost to ART. Co-infected patients who are on ARV treatment and TB treatment
simultaneously will receive additional clinical monitoring due to the increased risk of Immune Reconstitution
Syndrome, and challenges in the profiling of side effects. Emphasis is placed on adherence support to
address the heightened risk of non-compliance due to high pill burden, and to cope with higher incidence of
side effects due to drug interaction and overlapping hepatotoxicity. This activity plays an institutional
strengthening role at TB sites with a view to such sites becoming ART down referral sites. PEPFAR funds
will also be used to address minor infrastructure needs e.g. sputum rooms, nebulization apparatus and
mobile x-ray facilities to improve the diagnosis and infection control of TB transmission. Funds will be
utilized for culture and sensitivity tests where MDR-TB is suspected if government protocols or facility
budgets do not make provision for such testing.
ACTIVITY 2: Outreach
Active TB case finding will be utilized at selected sites to increase uptake of TB and HIV testing among
contacts of patients with TB and HIV coinfection. Dedicated staff (mentioned in Activity 1) will actively trace
all contacts of TB patients on treatment to encourage the participation of these contacts in CT for both TB
and HIV. ACTIVITY 3: Human Capacity Development. This activity ensures a cadre of skilled healthcare
practitioners, in predominantly government service, who are able to provide care to PLHIV who are co-
infected with TB. Healthcare workers will be trained on various subjects such as: clinical management of
AIDS and TB, Management of CT, Palliative care, and Adherence and Workplace, using a proven short
course training methodology that provides training close to participants work. PLHIV form part of the faculty
to help with stigma reduction among participants and to articulate the needs of PLHIV. To maintain
knowledge, an alumni program of newsletters and regular refresher sessions has been developed. Given
the high risk that MDR-TB poses for immune compromised individuals, particular emphasis will be placed
on training facility managers, facility designers and clinical managers on infection control. Training takes
place in all provinces for both public and civil society organizations, for public sector training such training is
coordinated with relevant HR Departments. ACTIVITY 4: Referral and linkages. The strengthening and
expansion of referral networks and linkages with care and treatment services for clients identified TB/HIV co
-infected will be a central focus of the project. Linkages with community mobilization and outreach activities
will be initiated to promote the uptake of both TB and HIV CT services PEPFAR funds may be utilized in the
form of sub-awards for NGOs working in the field of DOT support and community outreach.
FY 2008 COP activities will expand on the activities successfully started in previous years. FPD will
contribute to the PEPFAR goals of 2-7-10 by developing the capacity of organizations to expand access to
ART services for adults and children, building capacity for monitoring ART service delivery and reaching
thousands of individuals with care and ART.
Continuing Activity: 13742
13742 7986.08 U.S. Agency for Foundation for 6591 226.08 $950,600
7986 7986.07 U.S. Agency for Foundation for 4481 226.07 $750,000
Estimated amount of funding that is planned for Human Capacity Development $1,045,660
Table 3.3.12:
SUMMARY/BACKGROUND:
Private medical practices, private pharmacies, and tertiary educational facilities, as described in the FY
2008 COP, were not developed. This was due to financial constraints and the success achieved with the
mobile units to gain access in communities and the workplace environment. In FY 2008, the mobile units
will service the tertiary education facilities to perform CT. The mobile units will be increased from two to a
total of six, to accommodate the expansion of services in Gauteng, North West and Mpumulanga, and new
satellite sites will be established in KZN and the Eastern Cape. This expansion is in response to current
links with civil society and South African Government (SAG) and negotiations to provide access for CT
services for a total of 200,000 potential CT clients. The Foundation for Professional Development (FPD)
anticipates a CT uptake of 50 percent in workplace settings. Three new CT sites were established at faith-
based organization (FBO) sites. These sites will be assisted in FY 2009 to market their services more
broadly to the community.
Key activities include routinly offered and client-initiated CT models in the following settings:
1) Medical Settings: A combination of routinly offered and client-initiated CT will be offered at all FPD-
partnered SAG HIV/AIDS sites. Tertiary health care settings will emphasize routine offer CT; primary care
setting will provide a combined approach of routinly offered and client-initiated CT. Key activities at SAG
sites will include awareness campaigns targeting both facility health care staff and potential clientele on the
benefits of early testing and available linkages within the facility and/or community.
2) Faith-Based Organization Settings: Stigma-free client-initiated CT will be offered at two FBOs in Gauteng
and one in Limpopo. These FBOs also serve as HIV care and support centers for clients that are referred
by the local SAG and non-governmental organization (NGO) sites.
3) Mobile Unit Settings: The mobile units provide CT access to clients for whom time and cost contribute to
barriers to access. The CT mobile units have presented opportunities to partner with numerous government
departments, companies, institutions and communities in providing CT, often in conjunction with wellness
day activities and/or HIV awareness campaigns. FPD's mobile unit's capacity to test in the workplace,
schools, tertiary institutions and in communities creates a platform from which to promote a culture to test
early and regularly. This is done in an effort to educate clients on early referral and retention in care, as
well as breaking down the stigma surrounding HIV/AIDS. FPD's education department will be utilized to
provide HIV/AIDS training to managers and supporters in an effort to increase up-take of client-initiated CT
and creating support networks.
Ongoing training and supervision facilitate a CT culture of in-depth, individualized counseling tailored to
clients' needs. FPD provides access to training to advanced CT skills such as couples, family and child
counseling and related skills such as disclosure and prevention. FPD is also training CT staff on
tuberculosis (TB) basics in order to promote and strengthen TB screening of all newly identified HIV-
infected clients. Additional CT activities will include condom promotion and provision; strengthening down-
referral mechanisms and systems through networks; the provision of CD4 testing to determine clinical
staging and care or treatment services; and linkages to clinical services to support the assessment,
diagnosis and management of sexually transmitted infections (STIs).
In order to improve CT-HIV care integration and mitigate loss to HIV care, the electronic medical record
(EMR) utilized at antiretroviral treatment (ART) sites will be expanded to include a VCT module and rolled
out at FPD-supported VCT facilities. The EMR was developed at the direct request of the Tshwane District
of Health in order to strengthen and harmonize facility-based monitoring systems while ensuring that data
strengthening the integration of various HIV service points (CT, TB, HIV-palliative care, ART) and optimize
inter-connectivity with existing South African Department of Health (DOH) systems (district health
information systems and national health laboratory systems). In support of these activities, FPD will place a
strong emphasis on didactic training and ongoing on-site mentorship to build sustainable, local monitoring
and evaluation (M&E) and health management information systems (HMIS) systems.
The EMR is supported on an integrated virtual private network (VPN) which allows for the electronic transfer
and/or access of data between different HIV service points. This inter-connectivity holds great potential in
terms of monitoring service integration and continuity of care within a district. In the EMR, the electronic
HIV/AIDS data will be held in a physically and technically secure environment with minimum data
repositories and limited individual access. Data access will be determined by designated user roles and
rights. Key outputs will be an electronic scheduling system for follow-up counseling and/or repeat CT;
increased capacity to ensure that newly identified HIV-infected clients receive CD4 counts; an electronic
referral system to link HIV-infected clients to care and treatment services; an integrated database to track
patient progress and outcomes from a CT starting point; utilization of the defaulter tracing module to track
CT clients who do not return for CD4 results and/or do not complete a referral; and improved capacity to
monitor continuity of care and barriers of access between CT and HIV care service points. The resulting
EMR results in a sound and secure HMIS system to support data use and program improvement at the site
which is consistent with and informs the national HIV care and treatment patient monitoring system.
---------------------
This Foundation for Professional Development (FPD) project focuses on promoting early diagnosis of HIV
as an entry point to wellness programs and access to prophylactic treatment. FPD will expand counseling
Activity Narrative: and testing (CT) activities through various models ranging from institutional-based CT at antiretroviral
treatment (ART) sites to introduce new easily accessible CT at sites based in civil society e.g. pharmacies,
faith-based organizations (FBOs), tertiary academic institutions and private medical practices. FPD will
focus on offering routine CT (RCT) to all patients admitted to public sector hospitals where FPD supports
ART services. All patients who test positive will be referred to wellness programs to reduce loss to treatment
initiation. The emphasis areas are gender, human capacity development and local organization capacity
development. The activities will directly and indirectly target people living with HIV (PLHIV) and most-at-risk
southern Africa. PEPFAR funding has enabled large-scale training and substantially increased access to
ART. FPD has not received PEPFAR funding for CT activities in the past, even though CT services are an
integral part of the comprehensive care package offered at a number of FPD-supported clinics since FY
2004. To date, FPD has provided training for approximately 800 clinicians and nurses on CT. Coordination
with provincial Departments of Health (DOH) takes place through Memorandums of Understanding (MOUs).
The project will focus on various gender-related activities. It is envisaged that FPD will be the main project
implementer, but given that this is a new project activity, sub-agreements with local non-governmental
organizations (NGOs) and FBOs may be used to increase community participation and to increase CT
services.
FPD's activities will be aimed at strengthening the existing healthcare system, promoting closer cooperation
between the public sector and civil society institutions, and developing human capacity. It is expected that
all activities will offer sustainable and long-term benefits for the South African healthcare system.
ACTIVITY 1: Support to the South African Government at the sites where FPD is supporting treatment
activities
FPD will increase dedicated staff who will focus on expanding CT services for couples, infants and children
and adults, as well as cross-testing (testing STI and TB patients for HIV and vice versa). Dedicated CT
nurses and counselors will offer RCT for all patients moving through these healthcare facilities. Standard
registers and negotiated performance targets will be used to drive this activity and monitor its
implementation. PEPFAR funds will largely be used for human resources (e.g. nurses and lay counselors).
PEPFAR funds will also be utilized for training and to address minor infrastructure needs where necessary
for the delivery of CT services at government, NGO, and FBO sites. PEPFAR funds will be utilized for the
procurement and distribution of HIV test kits if necessary and may be utilized for CD4 count testing where
such tests are required to increase access to care.
ACTIVITY 2: Establishment of New CT Sites
FPD will introduce new civil society-based CT services at easily accessible sites such as private medical
practices, private pharmacies, tertiary educational facilities, mobile testing sites and NGOs and FBOs. In
addition, FPD will expand of CT services in the existing treatment services sites. Outreach activities will be
introduced to create awareness of these services in the larger community with specific emphasis on at risk
groups and vulnerable populations. The introduction of new testing sites at NGOs, FBOs, student
healthcare services, private practices, and private pharmacies will ensure the widespread and sustainable
availability of CT services. Emphasis will be placed on promoting client-friendly rapid testing facilities. The
introduction of CT services in venues that are not perceived as having an HIV or AIDS connotation (private
pharmacies or private medical practices) will contribute to overcoming stigma induced barriers to accessing
CT due to fears of being seen at an "AIDS facility". Staff will be trained on proper recording and data
management.
ACTIVITY 3: Human Capacity Development
FPD will provide training in CT services for medical practitioners, lay counselors, and nurses to ensure strict
adherence to CT protocols and high quality counseling. This activity emphasize gender issues as all
participants and CT staff will be trained on couple counseling, identifying and referring of victims of sexual
abuse and violence, and stigma reduction. The program will address gender by creating an ARV-related set
of services that will increase gender equity through mitigating the burden of care on women. At the time of
CT and other ARV related services women will be identified and -- if they fit the profile -- will be referred to a
number of faith-based programs that also support the clinics and CT sites. These faith-based programs
provide women with resources ranging from accommodation, to nutritional support and job creation
programs. Male norms and behaviors are addressed in the counseling provided at these facilities and all
staff actively work towards reducing violence and coercion by identifying victims of violence. The FBO
partners provide a shelter for female victims of violence. Training takes place in all provinces for both public
and civil society organizations. For public sector training such training is coordinated with relevant human
resources departments
ACTIVITY 4: Linkages and Referrals
The strengthening and expansion of referral networks and linkages with care and treatment services for
clients identified as HIV-infected will be a central focus of the project. FPD will link with local CBOs, NGOs,
and FBOs to increase demand for CT services and to help with referral and follow up. All CT staff will be
trained on referrals and linkages. Each CT site will have a list of local service providers that patients can be
referred to. All referrals will be bi-directional and followed up to make sure that clients are accessing the
services and providers are providing the services. PEPFAR funds will largely be used for human resources
(e.g. nurses and lay counselors) in support of CT services.
Activity Narrative: PEPFAR funds will largely be used for human resources (e.g. nurses and lay counselors) in support of CT
services. PEPFAR funds will also be utilized for training and to address minor infrastructure needs where
necessary for the delivery of CT services at government sites. The government will provide test kits at
government sites and kits will be purchased for use at non government sites. Funds may be utilized for CD4
count testing where such tests are required to increase access to care. FPD will also expand new civil
society-based CT services at easily accessible sites such as tertiary educational facilities, NGOs and FBOs.
Outreach activities will be introduced to create awareness of these services in the larger community with
specific emphasis on at risk groups and vulnerable populations. The introduction of new testing sites at
NGOs, FBOs, student healthcare services will ensure the widespread and sustainable availability of CT
services. Emphasis will be placed on promoting client-friendly, provider-initiated, rapid testing.
The above activities will be continued in FY 2008. Activities will be expanded to at least 20 new sites in FY
2008.
Continuing Activity: 13743
13743 7987.08 U.S. Agency for Foundation for 6591 226.08 $900,000
7987 7987.07 U.S. Agency for Foundation for 4481 226.07 $1,100,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $1,491,461
Table 3.3.14:
A specific drive will be initiated to promote family-centered services through integration of services and by
creating booking systems that allows a family group to gain access to services on the same day. The
retention of family members in care services will be tracked through the EMR system and retention barriers
will be identified.
-----------------------------------
The Foundation for Professional Development's (FPD) treatment activities focus on building public and
private sector capacity to deliver safe, effective and affordable antiretroviral therapy (ART). PEPFAR funds
will be used to procure ARVs and other drugs to support the expansion of faith-based organization (FBO)
treatment services in Pretoria (Gauteng province), one facility in the inner city and one in a nearby township.
Services will be expanded at the Pretoria Inner-City Clinic (PICC) in collaboration with a faith-based
coalition, the Tshwane Leadership Foundation and at Leratong Hospice. Both sites have been developed by
the not-for-profit private sector, and antiretroviral drugs will only be provided to residents who cannot access
public sector treatment for specific reasons. The Leratong Hospice will begin providing ART through
PEPFAR funding in 2007. For all of the Gauteng Department of Health (GDOH) facilities assisted by FPD
other than the PICC and Leratong Hospice, drugs are provided through the South African Government's
(SAG) ART roll-out program. The emphasis areas are construction/renovation, gender, human capacity
development (HCD) and local organization capacity building. Target populations for the activities include
the general population and people living with HIV (PLHIV). FPD will consider using the Partnership for
Supply Chain Management to assist with the procurement of drugs.
Southern Africa. Previous PEPFAR funding has allowed the training of thousands of healthcare
professionals and supported the provision of ART to thousands of PLHIV in South Africa. It provides
assistance to over 25 large public sector ART roll-out facilities. Although the SAG has a robust ARV roll-out
program, it is not universally accessible. This project provides ART and related services to vulnerable
groups living in the inner-city of Pretoria and in one of the surrounding townships who cannot afford private
care and do not have access to public sector care due to factors such as long waiting lists, inability to pay
minimum public sector user fees, fear of discrimination, and stigma.
Started with FY 2006 funding, this project partners FPD in a strategic alliance with the Tshwane Leadership
Foundation and the Leratong Hospice who operate clinics that do not provide ARVs. Both partners are
FBOs that currently provide social welfare services to PLHIV in the city, including hospice care. FY 2006
funds were used at one of these facilities to serve as a rapid initiation and stabilization site for patients
whose lives are at risk due to long waiting lists. Negotiations are currently underway with the GDOH to have
these clinics accredited as down referral sites for the major ART clinics at Tshwane District Hospital and
Kalafong Hospital (both already supported by FPD). Every effort is made at all facilities to reduce stigma
through staff training, one-to-one counseling, and counseling for families and support groups. Sustainability
is partially addressed through the public-private partnership (PPP) with the Tshwane Leadership
Foundation. This organization brings together a large number of churches in the city and has access to
additional funding sources to support the project. In addition, the government supports all drugs and labs. It
is only at one clinic where FPD provides drugs. FPD is working on getting this clinic accredited so that the
provincial government will supply the drugs. FPD is also working with government to transfer responsibility
for salaries when positions are filled.
ACTIVITY 1: Procurement and Distribution of Drugs
These sites provide an integrated ART service including treatment, palliative care, wellness programs and
psychosocial support for adults and children, and income generation schemes for women. The sites have a
minimum target of 10% of patients who will be children. PEPFAR funds will be used for the procurement
and distribution of ARV drugs for the PICC and the Leratong Hospice, supporting the salaries of necessary
doctors, nurses, pharmacists, social workers, counselors, and administrative staff. This project has a close
working relationship with an FBO consortium that supports the community of the inner-city and it is
envisaged that they will provide palliative care services and psychosocial support. Subject to needs
assessments, PEPFAR funds may be used to address minor infrastructure needs. Technical assistance and
systems strengthening will be provided for forecasting drug needs, procurement, storage, and related data
systems.
ACTIVITY 2: Human Capacity Development
Human capacity development is promoted by requiring all clinical staff at the three sites to attend mandatory
training. Training for staff at these sites will include training on supply chain management to ensure proper
procurement and related systems. The pharmacist that will supervise dispensing at all sites will also receive
refresher training. As part of the overall FPD program, FPD training ensures a cadre of skilled healthcare
practitioners able to provide care to PLHIV. Healthcare workers are trained in various courses, including
clinical management of AIDS and TB, counseling and testing, palliative care, adherence and workplace
AIDS programs using a proven short-course training methodology. PLHIV form part of the faculty to help
with stigma reduction among participants and to articulate the needs of PLHIV. To maintain knowledge, an
alumni program including regular continuing medical education (CME) opportunities, meetings, journals,
newsletters and mentorship has been developed. This program provides alumni with membership in a
relevant professional association (Southern African HIV Clinicians Society). FPD's public-private partnership
(PPP) with Eskom (large power and utility company) and Discovery Health (private health insurance
Activity Narrative: company) also financially support this training. All staff at the three PEPFAR-funded facilities will access all
of the training opportunities.
ACTIVITY 3: Quality Assurance/Supportive Supervision
Quality assurance mechanisms developed through a strategic alliance with JHPIEGO will be expanded to
these sites. These quality assurance mechanisms allow clinic staff to rate all aspects of service delivery
from drug procurement to patient care. This process will lead to continuous improvement of quality and will
be rated once a year by an external consultant. In addition, monitoring of CD4 counts, viral loads, and
resistance testing are part of the monitoring system.
Continuing Activity: 13744
13744 7985.08 U.S. Agency for Foundation for 6591 226.08 $873,000
7985 7985.07 U.S. Agency for Foundation for 4481 226.07 $500,000
Estimated amount of funding that is planned for Human Capacity Development $1,746,000
Table 3.3.15:
Due to requests from both PEPFAR partners as well as fellows, the majority (80%) of master's degree
fellows work timeframes will be extended from the current six-month period to that of one year placements
on the monitoring and evaluation (M&E) systems of South African PEPFAR partners.
A PEPFAR Partner Host Organization orientation process will be added in order to improve on the
supervision, management and appropriate skills development of fellows; stable hosts will be identified for
repeat placement of Fellows.
Due to experience to-date with the logistical implications of laptop packages and internet contracts provided
to fellows as functional support and the maintenance and risk management complexity there-of, host
organizations will be expected to provide such facilities to fellows in future. Only in selected circumstances
will this service be provided to fellowship placements with the primary focus on smaller organizations with
limited funding and resource possibilities.
Higher focus will be placed on placements with South African government (SAG) facilities that require and
request SI-related technical support.
The fellowship training program will be expanded to include a broader range of skills and will be facilitated
throughout the 12 month placement timeframe to create follow-up, feedback and mentoring sessions to
maximize the element of leadership potential and management skills development.
-------------------------
The Foundation for Professional Development (FPD) program supports the expansion of access to
comprehensive HIV and AIDS care by focusing on human capacity development (HCD). The project aims to
develop human capacity in strategic information (SI) at AIDS service organizations by having master's
degree fellows work for a six-month period on the monitoring and evaluation (M&E) systems of South
African PEPFAR partners. The emphasis areas for this activity are strategic information and local
organization capacity building. In FY 2008, this fellowship program has been offered to other PEPFAR
countries whereby they can provide funds to support fellows who are recent graduates of South African
universities but must return to their country of origin after they complete their coursework. This practicum
experience with a South African PEPFAR partner will provide them with skills for future work in M&E when
they return to their countries. FPD has also offered to teach other PEPFAR countries how to start a similar
program in their country. This new activity aims to improve south-to-south capacity development.
Southern Africa. With PEPFAR funding, FPD supported treatment to thousands of people living with HIV
(PLHIV) and training for thousands of healthcare providers and managers. This activity, started in FY 2006,
supports the more formalized approach to human capacity development (HCD) needs in South Africa. It will
be scaled up through the FPD given their ability to expand to all universities. FPD, as a nation-wide training
institution, is well placed for implementation of this activity as training and other HCD activities are their core
business and FPD has well-developed relationships with other academic institutions in the country. These
relationships will create a conduit to recruit master's degree fellows from a variety of these institutions. FPD
also provides training to various PEPFAR partners and other health service institutions. FPD will facilitate
the placement of fellows with PEPFAR partners who need to strengthen their M&E capacity. With FY 2008
funding, FPD will support the expansion of access to comprehensive HIV and AIDS care by focusing on
HCD. In addition to training and mentoring, this activity will close the gaps in capacity in a number of South
African institutions implementing PEPFAR-funded activities. M&E expertise is lacking for many partners,
who must develop systems and overall capacity to document progress toward implementation of the South
African PEPFAR program. Emphasis will be placed on ensuring gender representation in the recruitment of
fellows.
ACTIVITY 1: Human Capacity Development
The project is aimed at improving the skills of graduate students at masters degree level who have a
specialization or interest in SI by partnering them with implementing PEPFAR partners or other related
AIDS service organizations. The fellows who will provide M&E and SI assistance and support to these
organizations will be recruited from South African universities that specialize in SI-related qualifications.
Both the fellows and the organizations will be technically supported by FPD, university and USG M&E staff.
In addition, an effort will be made to design projects that are of interest to the fellow, so both the
organization and the fellow will benefit.
ACTIVITY 2: Local Organization Capacity Development
The project further supports the ability of such organizations to engage in SI activities by providing them
with a fellow with specialized knowledge in SI related disciplines. The aim of the fellowship is not just to do
reports for the organization, but also to provide technical assistance in the development and maintenance of
M&E systems. It is required that the organization accepting the fellow has a full-time M&E Officer, so the
systems built during the fellowship are sustainable. Funding will be utilized to appoint a dedicated project
manager, pay stipends and transport costs for fellows and to allow FPD to coordinate with various
universities and recipient organizations with regard to recruitment, placement and evaluation of the
program. The sustainability component of this project revolves around the premise that some of the
recipient organizations will recruit the fellows at the end of their placement period. It is also expected that
fellows will have effected a substantial improvement in the strategic information capacity of the recipient
Activity Narrative: organization during their placement and that this improvement will be maintained after their departure.
FPD will contribute to the PEPFAR 2-7-10 goals by developing the capacity of organizations to expand
access to antiretroviral therapy services for adults and children, building capacity for monitoring ART service
delivery.
Continuing Activity: 13746
13746 6407.08 U.S. Agency for Foundation for 6591 226.08 $625,650
7594 6407.07 U.S. Agency for Foundation for 4481 226.07 $900,000
6407 6407.06 U.S. Agency for Foundation for 2634 226.06 $100,000
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $625,650
Table 3.3.17:
