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 MODIFIED IN THE FOLLOWING WAYS:
ACTIVITY 5 described in COP 2008 has been moved to the TB Care Association COP. TB Care will be the
main partner on this project, working with the Medical Research Council to provide technical assistance
where necessary.
There are no modifications to ACTIVITIES 1 through 4.
-------------------------------
SUMMARY:
This project is implemented by a consortium of organizations, including the Medical Research Council of
South Africa (MRC), the Health Systems Trust, the University of the Western Cape (UWC) and Centre for
AIDS Development, Research and Evaluation (CADRE). The project focuses on improving the outcomes of
HIV-infected women and their infants through multiple approaches at the facility and the community level.
The project will also include a targeted evaluation of PMTCT effectiveness. Emphasis areas include
community mobilization/participation, needs assessment, quality assurance and supportive supervision,
strategic information, and training. Target populations include infants, women, pregnant women, people
living with HIV (PLHIV), HIV-affected families, nurses, and other healthcare workers.
BACKGROUND:
This ongoing project, started in FY 2005, builds on the PEPFAR-funded Good Start Cohort Study. The
study results highlighted the need for greater community support for HIV-infected mothers in relation to
infant feeding and postnatal care, and health systems weaknesses that have contributed to the poor
performance of PMTCT programs.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Community Peer Support Project
With FY 2005 and FY 2006 PEPFAR funding, UWC developed training materials and trained 36 locally-
identified peer supporters in basic child health skills. In FY 2007, the project focused on identifying pregnant
women in 34 project clusters, followed by providing peer support to each of these households until the
infants reached six months of age. The activity aimed to support exclusive infant feeding practices (either
exclusive breastfeeding or formula feeding); encourage mothers to attend antenatal care and to be tested
for HIV; support disclosure of HIV status; support access to child support grants; encourage women to
attend clinics postnatally for immunizations; provide cotrimoxazole and access to antiretroviral (ARV)
therapy if required; and support early cessation of breastfeeding for HIV-infected women choosing to
breastfeed. In FY 2008, the project will focus more on the early neonatal period, with the peer supporter
visits beginning within 24-48 hours after delivery. This change in focus is aimed at created greater linkages
between communities and the facility-based PMTCT programs. During their initial visits, peer supporters will
ensure that HIV-infected women's infants received nevirapine and that the women are aware of ongoing
PMTCT-specific care during the postnatal period. Funding for this activity will be used to provide a stipend
to the peer supporters, for supervision and mentoring of peer supporters and for transport to visit mothers in
the clusters. The expected results from this activity include identifying HIV-infected women and providing
community peer support to these women from the antenatal stage until the infants reach 10 weeks of age.
ACTIVITY 2: Monitoring and Evaluation:
Data collectors will be recruited to determine if the provision of peer support leads to increases in exclusive
infant feeding practices, uptake of PMTCT-specific care (e.g. nevirapine CD4 testing, infant six week
testing, cotrimoxazole) and improved infant HIV-free survival at 12 weeks. Data will be collected from
mothers enrolled in the project when their infants reach 12 weeks. Information on infant feeding practices,
morbidity, infant growth and health-seeking behavior of mothers will be collected. Dried blood spots will be
taken to determine the rate of mother-to-child transmission of HIV at 12 weeks. This data will be used to
determine the effectiveness of the peer supporter program on infant survival. The data will be reported to
the provincial departments of health and based on the findings the provinces will determine how the peer
supporter program should be scaled up.
ACTIVITY 3: Community Voluntary Counseling and Testing (VCT)
Using FY 2007 Funding, development of a pilot community-based VCT project for pregnant women is
underway. FY 2008 funding will ensure continuation of this pilot project. This activity is being undertaken in
the rural district of Sisonke in KwaZulu-Natal. It was designed in response to the finding that many pregnant
women in this district do not know their HIV status and are not accessing facility-based antenatal VCT. FY
2008 funding will ensure employment of community VCT counselors who will go door to door in their
communities identifying pregnant women and offering them home-based pre-test counseling. If women
agree to be tested, a mobile testing team led by a nurse will visit the home to perform the testing and post-
test counseling. Other household and family members will also be able to receive VCT. This project aims to
assess the feasibility and acceptability of a home-based VCT model in a rural area in South Africa.
ACTIVITY 4: PMTCT Integration
During FY 2006, this project developed a baseline assessment tool to assess the integration of PMTCT
within maternal and child health services. The assessments began in 2006/2007 in all facilities in two
districts in KwaZulu-Natal and were undertaken as a participatory process with district management teams.
During FY 2007, the results of the assessments were fed back to districts during workshops where district
teams identified interventions aimed at improving PMTCT service delivery. Examples of interventions
include provider-initiated opt-out antenatal HIV testing and an intervention to adapt the infant Road to
Health Chart to improve the identification of HIV exposed infants. The main focus has been on providing
technical assistance to district management teams to act on the identified bottlenecks to integration by
Activity Narrative: developing action plans. During FY 2008, the project aims to implement the identified interventions in the
two districts in KwaZulu-Natal and to monitor the effect of the interventions on key PMTCT indicators.
ACTIVITY 5: Facility-based Intervention
This project will involve various interventions to improve the quality of PMTCT care. Interventions would
include training health workers on appropriate use of PMTCT and HIV registers and training on
HIV/TB/PMTCT integration. During FY 2006 and 2007, two training workshops on TB/HIV/PMTCT registers
were held in Sisonke district with 50 people trained. The revised registers have been introduced in the
district. During FY 2008, the project plans to implement strategies to improve the linkages between the TB,
HIV and PMTCT program through management training, information system support and operational
research activities. This activity will be undertaken in Sisonke district, a rural part of KwaZulu-Natal.
These activities will contribute to PEPFAR's 2-7-10 goals by promoting exclusive infant feeding practices
among HIV-infected women, increasing the number of pregnant women who are aware of their HIV status
and who can access PMTCT, improving the quality of PMTCT services and providing strategic information
regarding the operational effectiveness of PMTCT. Ensuring that more pregnant mothers are aware of their
HIV status will empower more women to access PMTCT interventions, and a significant number of
postnatal HIV infections will be averted by increasing the number of women who practice exclusive feeding
during their infants' first year of life. These activities are in line with the USG goal of integrating maternal and
child health services into primary care systems.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14018
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14018 3550.08 HHS/Centers for Medical Research 6686 257.08 $1,072,500
Disease Control & Council of South
Prevention Africa
7955 3550.07 HHS/Centers for Medical Research 4508 257.07 $1,734,434
3550 3550.06 HHS/Centers for Medical Research 2705 597.06 Monitoring $250,000
Disease Control & Council of South PMTCT
Emphasis Areas
Gender
* Increasing women's access to income and productive resources
Health-related Wraparound Programs
* Child Survival Activities
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $80,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $120,000
Education
Water
Table 3.3.01:
This is a new PHE for FY09 that has been approved for $434,715.
PHE tracking number: ZA.09.0261
Title: PMTCT South African National Public Health Evaluation
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Public Health Evaluation $434,715
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
ACTIVITY 1: Drugs & HIV
Medical Research Council (MRC) will continue to work with the existing non-governmental organizations
(NGOs) to ensure outreach and prevention activities are implemented for high risk groups. In November
2008, MRC will conduct a stakeholder consultation to review methods used to achieve project targets in FY
2007. FY 2009 funds will be used to expand services geographically to other parts of South Africa by
moving into other areas not covered in FY 2007 and FY 2008.
ACTIVITY 2: Bar Project
The focus will be to expand the reach of the prevention program by rolling out the bar-based intervention to
six new sites (drinking venues) in urban areas, and conducting activities to determine its feasibility,
acceptability and effectiveness in rural settings.
ACTIVITY 3: Alcohol and HIV
Further formative work will be undertaken to better understand and quantify the pathways through which
alcohol affects HIV transmission. This will be a continuation of secondary data analysis of existing data on
burden of disease in South Africa that will be undertaken in FY 2008. In addition, following formative work,
an intervention to address alcohol and other drug (AOD) abuse and AOD-related HIV risk will be undertaken
in two medium sized manufacturing and two service industries in Cape Town and pre- and post-intervention
measures will be employed to evaluate effectiveness of the interventions. In each sector, one company will
be used as a company where the main intervention will be delivered and the other will be used for
comparison purposes with a standard (information only) intervention.
ACTIVITY 4: Alcohol & ARV adherence
Based on the formative project activities from FY 2008, the MRC will refine and pilot an intervention
program to reduce non-adherence to antiretroviral therapy (ART) due to alcohol use. The intervention will
consist primarily of a counseling program to enhance adherence. In order to monitor and evaluate the
program, the MRC will assess those who receive the program before and after their participation in order to
determine the extent to which change in their levels of adherence takes place, and to be able to make
recommendations about the use of the intervention for the general population.
ACTIVITY 5: Service Quality Metrics
MRC plans to facilitate two additional advisory group meetings in order to further the process of building
capacity for service quality monitoring (SQM) and performance measurement within substance abuse
treatment settings.
These activities have been modified to include additional foci on 1) developing capacity for service quality
and performance monitoring in a sustainable way among key stakeholders, 2) identifying and specifying
standardized measures for service quality and performance monitoring (such as provision of HIV services)
within substance abuse treatment settings, and 3) taking the recommendations from the advisory group
meetings held in FY 2008 forward by developing and designing interventions within these ongoing advisory
group meetings to apply the measures.
Using an internal evaluator, the process of introducing service quality measures into the substance abuse
treatment system and extent to which key outcomes for this phase of the project were achieved will be
evaluated. A major focus will be the extent to which the provision of HIV services and the integration of HIV
and substance abuse services are reflected in the SQM data.
ACTIVITY 6: Sexual Violence
The project has not yet started and MRC is in the process of getting institutional review board (IRB)
approval. It is a proof of concept study that aims to address the intersection of rape and HIV. The project
aims to provide training to service providers in study sites to deliver psychological support to rape survivors,
which will impact adherence to HIV post-exposure prophylaxis and decrease risky behavior following the
rape. In FY 2008, MRC will set up the study sites in Cape Town and Gauteng, develop training and testing
of the training intervention through qualitative interviews. In the first year MRC will mainly do the preliminary
qualitative research to establish the feasibility and acceptable of the intervention with the health care
workers and the rape survivors as well as setting up of the training of the health workers. In the second year
MRC will pilot test the intervention and describe its impact on mental health and sexual risk taking.
NEW ACTIVITY:
The Western Cape provincial Department of Health will be implementing Options for Health, an individual
counseling intervention to be implemented by adherence counselors. The intervention is based on a
counseling technique called motivational interviewing (MI)and is aimed at increasing medication adherence
and reducing sexual risk among people on ART. The intention is to monitor the roll-out of this intervention
over a period of five months in order to provide feedback for improving implementation. Specifically MRC
intends to: assess the readiness of counselors to adopt a new counseling style; evaluate the training
programme in order to assess its adequacy in imparting MI skills and the Options for Health eight-step
counseling protocol to counselors so that they can successfully implement it with their patients; assess
counselors' fidelity to the counseling protocol during implementation over a five month period in three
different populations of people on ART. These include 1) HIV-infected people being prepared for ARV
treatment but who are failing to meet the psychosocial criteria required for treatment, 2) people on ARVs
who are identified by ARV clinic staff as having problems with their adherence, and 3) adolescents on ARV
Activity Narrative: treatment.
---------------------
There are separate programs being implemented by the MRC in this program narrative. The first focuses on
vulnerable populations, the second on gender-based violence and HIV, and the third on male circumcision.
MRC's FY 2008 activities in the area of vulnerable populations build on FY 2005, 2006 and 2007 PEPFAR
investments to strengthen programs serving IDUs, sex workers and MSM by developing the capacity of
organizations to deliver services that enable these populations to reduce risk of HIV infection. Activities will
focus on creating multi-sectoral and multi-disciplinary consortia of substance abuse and HIV organizations
and developing organizational capacity to implement targeted community-based outreach interventions,
linking outreach efforts to risk reduction counseling related to drugs and HIV, and access and referral to
substance abuse, HIV care, treatment, and support services. In addition, the MRC will design and
implement a behavioral HIV prevention intervention to reduce sexual risk behavior associated with alcohol
use in bars in Tshwane. The major emphasis areas are the development of networks, linkages, and referral
systems; and information, education and communication.
Findings from the South African-conducted International Rapid Assessment Response and Evaluation (I-
RARE) of drug use and HIV risk behaviors among vulnerable drug using populations (injecting drug users
(IDUs), sex workers and men who have sex with men (MSM) point to: high prevalence of overlapping drug
and sexual risk behaviors; high prevalence of HIV in these populations; high levels of alcohol use and
sexual risk behaviors and barriers to access and utilization of risk reduction, substance abuse and HIV
services.
In FY 2005, PEPFAR supported MRC to conduct a rapid assessment of drug use and HIV risk among IDUs,
sex workers and MSM in Cape Town, Durban, and Pretoria. In FY 2006, PEPFAR supported the convening
of public and private partners, stakeholders, and organizations serving the target populations to develop
recommendations, based on the findings of the rapid assessment. In FY 2007 and FY 2008, the MRC, in
collaboration with a consortium of organizations and provincial governments is in the process of
implementing interventions to reduce high-risk drug use and sexual behaviors and increase access to and
utilization of services.
ACTIVITY 1: Linking and Coordination of Drug Abuse Treatment and HIV
Finding of the rapid assessment indicate lack of linkages and coordination of drug abuse treatment and HIV
services. This activity focuses ondeveloping the capacity of Non government organizations (NGOs) and
community-based organizations (CBOs) and other HIV and drug service organizations serving IDUs, sex
workers and MSM to implement interventions targeting high-risk drug use and sexual behaviors and
increase their access to and utilization of services. This activity will support the formalization of consortia
linking drug abuse treatment and HIV service delivery organizations and the development of capacity
among the consortia for the provision of comprehensive HIV and AIDS programs tailored for drug using
vulnerable populations and adapted to the local epidemic. Components will include community-based
outreach, risk reduction counseling, access and referral to HIV counseling and testing, substance abuse,
and other HIV care and treatment services, including STI services. Community workers will be trained to
access hidden populations and provide risk reduction related to violence, drug use, injecting and safer sex.
Existing training manuals will be adapted to train outreach workers to implement community-based
outreach. FY 2008 activities will be expanded to include underserved areas outside of the Durban, Cape
Town, Tshwane metropolitan areas and in Mpumalanga province.
ACTIVITY 2: Design and Implement an HIV Intervention to Reduce Sexual Risk Behavior Associated with
Alcohol use in Tshwane Bars
Using FY 2006 funding, MRC conducted formative research to identify a range of intervention methods that
may be effective in reducing HIV sexual risk behavior associated with alcohol consumption. FY 2007
funding was used to develop specific bar-based intervention using methods proven to be effective in prior
research. Future plans for this project build on FY 2006 and FY 2007 PEPFAR investments. In FY 2008, the
MRC will continue to refine the interventions and make recommendations for implementation in other
provinces and locations. FY 2008 COP activities will involve completing the pilot i; collecting three-month
follow-up data; making recommendations for adapting and scaling up the intervention to diverse socio-
cultural settings.
ACTIVITY 3: Design and Implement an HIV Intervention to Reduce Sexual Risk Behavior Associated with
Alcohol Use in Cape Town
Formative work related to (1) the design of a behavioral intervention aimed at reducing alcohol-related
sexual HIV risk and gender-related violence for women in Cape Town, (2) designing behavioral
interventions aimed at reducing drug abuse during pregnancy and associated HIV risk behavior, (3)
designing behavioral interventions aimed at reducing drug-related HIV risk behavior among first time
juvenile offenders and (4) better understanding the pathways through which alcohol affects HIV
transmission and quantifying this association.
ACTIVITY 4: Effective delivery of PEP after rape: challenge of compliance
Monitoring and support of patients on anti-retroviral therapy (ART) is an important aspect of AIDS treatment
and the daily support to patients to facilitate medication adherence during the initial stage is seen as an
essential aspect of care (NDOH National Antiretroviral treatment Guidelines, 2004). Many lessons on how
to support patients receiving post-exposure prophylaxis after a sexual assault can be gained from the ART
program, and include extensive pre-treatment information and education, encouraging use of tools such as
Activity Narrative: adherence diaries and motivational interviews during the initial period of pill-taking. The MRC is currently
engaged in a small proof of concept study that will lead to the development and testing of an information
leaflet for patient education and adherence diary and of a model of providing nurse-led telephonic support in
sites in the Western Cape and Eastern Cape with funds from Irish Aid. MRC will build on this work by
developing two components of health service delivery and undertake an evaluation to determine impact of
these on compliance with 28 day PEP courses. The first model of service delivery would be a model of
nurse-led counseling for rape survivors that could be provided during the routinely scheduled weekly follow
up visits to which patients are currently invited in services. The counseling would include adherence
counseling, but would mostly focus on providing general psychological support for rape victim/survivors.
The second model would be of follow up contact with victim/survivors on intermittent occasions during the
28 day period over which PEP is recommended. The model would seek to establish contact on days 2, 5,
13 and 20 after rape either by cell phone (~70% of South Africans have these) or home visit with the aim of
providing support and encouraging adherence. The counseling model would build on existing good practice
in the services. MRC will identify examples, study the approach and content of counseling in these settings,
and develop a short training intervention that would train staff to follow the counseling model. The
telephonic intervention would build on the MRC research in progress, but would in addition develop a model
of home visitation that would be feasible and affordable for health services, building again on current good
practice. The interventions will be implemented in the Western Cape, Eastern Cape and Gauteng Provinces
in 24 sites providing care to sexual assault victim/survivor. Target population includes all victim/survivors of
gender-based violence, including men, women and children of all ages. Victim/survivors would be given a
leaflet about rape and HIV with an adherence diary. Staff at the sites will be trained to provide counselling
during weekly follow up visits.
Activity 5: A rapid appraisal of traditional male circumcision (mc) and initiation processes
At the request of the NDOH, MRC will implement a rapid appraisal of traditional mc practices in 7 provinces
of South Africa. The purpose of the activity is to gain an in-depth understanding of the processes, practices
and meaning of initiation for boys and to gain an in-depth understanding of the community's response to the
finding that mc plays in the role of HIV prevention. The rapid appraisal will be conducted through the
implementation of focus groups, in-depth interviews and key informant interviews. The findings will be
presented to the ministry of health together with a policy brief highlighting how HIV prevention messages
and behavior change can be integrated into traditional male circumcision processes.
Continuing Activity: 14019
14019 7956.08 HHS/Centers for Medical Research 6686 257.08 $1,560,819
7956 7956.07 HHS/Centers for Medical Research 4508 257.07 $1,000,000
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
* Safe Motherhood
Estimated amount of funding that is planned for Human Capacity Development $24,728
Table 3.3.03:
The focus of the second year of the Medical Research Council (MRC) project will be upon providing follow
mentorship and technical support to the senior managers who have gone through the capacity building
process in the first phase. Support activities will include joint reviews of plans and programs, designing of
monitoring and evaluation systems and update of the nutrient values of the nutritional supplements and
foods be used in programs. MRC will expand the training program to include district and non-governmental
organization managers as well.
----------------------------
The Medical Research Council (MRC) in partnership with University of the Western Cape (UWC) will
strengthen basic care and support to people living with HIV (PLHIV) by developing training modules, and by
improving monitoring and evaluation of the impact of nutritional support provided to PLHIV. The proposed
project aims to train and build capacity throughout South Africa. This project will implement a mixture of
short and distance learning courses, and related mentoring activities. The overall aim of this activity is to (a)
strengthen nutrition programs in relation to HIV and AIDS and TB; (b) facilitate future development of
community-based programs; and (c) enable evaluation of the effects of nutrition interventions through other
programs. The target population includes national, provincial, district, sub-district, and facility level nutrition,
maternal and child health, TB and HIV managers, and non-governmental organization's (NGO) managers
who are involved in the management of TB and HIV programs at either the facility or community level.
Significant resources are invested in providing nutrition supplements to many patients on antiretroviral
treatment (ART). Hundreds of nutrition advisors and dieticians have been employed to provide nutrition
counseling, and the Department of Social Development is implementing a large HIV and AIDS livelihoods
program aimed at improving access to nutrition.
There has not been a formal evaluation of nutrition programs. However, reports from provincial government
and other food and nutrition programs in the country strongly point to the lack of human resource capacity to
implement, monitor, and evaluate these interventions optimally. This project aims to strengthen the capacity
of provincial, district and sub-district nutrition and HIV managers to design, monitor, and evaluate facility
and community-based food and nutrition interventions targeting people infected with HIV and TB.
ACTIVITES AND EXPECTED RESULTS:
Building such capacity is particularly challenging since a large number of people need to be reached but as
these people (managers) are in positions of responsibility they cannot be removed from their posts for
significant periods. The School of Public Health at the University of the Western Cape has conducted short
courses on nutrition policies and programming, nutrition information management and nutrition science for
more than 10 years, recently in collaboration with Tulane University's School of Public Health and Tropical
Medicine. However, the impact of such short courses is limited by the lack of follow up to consolidate and
implement such learning. Experience suggests that the combination of intensive face-to-face sessions along
with distance learning materials that encourage the implementation of knowledge learned, followed by
feedback and further learning can be an effective strategy. This project therefore aims to create learning
modules including a mix of face-to-face and distance learning formats. These modules are described in
detail below.
ACTIVITY 1: Nutritional Aspects of the Management of HIV and TB
This module will summarize the latest scientific evidence on the relationship between nutrition and TB/HIV;
provide updates on latest nutritional guidelines for HIV; include challenges of implementing clinical
guidelines; and provide information on aspects to consider when implementing nutrition interventions in
primary healthcare settings.
ACTIVITY 2: Nutrition Programming and Planning
This will build upon a module created by the University of the Western Cape with input from Tulane
University. The focus of this module is on community-based HIV and nutrition programs. This module will
emphasize the design, development, and implementation of community-based health and nutrition
programs, and their adaptation and application to addressing the HIV epidemic.
ACTIVITY 3: Nutrition Information Systems, Including Program Monitoring and Evaluation
This course will be based on existing modules used at Tulane University and University of the Western
Cape; a recent short course on this topic, run by UWC and Tulane with UNICEF support, provides a basis
for a distance module. Each of these modules will consist of five days of face-to-face teaching along with
readings and exercises that focus on the implementation of what has been learned. Participants may take
related distance learning courses that will count towards a masters degree in public nutrition, to be
developed under this program.
ACTIVITY 4: Mentoring and Trouble-shooting
The capacity to follow up with people trained through this process, and others working in national and local
offices, will be developed. Mentoring is already part of the UWC teaching procedures, with participants
conferring with faculty during the period of their learning (mostly in a distance format). These efforts will be
expanded to supporting nutritional interventions, which will require some strengthening of UWC/Tulane
capacities themselves. Trouble-shooting problems, as they arise, may form an integral part of this process.
The people who can provide this mentoring may be from UWC/Tulane, from other institutions (e.g. faculty of
other universities who participated in the UWC/Tulane training - and who may be providing similar training
themselves). Some resources will be needed for the mentors' time and travel expenses even though some
Activity Narrative: mentoring can be done at a distance by email for example.
Through the strengthening of and integration of nutrition into basic HIV and AIDS and TB services, the MRC
and its partners will help PEPFAR achieve its 2-7-10 goals.
Continuing Activity: 16898
16898 16898.08 HHS/Centers for Medical Research 6686 257.08 $615,819
Construction/Renovation
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $200,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $50,000
Table 3.3.08:
TBD funds will be utilized by MRC That's It for the recommended HIV/TB activities.
Table 3.3.09:
NO FY 2009 FUNDING IS REQUESTED FOR THIS ACTIVITY:
This activity was approved in the FY 2008 COP, is funded with FY 2008 PEPFAR funds, and is included
here to provide complete information for reviewers. No FY 2009 funding is requested for these activities. As
the Medical Research Council of South Africa (MRC) is dealing with research and not the implementation of
programs, a decision was made during the PEPFAR South Africa Interagency Partner Evaluation to
discontinue the TB/HIV multi-drug resistance budget as well as treatment, care and counseling activities,
and put them under a TBD Funding Opportunity Announcement. Therefore there is no need to continue
funding this program area with FY 2009 COP funds.
Continuing Activity: 14023
29539 29539.08 HHS/Centers for To Be Determined 12096 12096.08
Disease Control &
Prevention
29538 29538.08 U.S. Agency for Academy for 6451 6151.08 $66,000
International Educational
Development Development
29537 29537.08 U.S. Agency for CARE South 12095 12095.08 $2,250,000
International Africa
Development
29536 29536.08 U.S. Agency for JHPIEGO SA 12094 12094.08 $4,293,000
International
29535 29535.08 U.S. Agency for World Vision 6647 4103.08 World Vision $200,000
International South Africa
29534 29534.06 HHS/Centers for Association of 12144 12144.06 ASPH $150,000
Disease Control & Schools of Public Cooperative
Prevention Health Agreement
29533 29533.06 HHS/Centers for PATH AIDSTAR 12092 12092.06 $380,256
29532 29532.08 HHS/Centers for Deloitte Consulting 12090 12090.08 CDC Deloitte $88,380
Disease Control & Limited
29531 29531.08 HHS/Centers for University of 12088 12088.08 UCSF-Local $62,000
Disease Control & California at San
Prevention Francisco
29530 29530.05 Department of US Centers for 12085 12085.05 $251,461
Health & Human Disease Control
Services and Prevention
14023 2953.08 HHS/Centers for Medical Research 6686 257.08 $2,019,540
7660 2953.07 HHS/Centers for Medical Research 4508 257.07 $1,889,272
2953 2953.06 HHS/Centers for Medical Research 2645 257.06 TB/HIV Project $1,212,728
Continuing Activity: 14020
29559 29559.06 HHS/Centers for The American 12107 12107.06 Co Ag $45,545
Disease Control & Society for #CCU325119
Prevention Microbiology
29558 29558.06 HHS/Centers for Elizabeth Glaser 3928 3928.06 USAID/EGPAF $63,000
Disease Control & Pediatric AIDS
Prevention Foundation
29557 29557.06 HHS/Centers for US Department of 3931 3931.06 HHS/CDC $556,025
Disease Control & State ICASS
29556 29556.07 U.S. Agency for Management 12106 12106.07 USAID Track $785,500
International Sciences for 2.0 LMS ACT
Development Health
29555 29555.07 U.S. Agency for PROHEALTH 9216 9216.07 $175,000
29554 29554.08 U.S. Agency for Christian Health 9408 9408.08 USAID Track $67,382
International Association of 2.0 CHAN
Development Nigeria
29553 29553.08 U.S. Agency for Network on 12105 12105.08 USAID Track $0
International Ethics/Human 2.0 NELA
Development Rights Law
HIV/AIDS-
Prevention,
Support and Care
29552 29552.08 U.S. Agency for Gembu Center for 12103 12103.08 USAID Track $456,591
International AIDS Advocacy, 2.0 GECHAAN
29550 29550.08 U.S. Agency for Gembu Center for 12103 12103.08 USAID Track $252,660
14020 2955.08 HHS/Centers for Medical Research 6686 257.08 $1,355,000
7662 2955.07 HHS/Centers for Medical Research 4508 257.07 $2,623,000
2955 2955.06 HHS/Centers for Medical Research 2645 257.06 TB/HIV Project $1,148,000
Table 3.3.12:
ACTIVITY 1: Drugs and HIV
The Medical Research Council (MRC) will continue to work with the existing non-governmental
organizations (NGOs) to ensure voluntary counseling and testing (VCT) services are implemented for high
risk groups. Challenges identified in the midterm evaluation report will be addressed in FY 2009 to ensure
improved implementation. NGOs will continue to implement activities in accordance with FY 2008 funds. In
November 2008, MRC will conduct a stakeholders consultation to review methods used to achieve project
targets in FY 2007. Where modifications can be made to practices in FY 2008, they will implemented. For
those that cannot be implemented in FY 2008, modifications will be considered in the methodology to be
applied in FY 2009. In addition FY 2009 funds will be used to expand services geographically to other parts
of the Western Cape, Gauteng, KwaZulu-Natal and Mpumalanga by moving into other areas not covered in
FY20 07 and FY 2008. In addition services will be expanded to Limpopo province.
-------------------------
The Medical Research Council's (MRC) findings from the International Rapid Assessment Response and
Evaluation (I-RARE) of drug use and HIV risk behaviors among vulnerable drug using populations, including
injection drug users (IDUs), sex workers and men who have sex with men (MSM), in Cape Town, Durban,
and Pretoria point to: (1) high prevalence of overlapping drug and sexual risk behaviors; (2) high prevalence
of HIV in these populations; and (3) barriers to access and utilization of risk reduction, substance abuse and
HIV services. Activities of this project build upon FY 2005 and 2006 PEPFAR investments to strengthen
programs serving IDUs, sex workers, and MSM by developing the capacity of organizations in Cape Town,
Durban, and Pretoria to deliver services that enable these populations to reduce their risk of HIV infection.
Activities will focus on creating multi-sectoral and multi-disciplinary consortia of substance abuse and HIV
organizations and developing organizational capacity to implement targeted community-based outreach
interventions, and linking outreach efforts to risk reduction counseling related to drugs and HIV, and access
and referral to substance abuse, HIV care, treatment, and support services. The major emphasis area for
these activities is the development of networks, linkages, and referral systems between outreach workers,
NGO/CBOs, and healthcare service providers. Minor emphasis areas include community
mobilization/participation; information, education, and communication; linkages with other sectors and
initiatives; local organization capacity development; policy and guidance; quality assurance, quality
improvement, and supportive supervision; strategic information; and training. Primary target populations are
high-risk vulnerable populations, (including IDUs, sex workers, and MSM), and organizations that provide
service to these populations. This project is consistent with the revised South African National Drug Master
Plan and will provide guidance on how the South African Government can translate strategies into action.
Across all activities, sustainability is addressed by linking HIV counseling and testing, care and support
services for vulnerable populations, developing the capacity of existing programs, creating synergy across
organization and service provider networks, providing quality assurance and refresher trainings, and
enhancing data management systems. Legislative interests include: (1) gender, by increasing gender equity
in HIV and AIDS program; reducing violence, increasing women's access to income and productive
resources; and (2) reducing stigma and discrimination associated with HIV status and vulnerable
populations.
In FY 2005, PEPFAR supported the MRC to conduct a rapid assessment of drug use and HIV risk among
IDUs, sex workers, and MSM in Cape Town, Durban, and Pretoria. In FY 2006, PEPFAR supported the
convening of public and private partners, stakeholders, and organizations serving the target populations to
develop recommendations, based on the findings of the rapid assessment. In FY 2007, the MRC, in
collaboration with a consortium of organizations and provincial governments, is well positioned to implement
interventions to reduce high-risk drug use and sexual behaviors and increase access to and utilization of
ACTIVITY 1:
Linking Community-based Outreach to HIV Services among Injecting and Non-Injecting Drug Users, Drug
Using MSM, and Drug Using Women Engaged in Sex WorkThree separate activities focusing on the target
groups (IDUs, CSWs, and MSM) are consolidated into one activity description as they share similar
components.A major finding of the rapid assessment indicates a lack of linkages and coordination of drug
abuse treatment and HIV services. The focus of this activity is developing the capacity of NGO/CBOs and
other HIV and drug service organizations serving IDUs, sex workers, and MSM to implement interventions
targeting high-risk drug use and sexual behaviors and to increase their access to and utilization of services.
Specifically, this activity will support the formalization of consortia linking drug abuse treatment and HIV
service delivery organizations in Cape Town, Durban, and Pretoria/Johannesburg. This activity will develop
the capacity and skills among the consortia for the provision of comprehensive HIV and AIDS programs
tailored for drug users and adapted to the local epidemic. Components will include community-based
outreach, risk reduction counseling, and access and referral to HIV counseling and testing, substance
abuse, and other HIV care and treatment services. Individuals reached by outreach efforts will be linked
with tailored HIV counseling, testing, treatment, and other support services. Service providers will be cross-
trained to respond to issues of violence, drug abuse and HIV, including issues of sensitivity, confidentiality
and stigma related to vulnerable populations. To facilitate integration among drug and HIV services, a
system for referrals from counseling and testing to other services will be established in the consortia to
ensure HIV-infected and HIV-negative clients are linked to appropriate prevention, care, and treatment
services (e.g., antiretroviral treatment, PMTCT, palliative care, STI and tuberculosis treatment, substance
Activity Narrative: abuse treatment, and transitional services including job skills and income generation activities).
ACTIVITY 2:
Managing, Monitoring and Rapidly Evaluating Links and Coordination of Drug Treatment and HIV Services
for Drug Using PopulationsIn preparation for activities in FY 2007, the MRC will conduct formative key
informant and focus group interviews to ensure interventions are aligned with the current local epidemic and
adapt existing training manuals for community-based outreach. This activity will support the MRC in the
management, oversight, monitoring, and evaluation of the three activities summarized under Activity 1. The
MRC will regularly monitor all aspects of the activities, including ensuring that sub-partners coordinate
provision of trainings by local AIDS Training Centres. The MRC will establish a system for collecting data
on targets on an on-going basis. The MRC will rapidly evaluate Activity 1 to determine the relative
effectiveness of the interventions to reduce high-risk drug use and sexual behaviors and increase access
and utilization of services among the three target populations.Future plans for this project will build upon FY
2005 and 2006 PEPFAR investments and lessons learned from the implementation of the interventions in
FY 2007. In FY 2008, the MRC will continue to refine the interventions and rapidly scale them up to reach
other provinces and underserved populations. Results contribute to PEPFAR 2-7-10 goals by preventing
infections and increasing uptake of voluntary counseling and testing (VCT) among vulnerable drug using
populations to know their status and be appropriately referred to treatment services. Also, results are
aligned with South Africa goals to scale-up programs that serve IDUs, MSM, and sex workers; integrate
VCT into other healthcare delivery and by decreasing stigma and discrimination; and increase VCT services
links with referrals to health systems networks.
Continuing Activity: 14021
14021 3141.08 HHS/Centers for Medical Research 6686 257.08 $1,746,000
7664 3141.07 HHS/Centers for Medical Research 4508 257.07 $400,000
3141 3141.06 HHS/Centers for Medical Research 2645 257.06 TB/HIV Project $0
Table 3.3.14:
Funding allocated for 2009.
Continuing Activity: 14022
29549 29549.08 U.S. Agency for Network on 12105 12105.08 USAID Track $660,527
29548 29548.07 Department of To Be Determined 5831 3934.07 DAO
Defense
29547 29547.07 HHS/Centers for US Department of 12101 12101.07 State $555,052
Disease Control & State Department
29546 29546.08 HHS/Centers for Excellence 12100 12100.08 CDC RFA $50,000
Disease Control & Community
Prevention Education Welfare
Scheme (ECEWS)
29545 29545.08 HHS/Centers for Excellence 12100 12100.08 CDC RFA $50,000
29544 29544.08 HHS/Centers for Salesian Mission 12099 12099.08 CDC RFA $50,000
29543 29543.08 HHS/Centers for Salesian Mission 12099 12099.08 CDC RFA $100,000
29542 29542.08 HHS/Centers for The African Field 12109 12109.08 AFENET $40,000
Disease Control & Epidemiology
Prevention Network
29541 29541.08 HHS/Centers for US Department of 12098 12098.08 State $372,776
29540 29540.08 HHS/Centers for University 12097 12097.08 Multicountry CT $1,000,000
Disease Control & Research PHE
Prevention Corporation, LLC
14022 2954.08 HHS/Centers for Medical Research 6686 257.08 $1,164,000
7661 2954.07 HHS/Centers for Medical Research 4508 257.07 $1,020,000
2954 2954.06 HHS/Centers for Medical Research 2645 257.06 TB/HIV Project $1,682,000
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $5,889,767
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In 2001, South Africa restructured its public sector medical laboratory service and created the National Health Laboratory System
(NHLS), a parastatal organization funded through the National Department of Health (NDOH) and further supported by its fee-for-
service revenue generating activities. The NHLS is accountable to the NDOH through its Executive Board and is responsible for
public sector laboratory service delivery to approximately 85% of South Africa's health systems. The NHLS governs activities and
funds the National Institute of Communicable Diseases (NICD) to provide surveillance, research, and programmatic operations.
The NHLS also funds the National Institute of Occupational Health (NIOH) to develop policies and to support occupational health
exposure surveillance. The public service delivery arm of NHLS is comprised of approximately 260 laboratories, which include all
provincial diagnostic pathology labs, tertiary level, secondary, and primary laboratories in the nine South African provinces and
their associated district hospital laboratories. Each district laboratory supports a network of local clinics that provide primary care
In previous years, PEPFAR has provided limited direct support to the NHLS with a significant portion of COP activities focused
within the NICD to carry out the majority of laboratory related activities in the COP. In FY 2008, a new Cooperative Agreement
was awarded to the NHLS, expanding laboratory support activities across the NHLS, NIOH, and providing continued support of
the existing PEPFAR supported NICD activities. PEPFAR funds will be used to continue to address gaps identified by the NDOH,
NHLS, NIOH, and NICD, and to address laboratory-specific unmet needs and policy or administrative issues that impede full
implementation of public laboratory programs, which support the national antiretroviral treatment (ART) rollout and the
Tuberculosis Strategic Plan for South Africa, 2007-2011. Consistent with the priorities identified by the NDOH, and implemented
by the NHLS, NIOH, and NICD, PEPFAR will continue to provide funding to assure the accuracy and quality of testing services in
support of rapid scale-up of HIV testing and TB diagnostic capacity, and to build long-term sustainability of quality laboratory
systems in South Africa. In addition, PEPFAR funds will be used to fund Toga Integrated HIV Solutions (Toga), a second year
PEPFAR partner that aims to establish a network of HIV monitoring laboratories and associated service access tools to ART
settings in resource-constrained areas where existing public NHLS laboratory coverage is limited or stretched.
Toga is an organization based on the framework of an existing private molecular diagnostics laboratory. Toga provides molecular
diagnostic support to Ampath (National Pathology Support Services) and, as such, has become an integral part of the suite of
pathology services offered by that organization. Toga is comprised of a cohesive team consisting of clinical virologists, scientists,
and technologists who have accumulated considerable experience in the field of molecular biology. Toga is a valuable resource
that assists with HIV laboratory support and clinical management. Toga is committed to driving increased access to molecular HIV
diagnostic testing and treatment monitoring for all South Africans under the framework of the national HIV and ART rollout and
scale-up.
With the continuing expansion of HIV and TB services within NHLS and with significant increases in multi-drug and extensively
drug-resistant TB (MDR/XDR-TB) cases within South Africa, additional support is required to strengthen HIV and TB diagnostic
capacity and information management infrastructure. NHLS has responded to this need by planning to expand HIV diagnostics
and treatment monitoring capabilities in all nine provinces. There are 54 CD4 laboratories in the 9 provinces within the NHLS
system, but coverage within each health district is limited. There are only 14 laboratories in 5 provinces that are able to provide
viral load testing, and only 9 laboratories in 5 provinces are able to provide infant polymerase chain reaction (PCR) diagnostics.
NHLS will expand services to provide at least one CD4 laboratory per health district and will ensure that viral load and infant PCR
services are available in all the provinces. NHLS also recognizes their limited TB laboratory capacity due to high burden and
inability to capture and report MDR/XDR-TB cases to the National TB Control Programme (NTP). In response, NHLS will roll out
the line probe assay in 20 existing facilities. There is an urgent need to provide increased access to TB diagnoses and referral
services and to strengthen the management and reporting of MDR/XDR-TB cases, data mining activities, and surveillance
analysis from the existing NHLS Data Warehouse (DISA). Finally, it is critical that data is integrated into the existing national
Electronic TB Register (ETR.Net) surveillance system. The NHLS DISA system can extract laboratory data from existing NHLS
laboratory information systems and data can be imported into the ETR.Net database. The current system does require
strengthening and NHLS is actively working to improve the capacity and utility associated with this system, as well as a new
patient management system to be piloted this year.
National policies and standards on infection control programs within laboratories are limited. The NIOH is authorized to develop
policies for occupational health. PEPFAR funds will be used to promote an infection control network, and to develop robust and
manageable infection control policies and surveillance activities. Collaboration with other PEPFAR partners will assist in the
development of such policies and will lead to enhancement of existing infection control measures and implementation of national
infection control standards and monitoring for laboratory staff and other healthcare workers.
With the availability of significant technical and scientific resources within South Africa, NICD and NHLS are well placed to
continue to provide regional laboratory support within Sub-Saharan Africa. Both organizations will expand and strengthen existing
regional support mechanisms and will enhance collaboration with other PEPFAR-funded countries through the African Center for
Integrated Laboratory Training (ACILT). Expansion of services includes, but is not limited to, extending external quality assurance
(EQA) programs, TB and HIV laboratory diagnostic technical support and services, regional HIV rapid testing kit evaluations,
integrated TB/HIV training programs, and other HIV and TB related laboratory technical assistance. All regionally supported
activities will be funded by requesting countries within their COP submissions, and are not directly funded by South African
PEPFAR monies.
During FY 2009, PEPFAR funds will be used to continue support to NICD. Support includes: a) evaluating HIV incidence testing
methodologies; b) using EQA to monitor PCR DNA testing of infants and of molecular testing associated with ART for the NHLS;
c) providing quality assessments of HIV rapid test kits for the NDOH; d) assisting the NDOH in training staff in 4,000 VCT sites on
proper HIV rapid testing procedures and quality management systems, utilizing the WHO/CDC HIV Rapid Test training package;
e) implementing an operational plan to scale-up early HIV diagnosis in infants utilizing PCR testing of dry blood spots; f) assisting
the National TB Reference Laboratory in equipping and readiness preparation when completed in late 2008; and (g) providing
laboratory training for clinical laboratorians and renovating temporary student housing to accommodate long term-training
sessions under ACILT.
NICD will continue to support important strategic information activities to help inform the decisions of policy makers and program
officials regarding their HIV prevention and ART roll-out programs. These activities include HIV-1 and TB national drug resistance
and transmission surveillance; sentinel surveillance of opportunistic bacterial and fungal pathogens in HIV-infected persons;
microbiological etiological and antimicrobial resistance surveillance for other opportunistic infections; provision of training for
South African epidemiologists and laboratory workers; and collection of trend data on HIV incidence. Detailed descriptions of
these activities can be found in the Strategic Information section in the COP.
New collaborative NHLS activities aim to: a) increase national coverage of HIV and TB diagnostics (line probe assay rollout in 20
facilities) and treatment monitoring capabilities; b) ensure uniform quality assurance measures among laboratories; c) support
activities to initiate new and strengthen existing EQA programs; d) strengthen laboratory reporting systems in support of rural
clinics and laboratories; e) promote efforts to synchronize infection control activities in collaboration with the NIOH; f) investigate,
assess, validate, and implement new automated laboratory diagnostic equipment and high capacity instrumentation for high
burden diagnostics and service delivery needs; and g) expand upon the regional support and collaboration with other PEPFAR-
funded countries through the established ACILT.
Toga aims to increase national coverage of HIV diagnostics in remote rural areas by engaging local and provincial government
and placing four additional Togatainers in FY 2009. Toga has developed a Togatainer laboratory based on the MeTRo (Measure
to Roll Out) principle as a means of rolling out treatment capacity and developing a near real time laboratory information
management system. Togatainer addresses the need for peripheral deployment of these required laboratory services, recognizing
that laboratory services in the public sector are provided through regional centralized laboratories, with limited peripheral capacity
for specialized testing (e.g. CD4 and viral load).
Table 3.3.16:
The Medical Research Council of South Africa (MRC) has already conducted systematic reviews of the
monitoring and evaluation (M&E) system in the Western Cape and developed participatory approaches
towards addressing them. This has led to the establishment of a unified approach with the information, M&E
and program managers meeting and planning jointly. FY 2009 funding will focus on getting better M&E
processes implemented at the district levels. It will also further develop tools and approaches for
strengthening M&E systems in KwaZulu-Natal.
The focus will be to institutionalize the use of Respondent Driven Sampling (RDS) Surveys for surveillance
at the NDOH and build capacity at the provincial level to incorporate the outputs from HIV and behavioral
surveillance systems into decision making, planning and implementation of HIV prevention interventions.
ACTIVITY 3:
This will no longer be part of the COP in FY 2009.
ACTIVITY 4:
This activity has been moved to prevention.
This Medical Research Council of South Africa's project focuses on improving the performance of HIV
services in the public health sector. This will be achieved through a mixture of directly strengthening HIV
prevention services through interventions at the clinic level such as improving prevention activities. It will
also provide important new surveillance data on high-risk groups and increase the capacity of managers to
use data for decision-making.
ACTIVITY 1: Strengthening Health Information Systems
With FY 2006 and FY 2007 funds the Medical Research Council (MRC), in collaboration with Western Cape
Department of Health (WCDOH), have engaged with senior and district level managers to empower them to
use data for decision making. Managers have assessed primary health care (including TB/HIV) information
systems. Important changes in the way that data are collected and used have been made. Management
teams now regularly analyze routine data to measure performance of programs. To date these activities
have been conducted in select districts in the Western Cape province, but with FY 2008 funds this activity
will expand to cover the entire province. The MRC will consolidate the lessons learnt in strengthening health
information systems, and this will be used to support the expansion of a comprehensive TB/HIV program
including implementing changes in responsibilities for data collection and analysis. The organization will
produce a series of user-friendly guides and manuals to allow replication of the process of assessing and
improving information and monitoring systems in other provinces. The MRC is currently in negotiation with
the KwaZulu-Natal provincial government where a similar process of audit and quality improvement will be
implemented. Technical support to other provinces in using the materials and tools will be provided on an
ad hoc basis and as requested.
ACTIVITY 2: Respondent Driven Sampling (RDS) Surveys
With FY 2006 and FY 2007 funds, the MRC in collaboration with the WCDOH conducted two surveys using
RDS to gather behavioral and epidemiological surveillance data. These surveys capture high-risk groups
that have been missed by other surveillance methods. Specifically, these groups include men who have
multiple younger female partners and women who have multiple older male sex partners. The information
gathered from these surveys is used to guide the development of HIV prevention activities, especially those
targeting male norms and behaviors. With FY 2008 funds, the MRC will provide training and technical
support to allow the replication of RDS surveys in other parts of the country. Partner organizations that have
the capacity to perform surveys in other provinces such as KwaZulu-Natal and Gauteng will be trained and
supported to conduct RDS surveys and to perform the appropriate analysis. The MRC will also continue to
conduct surveys in the Western Cape in particular to evaluate interventions with men and women who have
multiple partners.
ACTIVITY 3: Implementation of Male Intervention the Western Cape
Following the findings of the RDS survey in 2006 that found very high levels of risky sexual behaviors
among a large network of peri-urban men, the WCDOH requested the MRC to assist them in designing,
managing and evaluating an intervention specifically targeting older men who have multiple younger female
sexual partners. The intervention will be aimed at shifting the social norms around multiple, concurrent
partners and increasing the availability and use of condoms. In the first year of the intervention the MRC will
complete the design of the intervention, gain permission from the relevant authorities and stakeholders,
recruit and train facilitators, and pilot the intervention. The intervention will based upon the peer opinion
leader approach in peri-urban setting. The intervention will build upon the RDS methodology to recruit men
who have characteristics of peer opinion and then work with them to model HIV safer attitudes and
behaviors.
ACTIVITY 4: Evaluation of a Prevention with Positives Intervention
Activity Narrative: With FY 2007 funds the MRC in collaboration with WCDOH and Human Sciences Research Council has
developed an intervention to reduce high-risk sexual behavior among people living with HIV (PLHIV) and in
particular among those who are on antiretroviral treatment (ART). The intervention is based upon two
interventions that have been previously used in the United States: Healthy Relationships, and Options for
Health. The former intervention is based on small support groups of PLHIV and typically builds on existing
support groups where they already exist while the latter is health-provider driven and builds upon existing
opportunities created during one-on-one clinical consultations by PLHIV receiving care and treatment. The
MRC will measure its effectiveness by measuring self-reported behavior changes and recording changes in
incidence of sexually transmitted diseases. In the second year of the intervention the MRC will aim to reach
all clinical settings that are providing ART in the Western Cape.
ACTIVITY 5: Strategic Information (SI) Activities Requested by the South African Government
The MRC will use a portion of the FY 2008 funds to conduct Strategic Information activities at the request of
provincial or national Departments of Health. The MRC has a close working relationship with the South
African Government and frequently receive requests for technical assistance in areas such as those
described in Activities 1 and 2. These exact activities have not yet been determined but the MRC will work
closely with the SAG as such opportunities for collaboration arise.
These activities described in this section are in line with the South African Government's priorities and those
described in the PEPFAR South Africa Five-Year Strategy.
Continuing Activity: 14024
14024 8044.08 HHS/Centers for Medical Research 6686 257.08 $1,050,000
8044 8044.07 HHS/Centers for Medical Research 4508 257.07 $800,000
Estimated amount of funding that is planned for Human Capacity Development $800,000
Table 3.3.17:
here to provide complete information for reviewers. No FY 2009 funding is requested for this activity. Based
on the PEPFAR South Africa Interagency Partner Evaluation, the review panel felt that this Medical
Research Council of South Africa (MRC) activity was not a system strengthening activity and was better
placed under the Other Sexual Prevention program area. The activity has therefore been moved to the
Other Sexual Prevention program area. Therefore there is no need to continue funding this program area
with FY 2009 COP funds.
Continuing Activity: 21635
21635 21635.08 HHS/Centers for Medical Research 6686 257.08 $127,716
Table 3.3.18:
