PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
The activity has been modified in three key focus areas:
A. The Qualitative Aspects of Palliative Care
1) Retention in care: The dedicated antiretroviral therapy (ART) clinics have, until recently, focused their
attention upon the treatment of those already in need of ART. Counseling and testing and the staging of
patients have been a minor activity provided to the relatively few walk-in patients. The vast majority of
patients are already tested and staged, having been referred by the government clinics in the area. A pre-
ART register has been instituted and these patients are being followed up at the required intervals.
2) Increase the promotion of adherence again: Despite effective compliance strategies, there is invariably
more that can be done to promote adherence. Many of the patients will at this stage of the program have
been on treatment for a number of years and it will be important to introduce adherence aids such as
pillboxes and calendars to sustain the effort. Support group meetings will be continued and linkages with
home-based care organizations will be maintained.
3) Pain management and the prompt availability of doctors for the treatment of opportunistic infections have
had a decided positive effect on patient adherence to treatment. This eases the patient's experience of the
condition and promotes quality of life.
4) Increase the linkages and communication with referring government clinics, which has been problematic
on both sides due to the high workload. The emphasis on compliance is strengthened by strong referral
systems with other facilities such as local hospitals and TB treatment sites. Local hospital linkages have
proven to be invaluable with regard to prevention of mother-to-child transmission cases and the subsequent
follow-up of mother and baby.
5) Ameliorate TB education, screening and follow up.
6) Increase prevention with positives: Government-supplied condoms are inserted in every medicine
package. Referrals to family planning clinics are practiced to avoid unwanted pregnancies and provide
sexually transmitted infection (STI) management.
7) Cotrimoxazole is widely available and yet the measurement of this indicator has been sub-par. This will
be addressed and rectified. Currently cotrimoxazole is available to 100% of patients although the period on
the medication differs from patient to patient.
B. The Quantitive Aspects of Care
1) The program currently supports ART at 15 primary health clinics, a youth clinic, and two dedicated ART
clinics.
2) The clinic sites provide palliative care to all patients and all uncomplicated opportunistic infections are
treated as part of the comprehensive ART care package offered. This includes the treatment of STIs.
3) Bringing the whole family into care: A family-centered approach is followed with patients encouraged to
bring their partners and children in to be tested.
C. Service Provider Quality Improvements
1) On the side of the service providers, access has been arranged to counseling services and an employee
assistance program has been developed for staff within the HIV division. This assistance extends to
counseling, psychologists and spiritual matters.
2) A number of external clinical audits on service provision will be conducted during the period to build upon
existing benchmark data. This is designed to address qualitative aspects of care and to inform future
service provision.
-----------------------------
SUMMARY:
HIVCare will use FY 2008 funds to work with the Free State Department of Health (FSDOH) to provide
antiretroviral treatment and care in private health facilities to patients who do not have medical insurance,
either through referrals from the public sector, or self-referrals. The Free State has mainly a rural
population, with only two major metropolitan areas (Bloemfontein and Welkom). In addition, the government
rollout of HIV care and treatment has been geographically limited, with only one treatment initiating site in
each of the five districts. The major emphasis area for this program will be the development of networks,
linkages and referral systems, with minor emphasis given to quality assurance & supportive supervision,
food and nutrition support as well as commodity procurement. The target population includes men and
women; families (including infants and children) of those infected and affected factory workers and other
employed persons, and government employees - specifically teachers, nurses and other health workers
(without medical insurance). The most significant target group is those persons in the economically active
age group of the population that cannot access services in the public health system due to the high demand
for services. Additional attention is to be given to the screening and treatment of TB among the patients
attending the program. The linkage with the youth centre will ensure that the program will have a larger
proportion of younger persons being attended to specifically adolescents aged 10-14 and 15-24. This focus
on the youth should further encourage some involvement with the street youth and it is anticipated that the
program will be marketed among those NGOs working with the street youth as a testing & treatment site.
Activity Narrative: BACKGROUND:
Since 2005, the main thrust of the activity was to match the FSDOH with partners from the private sector (in
this case Netcare, the largest private sector health provider in South Africa, through their primary health
centers) in order to build private sector capacity and absorb some of the burden from state facilities. Many
FSDOH centers have waiting lists of people waiting to go on ARV treatment. Patients from these waiting
lists who meet the eligibility criteria for this program are referred from those public sector clinics to one of
the primary health centers throughout the Free State Province for treatment. The FSDOH is a collaborating
partner in this public-private partnership.
The Medicross Medical Centre in Bloemfontein, a well-equipped private primary health center, provides the
main resource base and in conjunction with three other sites in Bloemfontein and another two in Welkom,
will provide an effective means of distributing antiretroviral treatment (ART) to patients who are either
referred from state facilities or who access the sites by word of mouth. In addition patients will be able to
access a private doctor from the Netcare network in a number of rural towns across the Free State
Province. These network doctors that will be enrolling patients onto the program are based in the following
communities: Botshabelo; Kroonstad; Harrismith; Phuthithaba; Frankfort; Winberg; Warden and
Viljoenskroon.
ACTIVITIES AND EXPECTED RESULTS:
The HIVCare treatment sites will provide comprehensive palliative care to those patients mostly referred by
state clinics in immediate need of ART. The program is able to focus its attention on actual ART patients as
a result of its linkages with the Department of Health facilities in the area.
ACTIVITY 1: Clinical Care
The clinic staff comprises a full-time HIV trained doctor, nurses (with training in HIV, TB and pain
management) and counselors. Clinical activities include the usual onsite activities of any HIV clinic: ART
education and readiness assessment, drugs and pathology testing as required for proper follow-up,
adherence education and follow-up, prophylaxis of opportunistic infections, treatment of minor out-of-
hospital opportunistic infections, management of disease and or drug-related associated symptoms such as
pain and diagnosis and treatment of TB through DOT. Nutritional supplementation is provided until
nutritional status has recovered to within normal range (BMI >16). The same activities, including family
planning, are to be provided at the Youth Clinic. Prevention with positives interventions will be emphasized.
ACTIVITY 2: Psychosocial Support
Psychosocial support is provided for those patients who are in need of it through a support group which
meets weekly. Where the clinic is far from the patient's home, the patient will be referred to a support group
with a more accessible venue. For patients who are bedridden, HIVCare has strong links with the local Red
Cross home-based care organization. Patients in this instance are visited in the home with deliveries of
medication and supplements as required. Counselors regularly contact patients in need of psychosocial
support where referred by the doctor or nurses and in addition provide an important support service to the
families of patients. Consultations with a trained psychologist are also available where appropriate to patient
wellbeing. Spiritual care is not directly provided at the clinic. Those patients requiring spiritual services are
usually referred to a religious support group near their home. A priest frequently attends the support group
sessions and HIVCare has further links with both the Protestant Church and the Catholic Relief Services (a
PEPFAR partner).
ACTIVITY 3: Social Care
HIVCare clinics place emphasis on social care in the context of the family. The testing of partners is actively
promoted as is disclosure to a spouse/partner. Child testing days over weekends are regularly organized for
the children of patients. Patients are educated on their rights and on the access to social grants. A social
worker is available on call.
Patients attend the clinic monthly to collect their medication. Those that do not attend on schedule are
phoned by counselors or visited at home by a Red Cross home-based carer.
ACTIVITY 4: Integrated Prevention Services
Apart from the family members of patients, the adult clinic does not promote extensive CT sessions. This
role is fulfilled through the Youth Centre, which serves to screen and provide HIV education for
children/adolescents. The Youth Clinic is situated in close proximity to provide clinical support and
treatment. This public-private partnership has been ongoing for a number of years and includes the greater
Netcare Group in the Free State.
By providing HIV care services to a significant population of people without private insurance and school
age children, HIVCare is contributing to the PEPFAR goals of providing care for 10 million others who are
infected with HIV. These activities also support care and treatment objectives outlined in the USG Five-Year
Strategy for South Africa by expanding public-private partnerships and expanding care to an underserved
population.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13770
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13770 7989.08 HHS/Centers for HIVCARE 6603 2801.08 $582,000
Disease Control &
Prevention
7989 7989.07 HHS/Centers for HIVCARE 4374 2801.07 $450,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $212,270
Economic Strengthening
Education
Water
Table 3.3.08:
It is largely anticipated that the funding requirements in this budget period will be reduced as accreditation
processes are completed and clinics are able to draw stock from government supplies.
The antiretroviral treatment (ART) clinics have been dedicated to providing ART to eligible patients. It does
not operate as a primary health clinic although the clinic does provide care and treatment for opportunistic
infections. It has existing systems for radiology, pathology and referral and is operating effectively. Sufficient
community-based organizations have been providing home-based care (HBC), tracing and similar services.
The activity has been modified in the following key focus areas.
A. An emphasis on qualitative aspects of patient care, including:
1) Retention in care at the dedicated ART clinics have until recently focused their attention upon the
treatment of those already in need of ART. Counseling and testing and the staging of patients have been a
minor activity provided to the relatively few walk-in patients. The vast majority of patients are already tested
and staged, having been referred by the State clinics in the area. A pre-ART register has been instituted
and these patients are being followed up at the required intervals. In addition to the clinics activities a
separate call center communicates with each patient in terms of a preset protocol with the objective of
informing, educating and promoting the patients personal interest in his/her condition.
2) Support group meetings will be continued and linkages with HBC organizations will be maintained.
3) Increase the linkages and communication with referring State clinics which has been problematic on both
sides due to the high workload. The emphasis on compliance is strengthened by strong referral systems
with other facilities such as local hospitals and TB treatment sites. Local hospital linkages have proven to be
invaluable with regard to PMTCT cases and the subsequent follow up of mother and baby.
4) Ameliorate TB education, screening and follow-up.
5) Increase prevention with positives: State-supplied condoms are inserted in every medicine package and
referrals to family planning clinics manage unwanted pregnancies and sexually transmitted infections
(STIs).
6) All patients accessing the ART centers have access to trained professional and lay counselors as well as
to psychologists should this be required. This assists in the treatment process by providing coping
mechanisms for the patient.
7) All ARV medication is issued on a doctor's script and an individual treatment plan is maintained for each
patient. This is overseen by an external clinical advisor who is both a highly experienced and qualified HIV
clinician. In a similar fashion all switching and treatment changes take place following discussion between
the treating doctor and the medical advisor. This ensures quality of care as well as continuity of referrals
where this is required.
8) All treatment protocols utilized are those of the National Department of Health in order to facilitate the
return of the patients to State care upon the cessation of funding.
B. An emphasis on quantitative aspects of patient care, including:
1) The Youth Clinic offers an outreach service to local church groups, orphanages and nursery schools in
order to promote the early identification of HIV-infected persons.
2) The program currently supports ART at 15 primary health clinics, a Youth clinic as well as two dedicated
ART clinics.
3) The clinic sites provide palliative care to all patients and all uncomplicated opportunistic infections are
treated as part of the comprehensive ART care package offered. This includes the treatment of sexually
transmitted diseases.
4) The doctor practices that are supported are able to offer routine HIV counseling and testing and this will
be provided. In addition this will be coordinated from the Head Office to ensure accost effective uptake.
5) Cotrimoxazole is widely available and yet the measurement of this indicator have been found wanting.
This will be addressed and rectified. Currently cotrimoxazole is available to 100% of patients although the
period on the medication differs from patient to patient.
6) Bringing the whole family into care: A family centered approach is followed with patients encouraged to
bring their partners and children and to have them test.
------------------------
HIVCare will use FY 2008 PEPFAR funds to work with the Free State Department of Health to provide
antiretroviral treatment in a private health facility to patients who do not have medical insurance and who
are referred from the public sector waiting lists for treatment. The Medicross Medical Centre, a well
equipped private primary healthcare center, provides the main resource base and in conjunction with
thirteen other sites, will provide an effective means of properly distributing ART to patients who are either
referred from public sector facilities or who access the site by word of mouth. The emphasis areas for this
program will be human capacity development and local organization capacity building. The target population
includes men and women; families (including infants and children) of those infected and affected, factory
workers and other employed persons, and government employees - specifically teachers, nurses and other
health workers (who do not have medical insurance). A further specific population that will be targeted will
be secondary school children. The most significant target group is those persons that cannot access
services in the public health system.
All treatment administered is done in strict accordance with South African Government (SAG) guidelines
Activity Narrative: and with due regard to the need to transfer the patients back to SAG facilities when feasible. Additional
attention is to be given to the screening and treatment of TB amongst the patients attending the program.
The linkage with the youth centre will ensure that we have a larger proportion of younger persons being
attended to, specifically adolescents aged 10-14 and 15-24. This focus on the youth should further
encourage some involvement with the street youth and it is anticipated that the program will be marketed
amongst those NGOs working with the street youth as a testing and treatment site.
BACKGROUND:
PEPFAR funding for the HIVCare project commenced in June 2005. The main thrust of the activity was to
match the Free State Department of Health (FSDOH) with partners from the private sector (in this case
Netcare, the largest private sector health provider in South Africa) in order to build private sector capacity
and absorb some of the burden from public sector facilities. Many FSDOH centers have waiting lists of
people for ARV treatment. Patients from these waiting lists who meet the eligibility criteria for this program
are referred from those public sector clinics to one of the four primary health centers in Bloemfontein and
one in Welkom for treatment. The FSDOH is a collaborating partner in this public-private partnership.
The HIVCare treatment sites will provide all medical services related to the delivery of HIV care and
treatment. Management and coordination activities will be provided by HIVCare. The majority of patients will
be referred from public clinics in the FSDOH network to the thirteen HIVCare centers based on the following
criteria: (1) Clinical criteria (CD4 <200 cells/mm3 or WHO stage III or IV); (2) Inability to pay (lack of private
insurance or state coverage) and (3) Overcrowding at referring clinic.
Among the non-medical criteria for enrollment (based on the SAG's Operational Plan for Comprehensive
HIV and AIDS Care, Management and Treatment for South Africa and a request from the FSDOH), is that
the patients have a stable point of contact to assure continued follow-up. HIVCare relies heavily on
telephone access to ensure that patients keep scheduled physician visits, collect their medication, and
respond to other questions.
Patients referred to the program receive PEPFAR-funded consultations and exams from HIVCare
physicians, who will also order relevant tests and refer patients to expert specialists when necessary. The
package of care also includes counseling and testing (for patients who do not know their status), adherence
counseling, and access to therapeutic nutrition support as per the national guidelines and OGAC guidance.
An initiative aimed at improving overall compliance and treatment efficacy is the distribution with the
medication of a parcel of nutritional supplements. The supplements provide a single fortified meal per day
for each of the indigent patients on ART and aids in the absorption of the medication. Patients are assessed
based upon their BMI and general condition. Benchmark weight amongst patients starting ART at the center
is just 55kg( -5.2). The patients that are on the waiting lists for ARV treatment at the public health facilities
are offered the option of attending the HIVCare treatment sites. The patients that choose the HIVCare
program present at the treatment center with a referral letter and other clinical notes (e.g. CD4 count) from
the public health center. The patients meeting the clinical criteria are enrolled onto the program. Where
patients present directly at the HIVCare treatment center and are found to be in need of TB treatment or
treatment of an opportunistic infection requiring specialized treatment, hospitalization or investigative
procedures, are referred to the local public facility for care. Similarly radiography and pathology for
investigative procedures is provided by the public health facilities. This is based on the request from the
FSDOH to provide only a limited range of services, and the HIVCare program is only meant to assist with
the unmet demand at the public sector sites, rather than create a parallel health service delivery program.
Due to this working relationship, referrals between the HIVCare sites and public sector sites are seamless.
With regard to pregnant patients, they receive PMTCT drugs and information on its use prior to the birth
event. Subsequent to this, the patient returns to the center to continue treatment and unless specifically
rejected by the mother, infant formula is made available. Prophylaxis syrup is also made available to the
infant until it is possible to perform the PCR test to determine the infant's status.
Data is shared with the DOH on two levels. Firstly data on all new patients enrolled onto ART is provided by
the pharmacy to the provincial authorities. Secondly a return is submitted to the National Department of
Health, with a copy to the provincial DOH, giving the data of all those on the program. In addition to this, a
representative of HIVCare attends the monthly provincial task team meetings.
In addition, HIVCare will expand its existing project to target children as part of its continuum of care. This
activity targets children between the ages of six and secondary school age through HIV awareness
activities. Older children will be provided with access to HIV care and treatment, as well as psychosocial
support services (in line with relevant South African laws and regulations pertaining to healthcare for
minors). A teen center catering for the specific needs of this age group has been established and PEPFAR
funding will be applied in continuing the treatment started in FY 2007. The funds will be specifically applied
in providing ARV treatment to children and some prevention materials (including abstinence and being
faithful) at a number of schools in order to expand awareness of HIV care and treatment services offered by
the program. The teen center will provide a testing service to local orphanages with treatment where not
otherwise provided through SAG resources. Other referrals will be made by the FSDOH clinics in the area
and through HIVCare's collaboration with other organizations, including the Anglican Church and Red Cross
Society.
A number of support groups have been established aimed at involving the partners of the mainly female
patients in the treatment process. These groups meet weekly and the aim is to promote support for the
patients among their family members and also to get their partners to test and where necessary to join the
treatment group. The Welkom area will include two treatment sites which should encourage a greater
proportion of male patients into the program as a result of the number of large mines in close proximity and
their use of migrant, mainly male labor. Case managers employed by HIVCare provide psychosocial
support, treatment management and compliance promotion. This individualized management approach will
Activity Narrative: also include telephone support for patients and their families, information about the condition and its
symptoms, nutrition advice and healthy living. Case managers actively assist patients to identify and utilize
the family and community structures that may exist as well as providing information on other available
support . A defaulter program exists that utilizes local resources - Home-based Carers - to follow up not
compliant patients. The service is provided through the church and the Red Cross.
By providing comprehensive ARV services to patients and promoting ARV services for a large population of
underserved people living with HIV, and who do not have private insurance) and school age children,
HIVCare is contributing to the PEPFAR goals of placing 2 million people on ARV treatment and providing
care for 10 million others who are infected with HIV. These activities also support care and treatment
objectives outlined in the USG Five-Year Strategy for South Africa by expanding public-private partnerships
and expanding care to an underserved population.
Continuing Activity: 13773
13773 3299.08 HHS/Centers for HIVCARE 6603 2801.08 $2,134,000
7312 3299.07 HHS/Centers for HIVCARE 4374 2801.07 $1,550,000
3299 3299.06 HHS/Centers for HIVCARE 2801 2801.06 $804,000
Table 3.3.09:
FY 2008 COP activities will be expanded to include:
-A focus on differentiating and strengthening the qualitative and quantitative aspects of pediatric care and
support services, as well as reporting of results and findings.
HIVCare will use FY 2009 PEPFAR funds to work with the Free State Department of Health to provide
equipped private primary health care center, provides the main resource base and in conjunction with
referred from public sector facilities or who access the sites by word of mouth. The emphasis areas for this
includes the infants and children of men and women (infected and affected), factory workers and other
(who do not have medical insurance). A further specific population that will be targeted will be secondary
school children. The most significant target group is those persons that cannot access services in the public
health system.
are referred from those public sector clinics to one of the primary health centers throughout the Free State
province for treatment. The FSDOH is a collaborating partner in this public-private partnership.
In Sub Saharan Africa, AIDS has become one of the leading causes of death among children under 5 years.
A recent Actuarial Society of South Africa (ASSA) study revealed an incidence of HIV among children at
birth of 4.1%. Patients that are enrolled will proportionately increase the percentage of pediatric patients on
the program. As a population group, this sector remains underserved.
be referred from public clinics in the FSDOH network to the HIVCare centers based on the following criteria:
(1) Clinical (CD4 <200 cells/mm3 or WHO stage III or IV, [South African National Guidelines]); (2) Inability to
pay (lack of private insurance or state coverage); and (3) Capacity constraints at referring clinic. Patients
are referred in general by adult treatment centers.
During the course of the treatment of adults, HIVCare was, of necessity, required to treat and manage the
children of existing patients. This was later formalized and the children of patients are now routinely tested
and included in the treatment program. At that time treatment for HIV and related conditions at the time was
not readily available to young children within local structures and only one specialized pediatric clinic
existed. In late 2007 HIVCare launched a dedicated site for Voluntary Counseling & Testing (VCT) and
treatment of adolescents (12-18 years).
ACTIVITY 1:
package of care also includes counseling and testing (for patients who do not know their status and
including early PCR testing for babies), adherence counseling, and access to therapeutic nutrition support
as per the national guidelines and OGAC guidance. An initiative aimed at improving overall compliance and
treatment efficacy is the distribution with the medication of a parcel of nutritional supplements. The
supplements provide a single fortified meal per day for each of the indigent patients on ART and aids in the
absorption of the medication. Patients are assessed based upon their body mass index (BMI) and general
condition. The patients meeting the pediatric clinical criteria are enrolled onto the program. Patients
presenting directly at the HIVCare treatment center and are found to be in need of TB treatment or
treatment of an opportunistic infection are addressed unless hospitalization is required. Similarly
radiography and pathology for investigative procedures are available.
ACTIVITY 2:
Due to the high (up to 19%) prevalence of HIV among teenagers in the Free State province, HIVCare
introduced a large VCT program targeted at this population group. The Youth Clinic provides on site
ancillary services, such as psychologists and social workers. In addition the clinic promotes abstinence,
being faithful, responsible condom use and informs on family planning. Young women are referred to State
family planning sites for contraception where needed.
Data is shared with the FSDOH on two levels. Firstly data on all new patients enrolled onto ART is provided
by the pharmacy to the provincial authorities. Secondly a return is submitted to the National Department of
Health, with a copy to the Provincial FSDOH, giving the data of all those on the program. Additionally, a
representative of HIVCare attends the monthly provincial HIV task team meetings.
Activity Narrative: ACTIVITY 3:
underserved people living with HIV (who do not have private insurance) and school age children, HIVCare
is contributing to the PEPFAR goals of placing 2 million people on ARV treatment and providing care for 10
million others who are infected with HIV. These activities also support care and treatment objectives
outlined in the USG Five-Year Strategy for South Africa by expanding public-private partnerships and
expanding care to an underserved population. The HIVCare program was initiated as a Public Private
Partnership between the Department of Health in the Free State, PEPFAR and Netcare Pty Ltd. In terms of
this partnership, some of the patient burden of State amenities would be alleviated through the use of
private sector primary health facilities throughout the province. In summary, the PPP places the following
obligations on the three parties. Netcare's HIVCare program provides all medical services related to the
delivery of HIV care and treatment through its primary health sites in the province, funding for the treatment
of patients is provided by PEPFAR and the Free State Department of Health provides technical support,
hospitalizations and specialist treatment where required.
The activity has been modified since inception in two key focus areas:
1-The qualitative aspects of patient care. i.e.:
a) Ameliorate TB education, screening and follow-up.
b) Bringing the whole family into care: A family centered approach is followed with patients encouraged to
bring their partners and children in and to have them tested for HIV. Days are organized for the testing of
patient's children (children represent actually 5% of the patients in the adult clinic and at the doctors
network.
c) Referrals are mainly from State primary health centers with children often in a poor physical condition
upon presenting at the clinic.
d) Primary caregivers are biological mothers, grandmothers or aunts. Attention is to be given to contacting
these caregivers through day care, PMTCT clinics and church groupings.
e) Efforts around the family are mainly centered on the Youth Clinic established by HIVCare with FY 2007
funding, where access to social workers is made possible as needed.
f) The family needs of the Youth Clinic differs from that of the ART sites in that parental consent issues
predominate at the Youth Clinic while at the ART sites, partner participation and testing are key concerns
2-The quantitative aspects of patient care. i.e.:
a) The program currently supports ART at 15 primary health clinics, a Youth Clinic as well as two dedicated
b) A special children's register is to be maintained at the ART sites and Youth Clinic.
Two specific challenges that are being addressed in the current period are firstly to monitor adherence
effectively particularly where the mother, as caregiver, is also ill and secondly the early identification of HIV
positive children. These are being addressed through visits to churches, local nursery schools and churches
in the townships and strong linkages with other facilities.
The sustainability of the Youth Clinic is provided for in the current inclusive Memorandum of Understanding
that is pending with the FSDOH.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Food and Nutrition: Commodities $23,585
Table 3.3.10:
HIVCare will use FY 2009 PEPFAR funds to work with the Free State Department of Health (FSDOH) to
provide antiretroviral treatment in a private health facility to patients who do not have medical insurance and
who are referred from the public sector waiting lists for treatment. The Medicross Medical Centre, a well-
thirteen other sites, will provide an effective means of properly distributing antiretroviral therapy (ART) to
patients who are either referred from public sector facilities or who access the sites by word of mouth. The
emphasis areas for this program will be human capacity development and local organization capacity
building. The target population includes the infants and children of men and women (infected and affected),
factory workers and other employed persons, and government employees - specifically teachers, nurses
and other health workers (who do not have medical insurance). A further specific population that will be
targeted will be secondary school children. The most significant target group is those persons that cannot
access services in the public health system.
match the FSDOH with partners from the private sector (in this case Netcare, the largest private sector
health provider in South Africa) in order to build private sector capacity and absorb some of the burden from
public sector facilities. Many FSDOH centers have waiting lists of people for ARV treatment. Patients from
these waiting lists who meet the eligibility criteria for this program are referred from those public sector
clinics to one of the primary health centers throughout the Free State province for treatment. The FSDOH is
a collaborating partner in this public-private partnership. In terms of this partnership, some of the patient
burden of State amenities would be alleviated through the use of private sector primary health facilities
throughout the province. In summary, the PPP places the following obligations on the three parties.
Netcare's HIVCare program provides all medical services related to the delivery of HIV care and treatment
through its primary health sites in the province, funding for the treatment of patients is provided by PEPFAR
and the Free State Department of Health provides technical support, hospitalizations and specialist
treatment where required.
In Sub-Saharan Africa, AIDS has become one of the leading causes of death among children under five
years old. A recent Actuarial Society of South Africa (ASSA) study revealed an incidence of HIV among
children at birth of 4.1%. Patients that are enrolled will proportionately increase the percentage of pediatric
patients on the program. As a population group, this sector remains underserved.
(1) Clinical (CD4 <200 cells/mm3 or WHO stage III or IV, (South African National Guidelines)); (2) Inability
to pay (lack of private insurance or state coverage) and (3) Capacity constraints at referring clinic. Patients
During the course of the treatment of adults, HIVCare was, by necessity, required to treat and manage the
existed. In late 2007 HIVCare launched a dedicated Youth Clinic for Voluntary Counseling and Testing
(VCT) and treatment of adolescents (12-18 years).
ACTIVITY 1: Pediatric Treatment
including early Polymerase Chain Reaction (PCR) testing for babies), adherence counseling, and access to
therapeutic nutrition support as per the national guidelines and OGAC guidance. An initiative aimed at
improving overall compliance and treatment efficacy is the distribution with the medication of a parcel of
nutritional supplements. The supplements provide a single fortified meal per day for each of the indigent
patients on ART and aids in the absorption of the medication. Patients are assessed based upon their body
mass index (BMI) and general condition. The patients meeting the pediatric clinical criteria are enrolled onto
the program. Where patients present directly at the HIVCare treatment center and are found to be in need
of TB treatment or treatment of an opportunistic infection, this is addressed unless hospitalization is
required. Similarly radiography and pathology for investigative procedures is available.
ACTIVITY 2: Youth Clinic
Due to the high (up to 19%) prevalence of HIV amongst teenagers in the Free State province, HIVCare
introduced a large VCT program targeted at this population group. The Youth Clinic provides on-site
ancillary services such as psychologists and social workers. In addition, the clinic promotes abstinence,
being faithful, responsible condom use and informs on family planning. Young women are referred to public
sector family planning sites for contraception where needed.
ACTIVITY 3: Data Sharing
Health, with a copy to the provincial FSDOH, giving the data of all those on the program. In addition to this,
a representative of HIVCare attends the monthly provincial HIV task team meetings. The sustainability of
the Youth Clinic is provided for in the current inclusive Memorandum of Understanding that is pending with
the FSDOH.
Activity Narrative: ACTIVITY 4: Patient Care
The activity has been modified since inception in two key focus areas - the qualitative aspects of patient
care, and the quantitative aspects of patient care.
In terms of the qualitative aspects of patient care, activities are focused on:
a) TB education, screening and follow-up.
b) Bringing the whole family into care: A family-centered approach is followed with patients encouraged to
c) Referrals mainly from primary health centers.
d) Contacting primary caregivers (e.g. biological mothers, grandmothers or aunts) through day care,
PMTCT clinics and church groupings to bring children for health screening.
The program currently supports ART at 15 primary health clinics, a Youth Clinic as well as two dedicated
ART clinics. A special children's register is to be maintained at the ART sites and the Youth Clinic.
effectively particularly where the mother, as caregiver, is also ill and secondly the early identification of HIV-
infected children. These are being addressed through visits to churches, local nursery schools and
churches in the townships and strong linkages with other facilities.
underserved people living with HIV (who do not have private insurance) and school-age children, HIVCare
is contributing to the PEPFAR goals of placing two million people on ARV treatment and providing care for
ten million others who are infected with HIV. These activities also support care and treatment objectives
expanding care to an underserved population.
Some elements of pediatric treatment are also addressed in more details in other linked areas of the COP,
including Pediatric Care and Support, Counseling and Testing, ARV Drugs, and Adult Treatment.
Table 3.3.11:
HIVCare will continue with FY 2008 activities, with the following modifications:
a) The TB program has been enhanced through audits of infection control and adapting HIVCare clinics to
the required standard of infection control. This is in accordance with the WHO Guidelines for the Prevention
of Tuberculosis in Healthcare Facilities in Resource-Limited Settings, 1999. One of the HIVCare facilities is
in a commercial center in central Bloemfontein and it is critical that the structure of the building is adapted to
the South African stands for infection control All TB treatment is provided free of charge to all patients.
b) HIVCare will provide basic screening of all patients through questionnaires (using the Columbia
University TB screening questionnaire) in waiting rooms will be implemented. Several studies have shown
that this strategy helps in the early triage and diagnosis of TB patients.
c) HIVCare will screening all patients with symptoms of TB disease in waiting areas, in accordance with the
WHO's Tuberculosis Infection Control in the Era of Expanding HIV Care and Treatment.
d) Advocate against TB discrimination and promote masks for TB infected patients to use while in the
e) HIVCare will implement surveillance of staff (annual chest X-ray and Mantoux tests) and education health
-are workers about signs and symptoms of TB. Chest radiograph and tuberculin skin test screening,
although difficult to interpret immediately, serve as adequate baseline measurements in case of later
suspected infection.
f) Specific education on TB through posters, brochures and lectures within the support groups will be
provided.
g) HIVCare will focus on enhancing access to TB prevention with INH, after excluding active TB through
physical examination, TB sputum, chest X-ray and liver function tests.
h) HIVCare will provide DOT to patients with TB. DOT is provided across many varied sites and in different
circumstances by health-care workers, and treatment systems are individualized.
i) Monitoring TB adherence has been added to the duties of designated case managers and this indicator
has been included in HIVCare's Management Information System (MIS).
j) HIVCare will screening all members of a TB patient's household for TB as per existing protocols.
This activity will be conducted at the three clinics including the adolescent clinic, and at all sites within the
General Practitioner's network. This approach is especially effective in rural areas where TB prevalence is
high.
------------------------------------
rollout of HIV care and treatment has been geographically limited, with only one site in each of the five
districts.
Since 2005 and the start of the program, patients have been referred from the State facilities to the HIVCare
centers mostly already staged for HIV and assessed for TB. Following an analysis of lost to follow-up cases,
HIVCare determined that splitting HIV and TB treatment and monitoring resulted in delays with access and
adversely impacts on compliance. In coordination conjunction with the TB department of the FSDOH, TB
assessment and treatment is to be integrated into HIVCare activities. Following technical input from the
FSDOH, the centers chosen for TB treatment sites are suitable and certain recommendations have been
made. These recommendations include separate facilities for patients and staff, air circulation and
extraction processes in the clinic and a separate area for sputum collection. Various policies relating to
infection control have been provided by the FSDOH for HIVCare implementation and these policies have
been adopted within the centers' operational procedures.
The clinic is in possession of all of the necessary forms and registers, supplied by the FSDOH, to comply
and integrate its TB service with theirs. Staff in the HIVCare centers are experienced public health nurses
and refresher training is to be provided in TB management by the local FSDOH offices.
Staff are routinely monitored on an annual basis for TB infection including the requisite chest x-ray.
The major emphasis area for this program will be the provision of comprehensive care and support to
persons infected with HIV as well as the improvement of referral systems, with minor emphasis given to
quality assurance & supportive supervision, food and nutrition support as well as commodity procurement.
The target population includes men and women; families (including infants and children) of those infected
and affected factory workers and other employed persons, and government employees - specifically
teachers, nurses and other health workers (without medical insurance). A further specific population that will
be targeted will be secondary school children. The most significant target group is those persons in the
economically active age group of the population that cannot access services in the public health system due
to the high demand for services. Additional attention is to be given to the screening and treatment of TB
Activity Narrative: among the patients attending the program. The linkage with the youth center will ensure that HIVCare has a
larger proportion of younger persons being attended to, specifically adolescents aged 10-14 and 15-24. This
focus on the youth should further encourage some involvement with the street youth and it is anticipated
that the program will be marketed among those NGOs working with the street youth as
FSDOH centers have waiting lists of people waiting to go on ARV treatment. The Free State Province has a
large prevalence of TB because of the number of deep mining activities in the area. MDR and XDR-TB have
been identified in the province. As a result, a large proportion of newly identified patients are co-infected
with TB. In the past all patients were referred back to government facilities to initiate TB treatment prior to
beginning on ART with the HIVCare program. Aside from the general delay that this caused, some
confusion among patients occurred. In addition, the inconvenience of further travel expenses and waiting
periods to access the TB treatment resulted in many patients simply abandoning treatment and not
returning to the clinic.
main resource base and in conjunction with three other sites in Bloemfontein and another one in Welkom,
will provide an effective means of providing TB treatment to patients who are either referred from state
facilities or who access the sites by word of mouth.
Following consultation with the FSDOH, the activities of the clinic operations have been expanded to
include TB screening, related laboratory sampling and clinical treatment of TB using DOTS. Patients from
clinics to one of the three HIVCare primary health centers in Bloemfontein and one in Welkom for TB
treatment. The FSDOH is a collaborating partner in this public-private partnership.
All pathology samples will be tested by the National Health Laboratory Service and all statistics relating to
TB treatment will be forwarded to the TB department for inclusion in national figures.
Patients referred to the program receive PEPFAR-funded consultations and exams from HIVCare center
physicians, who will also order relevant tests and refer patients to expert specialists when necessary. Based
on the partnership with the FSDOH and the services requested that HIVCare provide, HIVCare centers do
not provide free treatment for complex opportunistic infections, although some prophylaxis is provided (e.g.
cotrimoxazole) and HIVCare staff will treat minor infections and HIV conditions that do not require
investigative procedures or hospitalization.
Patients are still able to access public health facilities for more serious opportunistic
infections/hospitalizations. Likewise, treatment for tuberculosis (TB) can be obtained from the centers. In
those instances where patients are referred back to government facilities, a referral letter is provided from
the treatment center to the public clinic with a request for information about the patient's TB regimen. Due to
the close working relationship and partnership between HIVCare and the FSDOH facilities, this referral
process is seamless. Very sick patients that are unable to access the centers will able to receive their
medication via the HIVCare linkage with the Red Cross home-based carers.
HIVCare's activities to integrate TB and HIV care contribute to the PEPFAR 2-7-10 goals.
Continuing Activity: 13774
13774 13774.08 HHS/Centers for HIVCARE 6603 2801.08 $242,500
Estimated amount of funding that is planned for Human Capacity Development $35,000
Table 3.3.12:
A. Promotion of voluntary counseling and testing (VCT) through the youth clinic, the antiretroviral treatment
(ART) sites and the testing of the youth.
1) Bringing the whole family into care: A family centered approach is followed with patients encouraged to
bring their partners and children in and to have them tested for HIV and screened for tuberculosis (TB).
2) Considerable attention is given to prevention among those already HIV infected, including regular
assessment for sexually transmitted infections (STI), condom promotion and contraception.
3) A VCT coordinator based in the head office will coordinate the numbers of tests performed throughout
the 18 sites. In addition, this nurse coordinator will arrange counseling and testing (CT) events in the clinics'
immediate area that cannot be arranged through local medical staff.
4) The offer of home-based CT will be made available to those patients who have disclosed their status to
their partners/families and where they are reluctant/unable to attend at the clinic. This is especially true at
the Tsogang site where space constraints prevent staff from isolating persons wishing merely to test from
those undergoing treatment. Further to the problem of space constraints, child testing takes place over
designated weekends when the clinic is empty.
B. The implementation and management of routine offer of HIV testing at all supported sites
1) All patients attending primary health clinics will have access to HIV counseling and testing through the
intervention of the general practitioner. This will ensure that the VCT process is part of the basic diagnostic
assessment and that as many individuals as possible are tested. This is at all times accompanied by a
signed consent document and following pre-test counseling.
2) All persons testing positive are staged and where necessary enrolled into the ART program. Where ART
is not then required the persons will be entered into the pre-ART register for follow-up. The clinic has been
established specifically to provide ART to patients so very few pre-ART patients are referred to us. The
existing pre-ART patients are mainly family members of program patients.The demand for ARV amongst
patients is still so large that ART remains the primary focus of the clinics.
3) Training for health providers including doctors and nurses will be conducted on the promotion of a routine
offer of counseling & testing. This has been lacking in previous programs and has been identified as a need
in smaller primary health practices.
Rapid testing is used for adults as it is minimally invasive. In the event of a positive result, a second rapid
test is used as a confirmatory test using a different type of testing kit. In children, the same procedure is
used but using saliva tests. All tests used are recommended by the World Health Organization and have
had their sensitivity and specificity tested by the South Africa National institute of Communicable Diseases.
Where there is discord between the initial and confirmatory tests, an Enzyme-Linked Immunoadsorbent
Assay (ELISA) test is performed. Persons testing negative are counseled on the window period and
encouraged to return for a later test in three months time.
As an additional quality control measure all batch data is recorded for all tests performed.
-----------------------
antiretroviral treatment in private health facilities to patients who do not have medical insurance (either
through referrals from the public sector, or self-referral). The Free State has mainly a rural population, with
only two major metropolitan areas (Bloemfontein and Welkom). In addition, the government rollout of HIV
care and treatment has been geographically limited with only one treatment site in each of the five districts.
The Medicross Medical Centre, a well-equipped private primary health center, provides the main resource
base in conjunction with three other sites in Bloemfontein, another two in Welkom and nine other centers
located in rural towns within the province. The centers will provide an effective means of providing HIV care
and treatment to patients who are either referred from state facilities or who access the sites by word of
mouth. The major emphasis area for this program will be commodity procurement, with minor emphasis
given to logistics and the development of networks, linkages and referral systems, quality assurance and
supportive supervision. The target population already includes men and women; families (including infants
and children) of those infected and affected factory workers and other employed persons, and government
employees - specifically teachers, nurses and other health workers. A further specific population that will be
targeted will be secondary school children as HIVCare has determined that a definite need exists. Activities
will include active prevention campaigns, HIV counseling and testing (CT) and treatment for those
diagnosed. The most significant target group is those persons in the economically active age group of the
population that cannot access services in the public health system. Additional attention is to be given to the
screening and treatment of TB amongst the patients attending the program. The linkage with the youth
centre will ensure that the program will have a larger proportion of younger persons being attended to,
specifically adolescents aged 10-14 and 15-24. This focus on youth should further encourage involvement
with the street youth and it is anticipated that the program will be marketed among those NGOs working
with the street youth as a testing and treatment site.
The HIVCare project began in June 2005 with PEPFAR funding. The main aim of the program was to match
Activity Narrative: the FSDOH with partners from the private sector (in this case Netcare, the largest private sector health
provider in South Africa, through their primary health centers) in order to build private sector capacity and
absorb some of the burden from state facilities. Many FSDOH centers have waiting lists of people for ARV
treatment and given that CT is the mainstay of the National Strategic Plan, these waiting lists are likely to
continue to grow. Prevalence amongst children in the 9 to 15 year age group in the Free State province is
among the highest in the country. The HIVCare site is the only child-friendly site in the area. Patients from
these waiting lists, who meet the eligibility criteria for treatment, are referred from those public sector clinics
to one of the HIVCare primary health centers. The FSDOH is a collaborating partner in this public-private
partnership.
ACTIVITY 1: Provision of Medical Services
treatment. In addition they will provide counseling and testing services. Management and coordination
activities will be provided by HIVCare. Active marketing of CT service will only be done within local
secondary schools as part of an HIV awareness and prevention strategy although it is expected that word of
mouth and the central location of the sites will provide the desired accessibility for the public and will
furthermore ensure that the required patient numbers are achieved. Consideration will be given to the
principle of opt out testing embodied in the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011.
This principle will be applied with due regard to the sensitivities involved with dealing with the youth. In
addition to clinic referrals, Free State government employees will be encouraged to make use of the
HIVCare services. The HIVCare centers are promoted among government employees (who do not have
medical insurance) in the Bloemfontein area as independent testing and treatment sites where
confidentiality can be ensured.
ACTIVITY 2: Counseling and Testing
Patients attending the center for testing receive comprehensive counseling and testing. Persons testing
positive, with their consent, are screened for treatment and care options including staging tests (e.g. CD4)
to determine the level of disease progression. Those that meet the clinical criteria will be referred to the
treatment program. Persons participating in CT will be provided with a call center number, which they will be
able to use to access further advice and /or information. Literature on HIV and related matters will also be
provided. All persons testing negative receive post test counseling and are encouraged to test again within
three months, receive information as to where they can access condoms and are provided with the phone
number of the 24-hour assistance line. Those persons testing positive receive the same information and are
staged. On returning for their results are asked to return after six months to check the progression of the
disease should they not need to initiate antiretroviral treatment (ART).
ACTIVITY 3: Public Private Partnership
This program area will promote the public-private partnership between HIVCare/Medicross and the FSDOH.
This partnership strengthens the system of both parties and allows for the sharing of knowledge and skills.
This public-private partnership has been ongoing for a number of years and includes the greater Netcare
Group in the Free State. In addition, HIVCare will expand its existing project to target children as part of its
continuum of care. This activity targets girls and boys of mainly secondary school age through messages of
awareness of HIV care and treatment. A teen center catering for the specific needs of this age group has
been established and PEPFAR funding will be used to continue the treatment services already started. CT
that takes place at this center will be provided in an environment that is sensitive to the special needs of this
group and in line with the South African laws and regulations pertaining to children and HIV.
By providing comprehensive CT services to patients and promoting ARV services for a significant
population (people without private insurance and school age children) HIVCare is contributing to the
PEPFAR goals of placing 2 million people on ARV treatment and providing care for 10 million others who
are infected with HIV. These activities also support care and treatment objectives outlined in the USG Five-
Year Strategy for South Africa by expanding public-private partnerships and expanding care to an
underserved population.
Continuing Activity: 13771
13771 7988.08 HHS/Centers for HIVCARE 6603 2801.08 $291,000
7988 7988.07 HHS/Centers for HIVCARE 4374 2801.07 $250,000
Table 3.3.14:
The Netcare Group is the largest single purchaser of medical supplies in South Africa outside of the South
African Government (SAG), and effective supply lines exist for the procurement of all commodities required
by the program. The prices of products are continually updated and staff ordering stock have the latest
prices at their disposal.
The program currently supports antiretroviral therapy (ART) at 15 primary health clinics, a youth clinic as
well as two dedicated ART clinics. It is largely anticipated that the funding requirements in this budget
period will be reduced as accreditation processes are completed and clinics are able to draw stock from
SAG supplies.
All freight costs involved with delivering the medication to outlying areas has been included, and existing
infrastructure is used in providing for the delivery and receipt of medicines and related commodities.
The clinic sites provide palliative care to all patients and all uncomplicated opportunistic infections are
transmitted infections.
-------------------------------------
HIVCare will use FY 2008 PEPFAR funds to work with the Free State Department of Health (FSDOH) to
and with due regard to the need to transfer the patients back to SAG facilities when feasible. Additional
attention will be given to the screening and treatment of TB among the patients attending the program. The
linkage with the youth center will ensure that HIVCare reaches a larger proportion of younger persons,
specifically adolescents aged 10-14 and 15-24. This focus on the youth should further encourage
involvement with street youth and it is anticipated that the program will be marketed among NGOs working
with street youth as a testing and treatment site.
match the FSDOH with private-sector partners (in this case Netcare, the largest private sector health
provider in South Africa) in order to build private sector capacity and to absorb some of the burden from
these waiting lists who meet the eligibility criteria for this program are referred from these public sector
clinics to one of the four primary health centers in Bloemfontein and one in Welkom for treatment. The
FSDOH is a collaborating partner in this public-private partnership, and they have commited incorporate
HIVCare patients into existing FSDOH treatment sites on cessation of PEPFAR funds. An intermediate
project that is underway is the credentialing by the FSDOH of the HIVCare sites so that ARV medication
can be drawn from state supplies. This will dramatically reduce the requirement for external purchases.
Drugs and other commodities used in the treatment process are procured through the Netcare purchasing
system, the single largest purchaser of medical supplies outside of the South African government. The
drugs, specifically regulated in terms of South African legislation, are distributed to treatment centers via the
Netcare pharmacies in Bloemfontein and Welkom and are dispensed to patients by qualified pharmacy
staff. All medication issued to patients is done on presentation of a prescription issued by the treating
physician. All other products are purchased within the procurement system of Netcare and some products
are specially packaged for the program. Maximum use is made of volume discounts where possible
although current SA legislation makes this problematic in respect of medicines. The Netcare purchasing
department continually receives pricing updates from all major suppliers and all purchases are subject to
competition amongst said approved suppliers. All antiretroviral drugs procured are in line with national
treatment guidelines, and generic drugs purchased are FDA-approved and registered by the Medicines
Control Council. All medication and supplements are stored off site and delivered either daily or weekly as
required. Due to the availability of medicines, a month's buffer stock is available at any time while two
months stock of other products is maintained. Due to space limitations within the clinic itself, large deliveries
are impossible and smaller frequent deliveries are made. Medication is delivered to the clinic weekly.
HIVCare also includes a parcel of nutritional supplements with the medication to improve treatment efficacy.
The supplements provide a single fortified meal per day for each of the indigent patients on ART and aids in
the absorption of the medication. Patients are assessed based upon their body mass index and general
condition. The benchmark weight among patients starting ART at the center is just 55 kg (-5.2). In previous
years the nutritional supplements were obtained with private funds, but in FY 2008, these will be purchased
with PEPFAR funds in line with the Food and Nutrition guidance.
Activity Narrative: The program is subject to regular management review through the Netcare management and the medical
director. This forms a crucial aspect of continuous improvement as practiced by the company. Both clinics
are equipped with software specifically designed to monitor and manage patients. This program, coupled
with individual patient folders, follows the specifications, definitions and classifications listed in the WHO
2006 patient monitoring guidelines for HIV care and antiretroviral therapy. The list of collected data includes
demographic information, family status (partners, children and their HIV status when known), treatment
supervisor details, clinical relevant information (symptoms, opportunistic infections, staging, TB status,
family planning method or pregnancy status, weight, and height) and laboratory results. All of the
abovementioned indicators as well as prophylaxis and antiretroviral treatments, starting dates, interruptions,
reasons, side effects and severity are recorded. These data form the basis of internal management reports
used to improve systems.
The existing program is small and makes use of existing infrastructure and skills. Training focuses on skills
enhancement takes the form of mentorship and on-the-job development. Formal training is restricted to
addressing identified skills gaps.
The following procedures are followed to ensure the optimal follow-up for the patient: (a) scripts are written
by the doctor (full-time HIV trained doctor); (b) scripts are delivered to the designated pharmacy; (b) drugs
are prepared, labeled, named and packed for each patient; (c) parcels are sent back and stored at the
clinic, pending collection; and then (d) treatment is dispensed to the patient after consultation and recording
patient adherence, side-effects (if any) and weight in the patient folder. These details are captured using the
software described above.
The software allows the clinic staff to monitor any relevant information as side-effects, complications,
opportunistic infections, TB statistics, etc.. Clinic management reports are distributed to the local treating
doctor as well as to the medical director. Procedures are in place to address matters arising with staff in the
form of corrective action and training.
By providing comprehensive ARV services to patients and promoting ARV services to a large population of
underserved people living with HIV (people without private insurance) and school-going children, HIVCare is
contributing to the PEPFAR goals of placing 2 million people on ARV treatment and providing care for 10
Continuing Activity: 13772
13772 3298.08 HHS/Centers for HIVCARE 6603 2801.08 $2,910,000
7311 3298.07 HHS/Centers for HIVCARE 4374 2801.07 $1,800,000
3298 3298.06 HHS/Centers for HIVCARE 2801 2801.06 $896,000
Table 3.3.15:
