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
Reprogramming is related to the transition of the Track 1 CRS care and treatment program to 3 local
implementing partners, including Southern African Catholic Bishops Conference (SACBC).
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $24,715,378
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
South Africa, with a population of 48.3 million, has a highly generalized AIDS epidemic; the estimated HIV prevalence at mid-2007
was 18.1% for the 15-49 age group. Transmission is primarily heterosexual followed by mother-to-child transmission. HIV
prevalence among pregnant women attending antenatal clinics was 28% in 2007, reflecting a small decline since 2005 after rising
steadily since the early 1990s.
HIV infection rates vary greatly by age and sex. Young adults have the highest infection rates; prevalence peaks at 33% for
women aged 25-29 and at 23% for men in their thirties. Almost twice as many women as men are infected. In the 15-24 age
group, the ratio of infected females to males is four to one. Young women aged 20-29 have extremely high HIV incidence at 5.6%;
incidence in pregnant women is also high at 5.2%. Although incidence rates are higher in 15-24 year olds, adults over age 25
account for two-thirds of new infections, owing to their larger numbers.
Prevalence varies greatly across geographic settings. Among provinces, KwaZulu-Natal had the highest antenatal care
prevalence in 2007 at 37.4%. Mpumalanga has the highest incidence among all the provinces (2.4%) based on 2005 survey
estimates. Recent data from the 2007 National HIV and Syphilis Prevalence Survey indicates that one or two districts in each
province contribute disproportionately to the epidemic. Urban informal settlements, which are a magnet for migrants, also have
very high HIV rates; in a recent study, migrant men had HIV prevalence double that of non-migrants.
Factors associated with high HIV transmission include high rates of multiple and concurrent partners and age mixing in sexual
partnerships, early sexual debut, and low consistent condom use. Alcohol and substance abuse also contribute to risky sexual
behavior. The mean age at first sex, currently about 17 years, is declining. Levels of sexual violence in South Africa are among
the highest in the world. Frequent labor mobility, low marriage rates, and low rates of male circumcision further contribute to HIV
transmission.
Basic knowledge and awareness of HIV and AIDS are almost universal, and exposure to mass media and interpersonal sources
of information about HIV and AIDS is high. Yet personal risk perception is astonishingly low ; 66% of South Africans do not see
themselves at risk of HIV, primarily because they do not understand the dangers of multiple and concurrent partnerships. In
addition, high levels of HIV in the early stages of HIV infection while people do not know their status and do not take necessary
precautions with sexual partners exacerbates rapid transmission among these dense sexual networks.
In 2007, the South African Government (SAG) issued the National Strategic Plan for HIV & AIDS and STI, 2007-2011 (NSP). The
plan seeks to involve all sectors of society in HIV prevention with an emphasis on maintaining the HIV-negative status of those
currently uninfected and strengthening social mobilization and poverty reduction. The NSP builds on national programs to address
gender-based violence and mainstream HIV and AIDS interventions with priority to the rural poor, urban informal settlements, and
marginalized groups. NSP priorities include strengthening behavior change programs, scaling up interventions for youth,
especially for young women, engaging parents and children in open discussion, and implementing workplace programs.
Consistent with the SAG strategy, the United States government (USG) supports a comprehensive, multisectoral, abstinence, be
faithful, and consistent and correct condom use (ABC) approach to prevention. The USG's Five-Year Strategy emphasizes a full
range of age-appropriate prevention messages and interventions to address the key drivers of the epidemic, especially multiple
concurrent partners, low rates of consistent condom use, and early onset of sexual debut. With South Africa's high, generalized
epidemic, the general population, and particularly adults, will increasingly be the focal point for mass media and community
outreach efforts, while specific targeted interventions for other populations, including youth, most-at-risk populations (MARPs),
migrants and disadvantaged populations living in informal settlements, and prevention with positives continue to be important
activities. In addition, integrated prevention activities that link prevention with counseling, treatment and care, and support
services will be reinforced.
Abstinence and Be Faithful (AB) funding was increased in FY 2008 to $32,518,850 million for more than 50 partners with a target
of 7 million people to be reached. As of March 2008, prevention efforts had reached 13,101,391 individuals with AB messages
and 2,343,755 individuals with other prevention (OP) messages. A total of 981,425 individuals were reached with abstinence-only
messages. The FY 2009 COP funding levels are approximately $36,693,000 for AB and $22,259,000 for OP. In FY 2009, based
on recommendations from the Prevention Technical Working Group, FY 2008 COP reviews, and the recent PEPFAR South Africa
Interagency Partner Evaluation, the USG proposes to take stock to assess the overall prevention program and to provide short-
and mid-term recommendations for developing a strategic focus and enhancing program impact.
In FY 2009, the USG will encourage greater attention to the quality of interventions, particularly training and peer education. In
addition, the USG will focus on the coordination of prevention activities to avoid duplication and to increase synergies. PEPFAR-
funded partners are encouraged to align their activities to the NSP and to sign Memoranda of Understanding with relevant
provincial governments in order to enhance sustainability and integrated programming. In addition, PEPFAR partners are
encouraged to create linkages with partners working in the same areas and with other donor programs to ensure greater
coordination and coverage. For example, a group of prevention partners meets monthly to share ideas and develop synergies with
Soul City's "One Love" campaign (funded by the United Kingdom's Department for International Development) that addresses
multiple concurrent partnerships.
USG assistance for HIV prevention complements support from other international donors, including the Global Fund, the
Japanese, British and Irish governments, as well as the European Union. The Round 6 Global Fund grant provided support to
several current USG prevention partners to expand their programs.
Ongoing prevention activities will continue to reinforce normative change and responsible sexual behavior through networks of
community- and faith-based organizations (CBOs/FBOs) and traditional leaders and healers to help individuals internalize these
norms in order to achieve sustainable behavior change. AB activities targeting adults will receive complementary funding for
Condoms and Other Prevention activities; funding will be used to provide comprehensive prevention education for individuals who
continue to engage in risky behavior. Linkages will be strengthened with counseling and testing partners and for those who test
positive, referrals will be made for further management and prevention with positives programs. Prevention programs will continue
to be integrated with PMTCT and care and treatment.
The USG will take a more balanced approach to address the drivers of the epidemic with increased focus on sexually active
adolescents and adults. Activities will focus on increasing risk perception to reduce multiple and concurrent partners,
intergenerational sex (primarily young women), and increase consistent condom use. For example, Johns Hopkins and Soul City,
two mass media partners, have launched multi-level, multimedia campaigns to increase understanding of the risks associated with
multiple and concurrent partners. This will be the thematic focus of a new television drama series and a series highlighting real-life
individual success stories in adopting abstinence and fidelity. Radio, outdoor media advertising, and a cellular phone text
messaging campaign will support the TV series. Campaign messages will draw on recent qualitative research on the drivers
underlying multiple partnerships. The campaign will emphasize the role that male attitudes norms and behavior play in sustaining
sexual networks, cross-generational sex, and high rates of concurrency and partner turnover.
In the lead-up to the 2010 World Cup in South Africa, the media campaign features prominent South African soccer players
delivering messages about male responsibility, personal risk perception, and community action to support healthy behaviors. The
campaign will also engage in a parallel effort to target the young women who are at highest risk. Women of reproductive age and
their partners will also be educated about the risks of HIV in pregnancy. The role of alcohol and substance abuse in risky
behaviors will be integrated into prevention education and disseminated to all audiences.
Media activities will be complemented by expanded community outreach to adult populations, especially men. A new initiative will
seek to promote partner reduction through high visibility advocacy by the leadership of national faith-based networks and NGOs.
As a comprehensive activity, the mass media, linked to community outreach and grassroots social mobilization, should shape new
community norms of responsible sexual behavior by working though local FBOs and CBOs. In addition, Population Concern
International (PCI) will implement new workplace programs that will target small and medium enterprises and selected
government departments. These new initiatives will deepen understanding of the risks associated with multiple overlapping
partners and cross-generational sex, the potential for exposure to HIV through regular partners, and the benefits of mutual
monogamy in the context of knowing both one's own and one's partner's HIV status. PCI will also address gender-based violence
with a focus on changing male behavior and community and cultural norms.
The USG will support the National Department of Health (NDOH) to create and lead an HIV prevention consultative core action
group (or "Action Tank"). The purpose of the Action Tank will be to help the South African government (SAG) accelerate the scale
-up of HIV prevention through an inclusive, broad-based process to develop comprehensive, coordinated, evidence-based, target-
driven national prevention implementation strategy. The group is slated as an "action tank" because in addition to providing
expert advice and recommendations, its primary purpose is to facilitate large scale preventions action under NDOH leadership.
The establishment of the Action Tank will be done through an active and participatory approach that will engage key stakeholders
and facilitate the alignment of prevention actions based on understanding the SA HIV epidemic.
The USG will continue to support the Department of Education (DOE) and a diverse array of indigenous faith-based and other non
-governmental partners to deliver intensive, curriculum-based and peer HIV prevention education to youth through schools,
churches, and other community fora. Messages focus on delayed onset of sexual activity for youth aged 10 -14 and improved risk
perception of multiple concurrent partners among sexually active youth. Partners will address gender issues by, for example,
tailoring curricula for girls and young women to enhance their self-esteem and to address the risks of transactional sex with older
men. The USG will also provide skills-building assistance to promote best practices, focusing on a combination of curriculum-
based HIV education, peer education, community mobilization, and parent interventions. Working with the DOE, the USG will
support a rapid assessment of school-based HIV education to help develop a more strategic and systemic approach to prevention
programming in schools.
With FY 2008 funding, the USG is adapting "Families Matter," an evidence-based intervention to engage adult family members in
communicating with youth about HIV prevention, which also aims to create safer contexts for young women. Using FY 2009
funding, many youth partners will begin implementing "Family Matters" with older family members of youth that are currently
participating in their programs. The USG continues to encourage linkages between AB and orphans and vulnerable children's
programs to ensure that orphans and other at-risk youth receive HIV prevention education. Several partners, including Ubuntu,
Youth for Christ, and Salesian Missions, will work with higher risk youth in disadvantaged locales.
The USG will continue and reinforce work with MARPs. Humana People to People will continue to provide support to sex workers
through door-to-door visits in townships. The Reproductive Health and Research Unit's comprehensive program addresses health
care and supports needs of sex workers, including HIV testing. The services were evaluated last year and results of the survey
will be used to re-orient the organization's services, including widening the reach of their program and strengthening referrals. The
Human Sciences Research Council (HSRC) and the Joint Working Group for Gay, Lesbian, Bisexual and Transgender people will
conduct research to identify gaps in programming for this vulnerable population. The findings will be used to expand targeted
prevention interventions with men who have sex with men. CDC will conduct an assessment on sex workers and HIV to identify
gaps and solutions to these gaps. The International Organization for Migration (IOM) will be working to reach migrant and mobile
populations in Limpopo and Mpumalanga provinces with comprehensive prevention education. IOM will also target young women
in their twenties in high transmission areas, including destination communities for migrants. The Medical Research Council (MRC)
will continue with its bar-based intervention focusing on people frequenting taverns, a public-private partnership with the South
African Breweries. MRC also links HIV treatment programs with prevention.
In FY 2009, the USG team will focus on the expansion of post-exposure prophylaxis (PEP) services and training on sexual
assault. The MRC and the National Department of Health will roll out a comprehensive training program aimed at health-care
workers and the judicial service to ensure better implementation of PEP services throughout the country.
The USG Prevention team has expanded and now includes senior prevention experts who will promote the adoption of evidence-
based, best practice intervention models, a common set of clear, actionable, behavioral messages, and coordination and synergy
across partners.
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
With FY 2009 funding, the Southern African Catholic Bishops Conference (SACBC) will expand current
home-based care for orphans and vulnerable children (OVC) and their family members to include the
important components of community integrated management of childhood illnesses (IMCI); cotrimoxazole
prophylaxis; active screening for health care needs of OVC in schools; and addressing the issue of alcohol
abuse amongst family members.
The SACBC will continue with the activities of FY 2008 but intensify the following:
ACTIVITY 1: Support to parents (primary caregivers)
The SACBC will conduct workshops to family members taking care of OVC as a means to provide good
parenting and to understand problems pertaining to such children at site level. This will require the
community mobilization to offer support to families and children. Advocacy on counseling and testing will
increase the number of persons on antiretroviral therapy (ART). Treatment literacy will be intensified to
promote adherence to treatment.
ACTIVITY 2: Building Networks through Linkages and Integration
As a means of strengthening the existing structures, the SACBC will ensure that all treatment sites are child
-friendly to accommodate children who are on treatment. The SACBC AIDS Office will also look into current
structures to improve the information and communication flow. This aspect will aid speedy referrals and
enable community members to know where they can access relevant assistance.
ACTIVITY 3: Mainstreaming Gender
The SACBC has found that mobilizing men as caregivers and members of the support group is a key way to
increase awareness of HIV prevention, women's and girls' rights, and to engage men in HIV and AIDS and
OVC activities. This will include working with various groups of men within dioceses to challenge some of
the cultural taboos which may give rise to the stereotypical attitude that views women as insignificant
members of the society. The SACBC's gender mainstreaming is centered on complementarity of species
rather than stressing the difference between men and women.
ACTIVITY 4: Capacity Building
Training at the implementing sites will target lay and health workers to reinforce the existing human
resources. The SACBC will collaborate with training service providers to conduct refresher courses and
training for the continuing caregivers and the new ones. This will ensure sustainability and task shifting to
the community at large. Emphasis will be on treatment literacy, opportunistic infections, linking of nutrition
and treatment, and adherence to treatment.
The SACBC, through an identified service provider, will equip the site communities with a variety of income-
generating activities, such as microfinance, and vendor models. Along those activities, the SACBC will
ensure that skills development is carried out within the most disadvantaged communities. The SACBC will
roll out training on self management to ensure proper use of social grants and to promote saving among the
recipients of these monetary grants.
---------------------------
SUMMARY:
The Southern African Catholic Bishops Conference (SACBC) AIDS Office has adopted a family-centered
developmental approach and a child-focused intervention for its OVC program. For the 2008 fiscal year the
SACBC AIDS Office will extend its program and services to the surviving parents, guardians and the foster
parents of HIV-infected individuals and orphans and other vulnerable children supported through this
program. The SACBC AIDS Office will support its sub-recipients in palliative care program design,
implementation and direct services for the surviving parents, guardians and foster parents living with HIV
and AIDS. The SACBC AIDS Office will guide its sub-recipients to implement a comprehensive, holistic and
interdisciplinary approach to HIV care. This program will strive to achieve optimal quality of life for people
living with HIV (PLHIV) and their families and minimize suffering through clinical, psychological, spiritual,
social and preventive care support. Through this program PLHIV will be referred to existing ART sites.
Some of the sub-recipient sites receive funding through a Track 1 partner, Catholic Relief Services, for HIV
care and treatment, and this co-location allows for ease of referrals.
ACTIVITIES AND EXPECTED RESULTS:
The SACBC AIDS Office will strengthen the capacity of families to protect and care for OVC by prolonging
the lives of the primary caregivers through clinical care which include HIV counseling and testing, routine
follow-up to determine the optimal time to initiate ART if HIV-infected; prevention and treatment of
opportunistic infections including cotrimoxazole prophylaxis such as tuberculosis (TB); HIV prevention and
behavior change counseling including prevention with positives. Sub-recipients will be encouraged to run
counseling and testing (CT) campaigns. Through these campaigns primary caregivers will be encouraged to
know their status. In addition the SACBC AIDS Office will support its sub-recipients to provide clinical,
psychological, spiritual, social care and integrated prevention services. The SACBC AIDS Office will support
its sub-recipients to establish community-based support groups and appropriate training will be provided.
Advocacy initiatives will also be conducted at the congregational level to ensure that the local priests are
supportive and promotes spiritual care through retreats. In addition the SACBC AIDS Office will support its
Activity Narrative: sub-recipients to develop programs geared towards stigma reduction. Sub-recipients will be supported to
run awareness and acceptance HIV campaigns within their respective communities.
The SACBC AIDS Office will provide technical support to its sub-recipients to strengthen and integrate
home-based care, community-based care and facility-based care for family members of HIV-infected into
the OVC programmatic interventions. The SACBC AIDS Office will ensure that its sub-recipients build and
sustain comprehensive HIV and AIDS care systems. The SACBC AIDS Office will ensure that strong
referral systems are in place at local level for the provision of prevention, treatment and care across
facilities, clinics, communities and homes. The SACBC AIDS Office has eight sites that already provide on-
site health care, and this ensures that access to health care for HIV-infected and OVC is improved.
Gender equity will form an integral part of the SACBC AIDS Office program's activities. The SACBC AIDS
Office will ensure that women and men are receiving equitable support and access to essential palliative
care services, especially treatment. Sub-recipients will be encouraged to work with male groups in their
dioceses to mobilize the involvement of men as caregivers and members of various support groups.
Communities will be mobilized to enforce female protection from exploitation and abuse and to mitigate
against gender-based violence. The SACBC AIDS Office will support its sub-recipients to work with the
existing gender-based violence programs within the Department of Social Development at district level. .
The SACBC AIDS Office promotes the teaching of the Catholic Church concerning abstinence and fidelity,
as well as the appropriate use of condoms for discordant couples.
The SACBC AIDS Office will provide technical support to strengthen the capacity of its sub-recipients by
providing training on various aspects of palliative care. In addition the sub-recipients will be provided with
ongoing supervision and mentoring. The SACBC AIDS Office will develop wraparounds with other partners
(such as the Department of Social Development) for food supplements and nutrition assistance to ensure
effective implementation of palliative care.
a) Training for secondary caregivers: In FY 2008, training of secondary caregivers will focus on treatment
literacy, psychosocial support and caring for PLHIV. The SACBC AIDS Office will identify a credible service
provider to provide the treatment literacy training. The course is conducted over five days. The Regional
Psychosocial Support Initiative (REPSSI) will provide the psychosocial support (PSS) course for caregivers
who are new to the program and are not well-versed in PSS. The psychosocial support course included
themes such as a sense of self-worth, of value, self-esteem, bereavement care, building resilience, listening
and talking to distressed children, child development; hero books and the holistic needs of human beings.
b) Training of primary caregivers: Families of HIV-infected individuals and OVC will be trained by secondary
caregivers in identifying and establishing viable income-generating activities for economic strengthening of
households. Primary caregivers will also be trained in basic nutrition, HIV and AIDS awareness and
prevention including prevention with positives, basic hygiene and treatment literacy particularly for families
of people living with HIV.
c) Training of trainers: In FY 2008, this program will target a few secondary caregivers from each sub-
recipient to be trained as trainers in treatment literacy, psychosocial support and home-based care. These
caregivers would then be responsible for training other caregivers using the same curriculum and materials
to maximize the impact of training and to improve chances that information gained from the various training
sessions is implemented at site level.
In all of the above activities, OVC will be counted only in the OVC program area. PLHIV will receive at least
one clinical and one other category of palliative care service. Palliative care to family members of PLHIV or
OVC will be provided in at least two or the five categories of palliative care services
These activities will contribute to the PEPFAR goal of reaching 10 million HIV-infected and affected
individuals with care.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13817
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13817 13817.08 HHS/Centers for South African 6623 4105.08 SACBC $485,000
Disease Control & Catholic Bishops
Prevention Conference AIDS
Office
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $293,425
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 $191,575
Economic Strengthening
Education
Water
Table 3.3.08:
The Southern African Catholic Bishops Conference (SACBC) is also currently a sub-partner under the Track
1 Catholic Relief Services (CRS) program. However, in FY 2009 the Track 1 CRS program will transition,
and SACBC will become one of three local implementing partners that will have CRS funds and
responsibilities transferred to it, and thus current funding levels will increase in FY 2009. These will be
adjusted through reprogramming in FY 2009. The Adult Treatment activities are thus mostly contained in
the CRS narrative, and the funded activities described in this COP narrative will address the efforts to
prepare the SACBC to assume full responsibility for the treatment activities in FY 2009. These activities are:
ACTIVITY 1: TREATMENT
The SACBC has a major orphans and vulnerable children (OVC) program described elsewhere in the COP.
Some of the SACBC already have co-located OVC and treatment services, and this will be scaled up in FY
2009. Appropriate staff at implementing sites will be identified for training around treatment issues to
provide for improved HIV care and treatment service delivery at OVC, as some sites currently only refer
people living with HIV (PLHIV) who qualify for treatment to appropriate local treatment centers. This training
will be provided by the CRS/SACBC Track 1 program. Efforts will be made at all sites to identify people who
qualify for treatment at an early stage to enable them to access services timeously.
ACTIVITY 2: GENDER MAINSTREAMING`
The program is aiming at ensuring equitable access for men and women to services, and address issues on
stigma mitigation. The program will address the obstacles that women and girls face in accessing health
care, ranging from cost of treatment, transportation, and child care, to appropriate appointment schedules,
sufficient women health workers, and guarantees of privacy and confidentiality. Where possible, training
and employment of women as health care workers to increase the confidentiality and comfort of women and
girls seeking treatment will be emphasized. Men will be targeted as caregivers and edify their role in the
society.
ACTIVITY 3: FAMILY-CENTERED APPROACH
A family-centered testing and care approach will be used where possible. Couple counseling and testing at
sites will be used to promote testing of men and to build their support for their female partners. It is also
hoped that, through community-based testing, increased outreach will be made to women and children in
villages. There will be a renewed emphasis on the family-centered approach through: grouping family visits
together, in providing psychosocial support, encouraging interactive family sessions, and assisting families
with social service applications (child grants etc.) where possible.
Awareness campaigns and workshops will be conducted to address various family members in areas
around treatment literacy, opportunistic infections, and linking nutrition with treatment.
ACTIVITY 4: CAPACITY BUILDING
Training of trainers will occur at the site level. Sites that are closer to each other will team up together to
facilitate training. Existing health systems serving patients in HIV care and support will be strengthened.
There will be scaling up of linkages, coordination and referrals to programs like immunization and if
necessary primary health care centers. The objective is to provide a comprehensive package of services
that includes wellness care and ART to HIV-affected; with the view of increasing the proportion of people on
treatment.
Continuing Activity: 22312
22312 22312.08 HHS/Centers for South African 6623 4105.08 SACBC $100,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $50,000
Table 3.3.09:
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $23,312,165
Table 3.3.11:
Table 3.3.12:
Linking with the Southern African Catholic Bishops' Conference AIDS Office (SACBC)/Catholic Relief
Services (CRS) treatment program will mean that the OVC program will benefit from the experience, M&E
expertise and good practices in this program. These treatment sites will focus on identifying HIV-exposed
children in the communities they serve. Early identification, screening and referral will be emphasized.
Every community health care worker will identify vulnerable children in the households they visit. Children
will be identified and registered. Parents will be counseled and motivated to have children tested. PCR
testing will be offered from 6 weeks of the infant's life for the first year. Thereafter rapid testing will be used.
The SACBC will continue with the FY 2008 activities and emphasis will be put on the following:
ACTIVITY 1: Support to Parents
SACBC will increase the number of surviving parents and guardians receiving care. Surviving parents and
guardians will be equipped with relevant training to enhance their economic opportunities. Advocacy on
prevention and VCT will be conducted at site level. Surviving parents and guardians will be trained in linking
nutrition with treatment, with an emphasis on healthy living.
ACTIVITY 2: Community Mobilization
SACBC will continue to give the sites relevant support to create new links and networks and strengthen
existing ones. The sites will be given training on formation of child care forums to enhance them with the
capacity to deal with the needs of OVC. Awareness campaigns will be conducted to promote responsibility
shifting within the communities. Communities will be educated on treatment literacy and the importance of
adherence.
ACTIVITY 3: Access to Services
The Education for Life program will continue at the site level, with emphasis on sexuality, morality,
psychosocial support, and spirituality. OVC will be educated on life skills training to help them make
decisive choices and not fall prey to situations. This will also reduce teenage pregnancy, street children,
drug and alcohol abuse and prostitution. Further, there will be scaling up of children accessing ARV. This
will require the improvement of transport services, and ART sites improved to be more child-friendly. More
referrals will be made on children with serious social problems as to reduce the rate of OVC dropouts from
school.
ACTIVITY 4: Gender, Stigma and HIV Prevention
Programs will be implemented to target cultural issues, especially the role of women in society. Advocacy
on behavior change and positive living will be at the core of gender mainstreaming program. Within the
OVC sites attention will be paid to addressing the needs of girl children and boys independently. The sites
will continue to provide HIV and AIDS education to combat stigma and encourage voluntary counseling and
testing. Activities and approaches to address gender issues will include involvement of men in the program
as decision-makers, family-centered care, couple counseling and testing links with treatment programs. The
program will involve partners (through increased partner testing, male support, prevention and interventions
with regard to gender-based violence), including support groups for HIV-infected patients, more so, the
OVC.
Partners of pregnant women will also be targeted and providing information to men on PMTCT, CT,
prevention and other health issues and encouraging couples counseling and testing in an attempt to
increase men's involvement in HIV and AIDS treatment and care programs and to reduce stigma and
violence against women. The approaches will include couple counseling and testing at CT and PMTCT sites
with the view of promoting testing of men as well as building their support for their female partners, where
possible. Efforts will be made to include health worker trainings to recognize signs of gender-based
violence, to provide appropriate counseling and referral services to social, legal, and community-based
support groups, as well as training and employment of women as health care providers to increase the
confidentiality and comfort of women and girls seeking treatment for HIV.
ACTIVITY 5: Exit Strategies for OVC
Through the assistance of the Department of Labour, with which the SACBC has working relationship, the
OVC will be equipped with skills development training that will assist them to fend for themselves when they
can no longer benefit from the project. The OVC would be assisted through career camps on the availability
of funding opportunities for their further studies and vocational training.
ACTIVITY 6: Training Secondary Caregivers
Surviving parents and guardians of caregivers would be trained in parenting skills, where they would be
assisted to deal with teenagers' development and how to handle their behavior. The guardians would also
be advised and trained on how to deal with children with disabilities and addressing their needs.
The goal is to mitigate the impact of HIV and AIDS and create and enabling social environment for care,
treatment and support. The objective is to strengthen the implementation of OVC policy and programs.
Another is to increase the proportion of children obtaining vital documents such as birth and death
registration to 90%.
-------------------------
The Southern African Catholic Bishops' Conference AIDS Office (SACBC) provides comprehensive care for
Activity Narrative: orphans and vulnerable children (OVC) to help them grow to be healthy, educated, and socially well-
adjusted adults. SACBC supports community programs and projects, linking them to various sources of
financial assistance, healthcare, legal aid and nutritional support. OVC services will be provided in 23 sites
in all eight provinces of rural South Africa within 18 dioceses of the SACBC Region. SACBC is a sub-
partner through Catholic Relief Services for its HIV care and treatment programs.
BACKGROUND:
The SACBC launched this PEPFAR-funded OVC program in September 2007. Over the last eleven months
the SACBC AIDS Office supported 21 sites in eight provinces with funding provided directly to sub-
recipients. Through this program about 6,700 OVC were reached with psychosocial, educational, nutritional,
economic support, health care, pediatric treatment referrals and child protection. In FY 2008, the sub-
recipients will continue to use PEPFAR funds to expand and scale up existing services to meet the
increasing needs of OVC in South Africa. The SACBC coordinates OVC services at 23 sites. Identification
of the OVC sites was based on evaluations of previous programs. Six of the 23 OVC sites also provide
antiretroviral (ARV) treatment to people living with HIV (PLHIV), including OVC. Many SACBC sites have a
network of trained volunteers. Mostly these are unemployed women, who volunteer in return for training and
a monthly stipend. These volunteers become auxiliary community home-based caregivers and continue to
develop into specialized OVC caregivers. Some of the volunteer caregivers are so well-trained that they are
able to move on to more sustainable jobs in other healthcare sectors. This creates a need for ongoing
recruitment of new volunteers and training. OVC at schools are highly stigmatized, and therefore the
SACBC response includes stigma mitigation. OVC face many forms of differential treatment and human
rights abuses, being denied access to schools and health care facilities. The OVC program will target
gender sensitivity and awareness training at schools, and will focus on advocating for the rights of the girl-
child, especially adolescent girls. One of the key partners in this program is the Catholic Institute of
Education, which focuses on the Education Access Project (EAP). The EAP aims to enable OVC in Catholic
schools to continue their education and remain healthy. EAP's strategy is to provide resources to poor
schools to assist selected learners orphaned by HIV and AIDS and made vulnerable by poverty with
education expenses, including fees, uniforms, transport, sport, outings and a daily ration of food (depending
on individual needs) and to motivate school communities to contribute to the care of those affected by HIV
and AIDS. SACBC is in partnership with the National Department of Social Development's (DOSD) National
Action Committee for Children Affected by HIV and AIDS (NACCA). The mandate for NACCA at national
level is to coordinate action for children affected by HIV and AIDS. SACBC adheres to the DOSD Policy
Framework on Orphans and other Children made Vulnerable by HIV and AIDS. SACBC is also an active
member of the various NACCA tasks teams, including Food and Nutrition, and Care and Support. SACBC
will encourage their sites to become active members of the provincial structures of NACCA as well as local
districts structures. Most of the selected OVC sites provide community care; only one provides residential
care. The family-centered developmental approach of the SACBC OVC program ensures that OVC are
placed in families and communities of care. The community mobilization program ensures that members of
the local community are in the best position to know which households need assistance and what
assistance is required for OVC care.
ACTIVITY 1: Support to parents
SACBC will strengthen the capacity of families to protect and care for OVC by prolonging the lives of
parents and providing economic, psychosocial and other support. This is currently carried out at some of
centers and will be expanded to other sites with PEPFAR funds. Economic strengthening, such as income-
generating activities play a key role in maintaining the livelihoods of OVC and their families. These income-
generating activities include food gardens, sewing school uniforms, and brick making training.
ACTIVITY 2: Community mobilization
SACBC will mobilize and support FBO/CBO community-based responses to OVC care by building
community responses through local networks and advocacy initiatives. This includes establishing Child
Care Forums at local level to reinforce the capacity of communities to respond to the needs of OVC.
SACBC will also increase the capacity of FBOs/CBOs with training programs for OVC care and support,
utilizing lessons learned and best practices from 'Choose to Care' to enhance training skills. SACBC will
provide technical assistance to FBO/CBO projects as they respond to the needs of OVC and their families,
including skills training and development and assistance to access the funding necessary to provide needed
services.
ACTIVITY 3: Access to services
SACBC will ensure that OVC and their families access essential services including education, healthcare
and other support. Existing services will be improved and expanded, including psychosocial counseling.
Coping strategies will include life skills training to reduce vulnerability, as well as assistance for education
costs (school uniforms and stationery) in line with South African Government policies and programs. The
SACBC project will also scale up educational, nutritional, social, medical assistance and psychosocial
support for OVC at new sites within 18 dioceses. The components of the program will feature cross-cutting
issues, child participation, gender issues and will address stigma and HIV prevention.
The Education for Life Program, is a behavior change skills building program geared towards young people,
targeting OVC aged 10 -15. It is divided into 3 stages, whereby the participants are led through a process of
self-introspection on their present reality to name and own behaviors that are life threatening and harmful to
their dignity. Through ongoing questioning and various participative activities youth are led to choose and
commit themselves to possible new behaviors that promote a positive and healthy lifestyle. The process will
Activity Narrative: provide positive engagement and open discussion around sexuality, sexual behavior, teenage pregnancies
and the role of women. It also addresses gender mainstreaming, and the SACBC will continue to develop
sites on the promotion of the needs of the girl child, especially from age 10-16.
NEW ACTIVITIES
ACTIVITY 5: Bicycle Project
In FY 2008, the bicycle project through collaboration with the Institute for Transport and Development Policy
(ITDP) will be introduced and piloted in 10 sites. A feasibility assessment will be done in advance to identify
opportunities and challenges of introducing this project in the selected sites. The pilot will include the
bicycles for OVC who have to travel long distances to attend school and the secondary caregivers to reach
ACTIVITY 6: Exit strategies for OVC
23 sites will be assisted in developing exit plans for children above 15. This is to ensure that when children
leave the program there are plans in place to further their education, access vocational training, establish
income generating activities or gain employment. The SACBC will develop wrap-around programs with
other partners (e.g.DOSD) for food supplements and nutrition assistance to ensure effective implementation
of OVC interventions.
ACTIVITY 7: Training
Secondary caregivers: Training to be provided in FY 2008 will focus on child and youth care, psychosocial
support and caring for children with disabilities, equipping participants with an understanding of the
fundamentals of child and youth care work and developing basic caring skills for children and youth.
Training of primary caregivers: Families of OVC will be trained by secondary caregivers in identifying and
establishing viable income-generating activities for household economic strengthening. Training will also
focus on basic nutrition, HIV awareness and prevention, basic hygiene and treatment literacy, particularly
for families of PLHIV. Training of trainers: This program will target a few secondary caregivers from each
sub-recipient to be trained as trainers in child and youth care work, psychosocial support and M&E. Training
of OVC: A series of formal and informal training sessions will be conducted with OVC across the program,
including child-headed households, focusing on life skills training (provided by two PEPFAR partners - Soul
City and FHI), reproductive health and HIV and AIDS. Informal training sessions will be held during career
camps and the after school programs, covering various topics, including child rights, basic saving and
budgeting as well as career guidance for older youth. Training of sub-recipients: In FY 2008, training will
focus on proposal writing and financial management.
Family Health International (FHI) is also funding SACBC as a sub-partner but these are different sites. Once
the agreement with FHI ends, these sites will be transitioned all to the SACBC (as a prime partner)
program.
Continuing Activity: 13816
13816 6563.08 HHS/Centers for South African 6623 4105.08 SACBC $1,940,000
7398 6563.07 HHS/Centers for South African 4401 4105.07 SACBC $1,500,000
6563 6563.06 HHS/Centers for South African 4105 4105.06 SACBC $1,300,000
Estimated amount of funding that is planned for Human Capacity Development $950,600
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $200,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $394,700
Estimated amount of funding that is planned for Economic Strengthening $394,700
Table 3.3.13:
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $30,003,298
South Africa's Operational Plan for Comprehensive HIV and AIDS Care, Management, and Treatment (Comprehensive Plan) was
approved by the South African Cabinet in November 2003 and guides the roll out of HIV and AIDS care and treatment throughout
the public sector in South Africa. The South African Government (SAG) has taken bold leadership in the introduction of
antiretroviral treatment (ART) through a five-year phased nationwide equitable roll-out program. The goals of this plan are
reiterated in the South Africa National Strategic Plan for HIV & AIDS and STI, 2007-2011 (NSP). The National Department of
Health (NDOH) has allocated approximately $410 million USD for the implementation of the Comprehensive Plan in FY 2009
(prevention, care, and treatment), mainly through conditional grants to the nine provinces. According to the NSP Costing Plan, the
total need for funding for ART alone in 2009 is $710 million for adults and an additional $128 million for children (a total of $838
million), clearly indicating the need for additional funding and support to the SAG and civil society. Much of this funding is directed
to the purchase of antiretroviral (ARV) drugs, as all drugs for the public sector ART program are procured and supplied by the
SAG. The SAG also provides, in some instances, the ARV drugs for non-governmental organizations (NGOs) and private sector
programs, with PEPFAR funding other service components. The USG is ideally positioned to support the implementation of the
NSP by ensuring equitable access to quality HIV care and treatment through support to the SAG by PEPFAR-funded partners.
The FY 2009 USG budget to support ART in South Africa is $217 million.
The USG ensures that all local policies, guidelines, and processes are adhered to, including the SAG requirement of accreditation
for facilities to provide ART services through a formal SAG process. The SAG has established standard treatment guidelines and
protocols and uses an extensive process to review and register ARV drugs (including several generic drugs) through the
Medicines Control Council (MCC). Due to these stringent controls, parallel importation is not within the SAG policy.
Currently, of the 98 generic ARV drug formulations that have been approved by the FDA and can be purchased with PEPFAR
funding, there are only 23 that are also registered by the MCC and can be purchased in South Africa with PEPFAR funding, 12 of
which are first-line drugs (as per the SAG national guidelines). However, as most of the treatment partners work in public health
facilities, drugs are provided by the SAG and not purchased with PEPFAR funding, allowing resources to be directed to other
important treatment-related activities such as training, community mobilization, and human capacity development. Since there are
a limited number of PEPFAR partners that procure ARV drugs, most individual partner budgets are not negatively impacted by the
availability of generic drugs that can be purchased. In addition, many PEPFAR treatment partners access branded drugs through
access pricing mechanisms, resulting in further savings.
Outside of the public sector, PEPFAR funds support NGO partners to expand treatment to specific target groups, including people
with TB, men, and people in workplace settings. Another important focus extends ART through general practitioners at community
clinic sites, especially in rural communities, which serves to increase access beyond the current SAG accredited roll-out sites. The
USG has also developed innovative partnerships with the private sector to provide ART. Some of the private sector partnerships
also include public-private partnerships between industry and the SAG. Some of these NGO and private partners either obtain (at
no cost) or procure their drugs through provincial health departments.
In FY 2009, there will be an emphasis on creating capacity at the primary health-care level to initiate and manage patients on
ART. This would also require the strengthening of drug distribution and storage systems at this level.
South Africa has a strong private pharmaceutical industry. The USG in South Africa does not manage the procurement of drugs
and commodities centrally; these arrangements are made directly by PEPFAR treatment partners. Those PEPFAR partners that
do purchase ARV drugs obtain them through monthly procurements from reliable private pharmaceutical distributors. Drugs are
pre-packaged individually for each patient and delivered to the relevant site. Emergency deliveries can be made within 24 hours.
Some of the treatment partners may utilize the Partnership for Supply Chain Management (PFSCM) in FY 2009 for limited
procurement, distribution, and to handle emergency procurements in the event of stock-outs.
In addition to supporting implementing partners, the USG supports the ARV rollout by strengthening drug distribution and
monitoring systems through logistics management, patient information, drug supply, and training. The National Department of
Health awards centralized tenders for all ARV drugs procured by provinces. There were no reported stock-outs of ARV drugs in
FY 2008. There were shortages of cotrimoxazole, but this was due to the global manufacturing shortage. Despite this, the SAG's
emphasis on strengthening key delivery systems (with PEPFAR assistance) continues to improve distribution systems and overall
effective drug management capacity. If stock-outs occur in PEPFAR programs that obtain drugs through the SAG, private sector
pharmaceutical suppliers are positioned and ready to provide the necessary back-up supplies in FY 2009.
The first-line regimen for ART in South Africa is stavudine (d4T), lamivudine (3TC) and either efavirenz or nevirapine. Most
patients are still on the first-line regimen. Switches are mainly due to side-effects, adverse reactions, and sub-optimal regimens
used in the private sector prior to the national treatment guidelines. Stavudine accounts for the highest number of adverse
reactions to ART, mainly lactic acidosis. As a result, the SAG is in the process of revising the national guidelines to allow for
switching first-line drugs, including tenofovir, to deal with these adverse reactions. These revised guidelines will also raise the
threshold for ART initiation to a CD4 count of 250, which will increase the number of people eligible for ART and thus lead to an
increase in drug procurements.
The USG also provides critical on-site assistance through its partners at public sector facilities. This assistance aims to strengthen
and improve the quality of logistics, recording, and ordering systems to ensure proper management of drugs and other
commodities required for treatment. These activities will continue and expand in FY 2009.
The achievements and targets for ART are found in the Adult and Pediatric Treatment sections of the COP.
There are no other donors that provide service delivery support for the provision of antiretroviral treatment, though DFID/United
Kingdom provides support to the SAG in strengthening drug delivery systems. The USG and DFID/United Kingdom are
collaborating to ensure there is no duplication of effort. The Global Fund supports ART in the Western Cape and KwaZulu-Natal
provinces, and one PEPFAR partner, CAPRISA, receives Global Fund support for the purchase of ARV drugs.
Table 3.3.15:
