ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ACTIVITY 1: Human Capacity Development and Training

mothers2mothers (m2m) training has been revised in light of new South African prevention of mother-to-

child transmission (PMTCT) policy guidelines, and will be significantly improved and expanded to include

new topics and tools for m2m staff to use with clients. m2m staff training on voluntary, age appropriate

family planning has been expanded though a privately funded project with Engender Health (financially

supported by Packard Foundation). Staff will be trained on infant feeding, HIV and AIDS basics, partner

counseling, prevention with positives, post-delivery care and other PMTCT topics to ensure knowledge

transfer to clients.

ACTIVITY 2: Service and Mentoring

m2m will actively seek to expand task-shifting opportunities at all facilities. In facilities where Mentor

Mothers can provide pre-test counseling for pregnant women, nurses and counselors will have more time to

provide critical services for PMTCT. m2m will continue to provide the critical education and support services

for pregnant women and new mothers so that they receive the full package of PMTCT care and services

before and after delivery. The program will strengthen efforts to link women and children to medical services

for follow-up and continuing care and treatment. The program will work in collaboration with PEPFAR

partners providing antiretroviral treatment (ART), including Foundation for Professional Development,

Perinatal HIV Research Unit, and Right to Care, to ensure that all HIV-infected women and HIV-exposed

infants are referred to appropriate care.

ACTIVITY 3: Counseling & Testing

m2m will expand its reach by encouraging HIV counseling and testing within PMTCT settings. The program

already works within labor and delivery wards to encourage pregnant and newly delivered women to test or

re-test for HIV. The program will also enhance testing opportunities for male partners of pregnant women to

prevent new HIV infections or re-infection during pregnancy and to encourage HIV-infected men to enroll in

HIV care programs. m2m will encourage mothers to bring all children from previous pregnancies for HIV

testing to ensure that those who are positive can be referred to care and treatment services. m2m will also

collaborate with PEPFAR partners to improve services through sharing of data and best practices.

NEW ACTIVITIES IN COP 2009:

ACTIVITY 4: Prevention

m2m mentors and site coordinators will receive enhanced training on HIV prevention during pregnancy.

Program staff will expand activities to include information sessions with all pregnant women to ensure that

those who test HIV-negative at a first antenatal visit understand the risks of infection during pregnancy, the

importance of partner testing and retesting during pregnancy, as well as how to protect themselves from

HIV infection. Program staff will continue ongoing prevention with positives activities, including education on

family planning, STIs and prevention.

ACTIVITY 5: Couples Support

The m2m model of care will be expanded to focus on engaging male partners by encouraging women to

bring male partners for HIV testing and then providing education and support for concordant HIV-infected

and discordant couples. Staff will educate couples about how to prevent infection or re-infection during

pregnancy through mutual fidelity and condom use, as well as how male partners can support partners to

take medications, seek care, and practice safe infant feeding.

ACTIVITY 6: Infant Feeding

m2m will enhance and improve its post-delivery program to focus on safer infant feeding to reduce post-

natal transmission. Enhanced training for Mentor Mothers on infant feeding and targeted program activities

for new mothers will be added to provide intensive education and support for women (and their male

partners) on how to maintain a chosen method of infant feeding.

ACTIVITY 7: Improved Monitoring, Evaluation, Patient Tracking and Follow-up

m2m will improve program monitoring to collect data to measure program activities and client outcomes

more effectively. m2m will implement systems for patient tracking and follow-up to ensure that clients

receive critical care and support needed for optimal PMTCT outcomes. The systems will allow m2m to

measure outcomes of program participants in the following areas: CD4 test results; ARV prophylaxis

uptake; ART for eligible women; post-delivery and ongoing care for mothers and babies, including receipt of

cotrimoxazole; support for, selection of, and adherence to an exclusive method of infant feeding; early infant

testing and enrollments of infected infants in care; and uptake of age appropriate voluntary family planning.

The client tracking system will allow Mentors to follow up clients who have been lost from care. The new

methods of patient tracking will be piloted at the m2m Innovation Center-10 healthcare facilities where new

ideas and strategies for service provision, monitoring and patient tracking will be tested. The program will

also use the Innovation Center to develop a system of quality assurance. The program aims to share patient

outcome data with facility managers and district/provincial PMTCT managers and other Department of

Health staff in order to contribute to healthcare systems strengthening.

ACTIVITY 8: TB Education

m2m will expand activities to include educating pregnant women and new mothers about TB diagnosis, care

and treatment. All site staff will be trained to use a simple screening tool that will help identify women in

Activity Narrative: need of referrals for diagnosis/care services. Women screened by m2m and identified with risk factors or

clinical indication of TB will be referred to medical services for definitive diagnosis and to start TB treatment.

------------------------------------

SUMMARY:

mothers2mothers (m2m) will implement activities to improve the effectiveness of prevention of mother-to-

child transmission (PMTCT) in HIV programs. Services are carried out through facility-based, peer

education and psychosocial support programs for pregnant women, new mothers and caregivers, all living

with HIV and AIDS. There are four components of the program: curriculum-based training and education

programs; psychosocial support and empowerment services; programs to increase uptake for counseling

and testing; and bridging services linking PMTCT treatment and care to antiretroviral treatment (ARV) and

other health services. The primary emphasis areas are human capacity development (training) and local

organizational capacity building. The target population is people living with HIV and pregnant women.

BACKGROUND:

m2m is a South African-based international NGO established in 2001 to help enhance and support publicly-

funded PMTCT programs through peer education and psychosocial support for HIV-infected pregnant

women and new mothers. With PEPFAR's support, m2m will increase the effectiveness of PMTCT services

through a comprehensive program of facility-based, peer education and psychosocial support for pregnant

women, new mothers and caregivers living with HIV and AIDS. m2m addresses issues of stigma through

group counseling, support groups, and linkages to income generation. All activities have been and will

continue to be coordinated with local PMTCT service providers and their partners, and will also be carried

out in conjunction with provincial, district and municipal health authorities. The programs have the active

support of the Departments of Health for KwaZulu-Natal, Mpumalanga and Western Cape provinces and

will be integrated into their healthcare structures. Current m2m programs are located in over 90 healthcare

facilities in four provinces in South Africa as well as in Lesotho. With funding from the PEPFAR New

Partners Initiative, m2m will initiate service provision in Kenya, Rwanda and Zambia in 2007/2008. With FY

2008 funding, m2m will enhance the existing South African program sites and improve infrastructure, while

adding significant numbers of facilities in these provinces. By the end of FY 2007 m2m will be active and will

have launched sites in one of the following three provinces: Northwest, Limpopo, Gauteng. In the remaining

two provinces, preparation during FY 2007 will have laid the ground work for implementation and site start-

up so that these sites will be ready to launch as early as possible in the following year. With the work of FY

2007 as a foundation for expansion, in FY 2008, m2m will continue to build the program and increase

service provision in new provinces and with new partners who offer antiretroviral care and treatment

services. By the end of FY 2008, m2m will have established service in up to 200 sites throughout seven

provinces in South Africa.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development and Training

PEPFAR funding will be used to support the delivery of a cascade of curriculum-based training for m2m

mentors and education programs designed to improve PMTCT outcomes through education and training of

pregnant women and new mothers with HIV and AIDS. The training curriculum that is given to m2m staff

provides guidance about PMTCT and ARV treatment tied to maternal and infant health, with the objective of

encouraging women living with HIV (PLHIV) to take responsibility for their own health, their child's health,

and the health of their partners. Additional critical subjects covered in the training include disclosure, safer

feeding options, family planning, nutrition, couples counseling, and prevention guidance for these PLHIV

and their partners ("Prevention with Positives"). An intensive two week training course is given to all m2m

Site Coordinators (SC) and Mentor Mothers (MM), all of whom are PLHIV. Training for Site Coordinators

includes an additional week of management training (3 weeks of training total). m2m staff, in turn, provide

curriculum-guided education and support (individual and group) to mothers in PMTCT programs during

antenatal care, post-delivery recovery, and at their return to clinics after delivery. Annual training is given to

all staff, inclusive of new staff and retraining for existing staff. m2m does not provide formal training on

direct PMTCT service provision for healthcare providers, including doctors and nurses. With FY 2008

PEPFAR funding, m2m will add a complement of trained PMTCT care providers (SCs and MMs) to

supplement the resources of frequently overburdened local healthcare providers in 3 new provinces. m2m

will also use funding to continue to support existing sites and open new sites. Simultaneously, the program

will also hone the skills and knowledge of existing healthcare staff in PMTCT related care and support. The

lasting impact of these activities will make a significant contribution to the sustainable development of the

capacity of local organizations. Through expanded partnerships with providers of ART, m2m will also be

able to train the staff of these organizations and have an impact on ARV care and treatment service

providers.

ACTIVITY 2: Service and Mentoring

PEPFAR funding will be used to provide individual and group psychosocial support and empowerment

programs for pregnant women and new mothers with HIV and AIDS to help them with issues including

stigma and discrimination, disclosure, reducing risky behavior ("Prevention with Positives") and pediatric

support. Nutritional support and guidance is also part of the programs. A related activity focuses on

providing specific support programs for the MMs and SCs ("Care for Caregivers"), contributing to their own

physical and emotional well-being as well as that of their clients. One objective of both group and individual

support is specific knowledge transfer around the many issues women living with HIV and AIDS faces in

navigating the PMTCT process. Another outcome is empowering the women to focus on and take

responsibility for the health of their babies, and their own health. By encouraging behaviors that can help

mothers sustain their well-being, the programs aim to reduce the potential that their children could become

Orphans and/or Vulnerable Children (OVC). While m2m does not provide formal referrals for healthcare,

MMs are well informed about where services are available and they inform women about how to access

both medical and social services. The program addresses the reality of the high rates of violence against

Activity Narrative: women in the communities served, as well as the specific ties between HIV and domestic violence. They

provide tactical as well as emotional support aimed at helping women confront this issue and reduce their

likelihood of becoming targets and victims. Women who come to the program are also giving information

about income generation projects in their area and are encouraged to participate in such programs.

ACTIVITY 3: Counseling and Testing

Working in close partnership with local health and government programs, m2m will facilitate the integration

of MMs and SCs into the antenatal intake process at both the community and facility levels. In this role, they

will focus on increasing counseling and testing uptake by serving as committed advocates, working with

women like themselves and drawing on their training and their own personal experience. Through this

program, the MMs and SCs also provide significant support for Pediatric Counseling and Testing during

home visits by advocating for pregnant women to return to clinics post-delivery to test their infants,

supporting the women in the post-delivery period, and providing referrals of babies to testing and treatment

programs.

ACTIVITY 4: Linkages and Referrals

This activity provides linkages and referrals in various forms including creating a bridge between PMTCT

services and other health and empowerment services. In active collaboration with local and provincial health

officials, PEPFAR funding is used to link ante/post natal women to programs providing wellness care for

themselves and their infants, and to refer women and infants with AIDS-defining conditions to ARV therapy

programs. With FY 2008 funding, m2m will expand partnerships with service providers of ARVs in order to

become fully integrated into HIV and AIDS care and treatment programs throughout South Africa. Working

at sites where ARV treatment is provided, m2m will be able to assist in the process of steering pregnant and

post-delivery women in need of referral for ARV care and treatment to these services.

The above results contribute to the PEPFAR 2-7-10 goals by increasing the number of women cared for by

PMTCT programs; by improving prevention (PMTCT) outcomes, thus reducing the number of infected

children; and by increasing the number of pregnant women, new mothers, and infants receiving treatment

by providing a referral system from PMTCT to ARV services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14025

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14025 8236.08 U.S. Agency for Mothers 2 Mothers 6687 4754.08 $6,775,000

International

Development

8236 8236.07 U.S. Agency for Mothers 2 Mothers 4754 4754.07 New APS 2006 $2,635,000

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $623,830

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $453,384

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01: