Detailed Mechanism Funding and Narrative

Years of mechanism: 2012 2013 2014 2015 2016 2017 2018

Details for Mechanism ID: 13904
Country/Region: South Africa
Year: 2012
Main Partner: TB/HIV Care Association
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: HHS/CDC
Total Funding: $1,800,000

TB HIV Care Association will strengthen the current health care system to provide accessible and sustainable HIV, STI and TB prevention services to sex workers (CSW) in collaboration with the South African DOH in Cape Town Metro, Western Cape, and eThekweni Metro Area, KwaZulu-Natal. The project aims to provide client-centered prevention services to CSW within the current health system and will contribute to the PEPFAR goals of preventing 12 million new infections by 2013, by preventing new HIV infections among CSW, by strengthening systems to prevent HIV transmission, and by promoting HCT to identify CSW with HIV and linking them to HIV/STI/TB care and treatment services. The projects strategy aligns with SAGs NSP to reduce vulnerability to HIV infection and the impacts of HIV/AIDS and reduce transmission of HIV and has been designed to encourage and promote stronger collaboration with existing service providers and promote local ownership and sustainability for the future. Training and mentorship will be aligned with South African DOH policies and plans, using materials adopted by the DOH. HCT and STI screening will be strengthened at health facilities and community-based services will be provided to reach CSW who dont access health facilities. Clinicians will be trained, mentored, and supported on CSW sensitivity and CSW-specific risk reduction counseling. The project will be monitored using an activity chart, work plan, GANNT chart, and reports on progress towards set targets relevant to the objectives. An M&E plan and system will be developed to measure prevention indicators, and the success of the program will be measured and a communication strategy will be developed to report on the success of the project. No vehicles will be purchased.

Funding for Testing: HIV Testing and Counseling (HVCT): $540,000

Through this project TB Care Association (THCA) will provide mobile and client-centered HCT, STI screening, and referral services for the entire sub-population of CSW in the target areas. Aside from preventing missed opportunities for diagnosing HIV at health facilities through provider-initiated HCT (PITC), community-based HIV counseling and testing (HBCT) services will be provided to reach people who dont access health facilities. HCT, TB, and STI screening will be delivered using one mobile HCT team in each of sub-districts. Each team will consist of 1 professional nurse (PN), 3 lay counselors, and 4 CSW Peer Educators (CPEs). All mobile teams will be equipped with a Pima CD4 machine ($8.00/cartridge), providing point of care CD4 counts to HIV positive clients. HCT will be provided according to national guidelines and counseling will focus on personalized risk assessment and risk reduction that take into consideration issues around CSW sexual risk behaviors. Community-based HCT and TB and STI screening will identify HIV-positive clients, TB suspects, and STI suspects who will be appropriately referred for diagnosis and treatment. CPEs will coordinate with community care workers to trace these patients ensuring continuum of care. Clinicians at identified sites will be trained, mentored, and supported on CSW sensitivity and CSW-specific risk reduction counseling and health needs. Patients started on ART or TB treatment at health facilities will be linked with CCWs to ensure retention in care and adequate treatment adherence support. Indicators will be monitored and reported on a quarterly basis to the project team, the District, and PEPFAR. Processes will be set in place to evaluate the effectiveness of prevention services and will be evaluated using the continuous quality improvement methods. Managers of the mobile HCT teams will be trained using the CQI approach and will work with nurses at health facilities to implement these interventions, review regular performance quality, improve quality and systematically close the gaps through the development and testing of innovative solutions to effectively deliver services. In FY 2012 THCA aims to provide HCT to 1,600 CSW (800 in Cape Town and 800 in eThekweni).

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $1,260,000

The project is focused on interventions that address the immediate health and safety needs of sex workers as well as targeting sex workers collectively with in-depth workshops around safer sex, general health, and life skills. In FY 2012, THCA will promote behavior change interventions and structural prevention strategies in consultation with the district and provincial department of health, community leaders, and important stakeholders, including NGOs with expertise in issues around HIV, sex work, gender, mental health, and substance abuse. THCA will collaborate with Sex Workers Education and Advocacy Taskforce (SWEAT) to engage all levels of society in addressing dominant concepts of masculinity, reducing stigma, discrimination, and gender-based violence towards sex workers; increase knowledge about HIV prevention; reduce CSWs risk behaviors; and improve rates of HIV testing for CSWs. To build the capacity of the public health system to address the health needs of CSWs, THCA will support the DOH to improve and integrate clinical care of CSWs into existing health services through clinical mentorship and supportive supervision of nurses and other health providers in the target areas, including sensitivity training and inclusion of risk behavior assessments specific to CSWs. Current and former sex workers will be empowered with skills to enhance their capacity to negotiate safer sex and make informed choices about their health, occupation, and human rights. To promote sustainability and government ownership, THCA will place focused emphasis on improving and developing a functioning tracking system for CSW client identification, treatment, care, and support follow through, using a community consultative approach in the development, integration, and implementation of the CSW HIV prevention project. Over the lifetime of the project, THCA aims to reach 80% of CSWs in the target areas with HCT and behavior change interventions. In FY 2012 THCA aims to reach to 1,600 CSW (800 in Cape Town and 800 in eThekweni) with individual or group level evidence-based prevention interventions and reach 400 HIV positive CSW (200 in Cape Town and 200 in eThekweni) with prevention with positives services.

Cross Cutting Budget Categories and Known Amounts Total: $150,000
Gender: Reducing Violence and Coercion $150,000
Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services
Increasing women's legal rights and protection