SUMMARY: Aurum has been awarded funding to provide prevention services to workers in small and medium sized companies initially in the central business district of Johannesburg. Educators and students at independent colleges located in the central business district will also be targeted by these activities. Services will be provide both within the workplaces as well as at checkpoints (stand alone or portable offices) and mobile units within the business district.

BACKGROUND: Aurum has been a partner providing care and treatment services in both the public and private sectors. This new activity is based on a recent award expanding public-private partnerships.

ACTIVITIES AND EXPECTED RESULTS:

Small and medium sized companies exist in nodes within the central business district. Companies within these nodes will be approached to determine both worker and employer willingness to participate in the training. This funding will be used to develop and deliver messaging targeted at workers and the surrounding communities..

ACTIVITY 1: Development of appropriate educational material

Aurum currently has training modules that address aspects of prevention such as identification of personal risk and development of skills to overcome peer pressure and cultural norms related to sexual behavior. As part of the new project there will be a review of the existing material and other available material and development of a set of modules that would provide ongoing messaging to the targeted workers. The main forum for communicating with the targeted workers will be in the form of small groups and individual counselling. Funding will be used to employ staff to man the checkpoints as well provide education to workers and communities that will assist them to adopt measure and behaviors that will reduce the risk of contracting HIV. Funding will also be used to develop material that will be specific and relevant to the targeted groups both in content and by the use of local languages. Staff will be trained to deliver the educational messages to the targeted groups in an effective manner. Young people that attend private colleges will be specifically encouraged to delay their sexual debut, be empowered to deal with peer pressure and if sexually active will be educated on the avoidance of risk taking and reduce the number of sexual partners.

ACTIVITY 2: Delivery of educational messages to workers and students and surrounding communities

An ongoing activity will be the delivery of targeted messaging to workers of small and medium sized companies, students and educators at independent colleges located in the Johannesburg Central business district and communities surrounding their targeted groups. The messaging will be delivered both in weekly small group sessions as well as through larger monthly community mobilization sessions. As part of the preparation process, a number of focus group sessions will be held with workers and students to determine what their current needs and preferred format for information related to HIV prevention would be. It is anticipated that there would be a range of responses but all groups would respond to and welcome messaging that is relevant to their particular needs. Messaging will specifically targets young men and young women and will encourage abstinence, delayed sexual debut, avoidance of risk taking behavior and reduction in the number of sexual partners. The project will involve interaction with male workers and encourage reduction in number of sexual partners, avoidance of violence in relationships. It is envisioned that through regular contact with the targeted workers, male workers will be able to express in small groups their views and perceptions and also be trained to identify that these behavior patterns could contribute to their increased risk of contracting HIV as well as spreading HIV if they are already positive. All the messaging will be provided in languages understood by the targeted group and the project will involve an ongoing conversation with the targeted communities.

ACTIVITY 3: Training of workers to deliver AB focused messaging.

During the course of the activity period, individuals within the targeted small and medium sized companies will be identified and provided with additional training in order for them to function as peer educators within their workplace and communities. Aurum already have a 5 day training module for peer educators. The existing curriculum will be reviewed to incorporate increased A/B focused messaging. As part of the curriculum review, other published material will be reviewed and incorporated prior to the development of new training material. Topics covered in the existing peer educator training include basic counselling skills, sexuality, HIV transmission, gender as related to the HIV epidemic, prevention methods, counselling for behavioral change, group and individual counselling.

Summary: The project activities will relate to strengthening of the use of other HIV prevention methods, namely male and female condoms, prevention of vertical transmission, provision of post-exposure prophylaxis.

BACKGROUND: Aurum has been a partner providing care and treatment services in both the public and private sectors. This new activity is based on a recent award expanding public-private partnerships.

ACTIVITIES AND EXPECTED RESULTS

PEPFAR Funding will be used to hire counselors to provide education in the community and at workplaces. Funding will also be utilized to procure condoms and ensure a reliable supply of condoms at the targeted outlets which will be at small and medium sized companies, checkpoints and doctors rooms. Specific messaging relevant to the targeted populations will be developed. In depth training of some workers to become Peer counselors will be provided

ACTIVITY 1: Distribution of condoms

The use of both male and female condoms will be encouraged and condoms will be disturbed at the workplace, testing sites and doctors rooms. The program will procure and distribute male and female condoms and educate workers and the community on the correct use of the condoms.Small gender-specific group sessions will be held at targeted workplaces to demonstrate the correct use of both male and female condoms and address any misconceptions that may exist. Condoms will also be available at the checkpoints and this will encourage workers to visit the checkpoints regularly.

ACTIVITY 2: Provision of Other Prevention Methods

Aurum has existing training material that covers prevention methods. This activity will include the review of existing material and translation of the material into the commonly used local languages. Through the messaging provided to workers , the availability of other prevention methods such as pMTCT and PEP in specific circumstances will be explained. Pregnant workers will be encouraged to enroll in PMTCT programs either at the workplace or in Doctor's rooms Post exposure prophylaxis will be offered to victims of sexual violence through local general practitioners.

INTEGRATED ACTIVITY FLAG:

This activity relates to Aurum Health Research (Aurum) activities in CT (#7299), TB/HIV (#7298), and provision of ARV Drugs (#7297) and ARV Services (#7296). This partner may benefit from the Partnership for Supply Chain Management ARV Drugs activity (#7935), which will explore current pain and symptom management practices, drug availability and cost, and provide recommendations.

SUMMARY:

Aurum palliative care program provides care to patients infected with HIV following HIV counseling and testing, and screening for treatment eligibility in accordance with South African Government (SAG) guidelines. The facilities where palliative care is provided include general practitioners' clinics, non-governmental clinics and public sector sites. These sites are located mainly in the Gauteng, North West and KwaZulu-Natal. Patients are also assessed for opportunistic infections and eligibility for ART and provided with preventive therapy i.e. INH and cotrimoxazole. Emphasis areas include human resources, commodity procurement, logistics, quality assurance and training. The primary target populations are people living with HIV (PLHIV), HIV-infected children, prisoners, homeless people and street youth.

BACKGROUND:

This is an ongoing program funded by PEPFAR since October 2004. The PEPFAR funded project aims to rapidly expand access to HIV care and treatment to South Africans living with HIV, and especially in areas (such as mining areas) where Aurum is familiar and other partners are less likely to work. Aurum has established a number of general practitioner (GP) clinics which are capable of providing care to large numbers of HIV-infected individuals and achieving high quality results. In order to ensure sustainability of this model, Aurum has partnered with Faranani Solutions, a network of general practitioners from a previously disadvantaged population. Advantages of this model, now termed the Auranani model, are that Aurum has been able to secure lower consultation rates for GPs and GPs are encouraged to provide assistance at their local hospital clinics. The presence of trained individuals in these public health facilities will enable the transfer of knowledge to nurses and doctors in the public sector. It is hoped that this model can be used to rapidly scale up delivery of HIV services in South Africa, in partnership with government efforts.Sites are located throughout the country, but are concentrated in Gauteng, North West province and KwaZulu-Natal. There is only one site each in the Northern Cape and the Western Cape.

A further extension of Aurum's program is to include care and treatment services in HIV prevention trial sites of the Aurum Institute in the North West (focus on vaccine trials), and the Medical Research Council site (focus on microbicide trials) in KwaZulu-Natal. These sites are placed within an existing program of HIV education and community engagement where potential participants visit the research sites for HIV testing in the hope that they will test HIV-negative and so will be eligible to participate in these trials. Thus patients are being diagnosed in early stages of their disease and are being counseled and prepared for antiretroviral therapy (ART) and palliative care. In both these provinces there is a close collaboration with SAG, and patients are referred to public sector facilities for ART initiation. These clinics are will be used in the future as down referral facilities

In FY 2006 Aurum fostered new relationships with non-governmental organizations (NGOs) and public sector sites. A number of primary healthcare clinics attached to NGO and faith-based organizations (FBOs) have been established. Metro Evangelical Services, a sub-partner, is a FBO providing training, housing and health services for the homeless and street youth of Hillbrow, Johannesburg. An HIV center has been established to provide CT and HIV services to this population. Aurum aims to get these centers accredited by the National Department of Health (NDOH) for ART delivery in the future, and they may develop into appropriate down referral sites. A contract was concluded with the Eastern Cape Department of Health for the support of a small rural hospital (Madwaleni). In the North West, a number of meetings were held to discuss the establishment of an Aurum outpatient clinic and the provision of support at Tshepong Hospital. Processes for obtaining accreditation for the outpatient clinic are in late stages. In Gauteng, a contract

has been concluded with Chris Hani-Baragwanath hospital for support and a contract for extension of these services to other parts of Gauteng is being negotiated with the provincial health departments. Aurum has met with the KwaZulu-Natal Department of Health about sites attached to the Medical Research Council. Furthermore, in Mpumalanga, one of Aurum's sub-partners, Reaction Consulting, has worked with the provincial health department to strengthen support for Breyten Hospital, and in the Northern Cape, Aurum's public-private partnership with De Beers Consolidated Mines in the Danielskuil area has been discussed. Training of staff at the Johannesburg Correctional Facility has been scheduled for September 2006. A number of Aurum's sites, Caritas Care, MES and Duff Scott collaborate with the local health departments that provide funding for inpatient care to palliative care patients.

ACTIVITIES AND EXPECTED RESULTS:

PEPFAR funding will be used to fund all central staff responsible for monitoring and evaluation of the program. FY 2007 funds will also be used to provide training and human resources at the sites. Focus areas of training include how to run support groups, disclosure and stigma, special counseling situations such as couples and children, and the prevention of mother-to-child transmission.

ACTIVITY 1: Monitoring for Opportunistic Infections

At each of the visits, a full physical examination including pain and symptom management of the patient is conducted to exclude the existence of opportunistic infections (OI). If a client presents with an OI, further investigations and management of the infection including the provision of cotrimoxazole may occur at the site, or the patient may be referred to another healthcare service. Adherence to OI medications (including cotrimoxazole prophylaxis and TB treatment) is also part of the package of services. Effort will be made to ensure equitable access to care services for both males and females (key legislative area).

ACTIVITY 2: Provision of Prophylactic Medication

Patients with CD4 below 200 will receive elements of the preventive care package including cotrimoxazole preventative therapy. It is expected that 30% of all patients receiving BHCS will be receiving cotrimoxazole preventive therapy.

ACTIVITY 3: Psychosocial Support

As part of a holistic approach to palliative care, patients receive counseling by trained staff member at each clinic visit. A psychologist, a dietician and a social worker based within the central office is responsible for education, training and support of site staff. Some of the sites have established psychological and spiritual support groups.

ACTIVITY 4: Work with prisons

Aurum will provide technical assistance to the Department of Corrections in Gauteng province in three areas: 1) assist in the development of the ART and care delivery system, 2) training health care workers on ART and holistic palliative care, and; 3) development of a data management system to track prisoners who are receiving ART and care support.

Aurum's palliative care services contribute to the PEPFAR goals of 10 million people in care by increasing the quality of care.

INTEGRATED ACTIVITY FLAG:

The Aurum Health Research (Aurum) TB/HIV program is part of a comprehensive HIV care and treatment program that includes CT (#7299), Basic Health Care & Support (#7300), ARV Drugs (#7297) and ARV Services (#7296).

SUMMARY:

Aurum's TB/HIV program aims to integrate HIV care with TB prevention and treatment. This integration is planned at all the HIV treatment sites which include general practitioners' clinics and community clinics throughout the country. In addition, Aurum plans to improve TB/HIV integration at Chris Hani-Baragwanath Hospital in Gauteng, and to include TB/HIV integration in the mobile counseling and testing clinics in the Matlosana area in North West province. Emphasis areas include human resources, infrastructure, commodity procurement, logistics, quality assurance and training. The primary target populations are people living with HIV (PLHIV), HIV-infected children, prisoners, homeless people and street youth.

BACKGROUND:

The main focus of the Aurum program in the public, private and NGO sector is to provide HIV care and treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality of counseling, patient care and patient monitoring. The model is centrally coordinated and designed to be implemented on a large scale where the peripheral sites are in resource-constrained settings and lack HIV specialists, information technology (IT) infrastructure, and laboratory and pharmacy capacity. Aurum has developed a centralized system of support which includes the following: (1) training of all levels of healthcare workers to ensure capacity building of clinicians to manage patients in resource-poor settings with remote HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive therapy (including INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child transmission and voluntary counseling and testing; (3) clinical and administrative support through site visits by staff involved in psychological support, training, clinical support and monitoring data management system; and (4) centralized distribution of medication and laboratory testing.

This program will supplement the South African government ARV rollout plan and therefore the program adheres to national guidelines and protocols.

This is a new activity that has not been funded by PEPFAR before FY 2007, although Aurum has received PEPFAR funds for other activities such as TB preventive therapy described in the FY 2006 COP under palliative care. In most areas, clients are referred to the public health clinics for definitive diagnosis and treatment of TB. Aurum is initiating a program where healthcare workers at sites are able to diagnose TB patients using algorithms and guidelines that are in line with the South African Department of Health (NDOH). Healthcare workers then refer patients to public sector clinics for treatment. In addition, patients who test HIV positive under the counseling and testing program will be screened for TB.

ACTIVITIES AND EXPECTED RESULTS:

There are three main activities in this program area.

ACTIVITY 1: TB Preventive Therapy for HIV-infected Individuals

CD4 count testing is done 6-monthly or 3-monthly in patients with CD4 above or below 350 respectively. Patients are given TB preventive therapy with 300mg isoniazid taken daily for 6 months after exclusion of TB, repeated every 2 years. Aurum expects that a minimum of 10% of all palliative care patients will require TB preventive therapy. This integration will be implemented at all the HIV treatment sites run by general practitioners and community clinics throughout the country. Sites include the Metro Evangelical Services Clinic, which provides services for the homeless population and street youth of Hillbrow, Johannesburg, and the Medical Research Council (MRC) sites, providing care primarily to women. Aurum's sites are located primarily in Gauteng, North West and

KwaZulu-Natal. There are sites in all the other provinces but only one site in each of Northern Cape and Western Cape.

ACTIVITY 2: Diagnosis and Treatment of TB in the HIV-infected

When initiating the ARV program or the palliative care program, a symptom screen and a chest radiograph will be done on each patient. At each clinic visit, there is symptom screening by trained nurses. Guidelines for screening tuberculosis will be followed and monitored.

In addition, in the Matlosana District, North West Province, Aurum plans to deploy two to three mobile vehicles which will expand the counseling and testing services. The mobile units will also be used to screen all HIV-infected patients for TB. Aurum has provided for the mobile clinics in the COP (infrastructure in the emphasis area for this activity). Aurum plans to evaluate the effectiveness of screening mechanisms for TB and whether they are in place at Tshepong Hospital, a large public sector facility in the North West.

ACTIVITY 3: HIV Counseling and Testing for TB Patients

Aurum will provide support to provide TB/HIV integration services at the Chris Hani-Baragwanath Clinic, a large government hospital in Gauteng. Aurum will employ a nurse and counselor who will provide HIV counseling and testing to all TB patients and ensure referral of those who test positive to the HIV clinic. In addition, Aurum will develop a data system that will assist in ensuring successful incorporation of these patients in the HIV care program.

PEPFAR funds will be used to strengthen the TB/HIV integration input at Chris Hani-Baragwanath clinic, by hiring two staff members to manage the data. In addition, funds will be used to pay for all the screening services i.e. x-rays, TB smears and TB cultures where appropriate.

Aurum's TB/HIV activities contribute to the PEPFAR goal of 10 million people receiving care.

INTEGRATED ACTIVITY FLAG:

The Aurum counseling and testing program is part of a comprehensive HIV care and treatment program that includes Basic Health Care and Support (#7300), TB/HIV (#7298) and provision of ARV Drugs (#7297) and ARV Services (#7296).

SUMMARY:

The Aurum program provides HIV counseling and testing (CT) for patients in private general practitioner (GP) practices and non-governmental sites. Where Aurum provides support in the public sector, the voluntary counseling and testing (VCT) human resources and commodities are provided by the South African government. Emphasis areas include human resources, commodity procurement and quality assurance. The primary target populations are people living with HIV (PLHIV), HIV-infected children, prisoners, homeless people and street youth.

BACKGROUND:

Aurum Institute for Health Research (Aurum) is a not-for-profit, public benefit organization that is committed to improving the health of disadvantaged individuals and communities through transformational research (the research programs are not PEPFAR-funded), management of TB and HIV programs and provision of HIV testing, treatment and care.

The main focus of the Aurum program in the public, private and non-governmental sector is to provide HIV care and treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality of counseling, patient care and patient monitoring. The model is centrally coordinated and designed to be implemented on a large scale in peripheral sites that are resource-constrained and lacking basic resources such as HIV specialists, information technology (IT) infrastructure, and laboratory and pharmacy capacity. Aurum has established a centralized system of support which includes the following: (1) training of all levels of healthcare workers to ensure capacity building of clinicians to manage patients in resource limited settings with remote HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive therapy (including INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child transmission and VCT(3) clinical and administrative support through site visits by staff involved in psychological support, training, clinical support and monitoring data management systems; and (4) centralized distribution of medication and laboratory testing.

This program will supplement the South African government's ARV rollout and therefore the program adheres to national guidelines and protocols.

This is an ongoing program funded by PEPFAR since October 2004. It is a facility-based program in which Aurum works with general practitioners, a faith-based organization (FBO) and within the public sector.

ACTIVITIES AND EXPECTED RESULTS:

Aurum will carry out eight activities in this Program Area.

ACTIVITY 1: Establishing Capacity for VCT

This activity will take place in two primary health clinics and two prison clinics. This activity will include the provision of and training of staff in these clinics as well as provision of running expenses for these clinics. The coverage area includes most provinces of South Africa, excluding Western Cape.

ACTIVITY 2: Counseling and Testing

Counseling and testing is conducted at selected GP sites, primary health centers and mobile clinics. Generally the counseling and testing includes pre- and post -test counseling and rapid finger prick testing with a screening and a confirmatory test. Provision has been made for the mobile clinics under infrastructure.

ACTIVITY 3: Quality Control of HIV Testing

Quality control specimens are supplied on a monthly or twice monthly basis to the VCT sites, depending on the size of the sites.

ACTIVITY 4: Training on Voluntary Counseling and Testing

A five-day course is provided to all new personnel involved in VCT. In addition, an annual meeting is held and new findings, discussions on counseling, running of support groups are covered. Training includes a focus on stigma and discrimination.

ACTIVITY 5: Data Management

All encounters are recorded on a standardized form and then captured onto a centralized database which is used for reporting.

ACTIVITY 6: Supply and Distribution of Testing Kits

Kits are ordered using a form that is faxed to, and authorized at, Aurum. The supplier then delivers the kits to the sites.

ACTIVITY 7: Marketing and Promotion

Educational pamphlets and campaigns are provided. Various methods are being used to market and encourage counseling and testing. Some sites (MES and Aurum Klerksdorp) run VCT campaigns over short periods of time. Other sites run activities on commemorative days such as Valentine's Day and World AIDS Day. Marketing material is developed locally by the site according to their needs.

Aurum will contribute to the PEPFAR 2-7-10 goals by promoting and providing counseling and testing services to allow for entry into HIV care and treatment programs.

ACTIVITY 8: SME Project Counselling and testing will be provided to employees of targeted companies. Stand-alone testing sites and a mobile vehicle will be utilized to ensure access. Funding will be used to purchase test kits, hire nurses and counselors, purchase and maintain a mobile vehicle, purchase and maintain checkpoint sites and develop a smart card system.

Aurum will contribute to the PEPFAR 2-7-10 goals by promoting and providing counseling and testing services to allow for entry into HIV care and treatment programs.

INTEGRATED ACTIVITY FLAG: Aurum Health Research ARV Drugs program is part of an integrated program also described in the Palliative Care (#7300), TB/HIV (#7298), CT (#7299) and ARV Services (# 7296) sections of the COP.

SUMMARY: Aurum Health Research (Aurum) will use PEPFAR funding to continue an ongoing clinical program that works through general practitioners and community clinics throughout the country, and to expand the program to three public hospitals in the Eastern Cape, North West and Gauteng provinces. The major emphasis area for this activity will be commodity procurement with minor efforts in linkages with other sectors and initiatives, logistics, quality assurance and supportive supervision, SI, and training. Target populations include infants, children and youth; adults, including men and women of child-bearing age; people living with HIV (PLHIV), including HIV-infected pregnant women, infants and children; and street youth.

BACKGROUND: The main focus of the Aurum program in the public, private and non-governmental sector is to provide HIV care and treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality of counseling, patient care and patient monitoring. The model is centrally coordinated and designed to be implemented on a large scale in peripheral sites that are resource-constrained and lacking in HIV specialists, information technology (IT) infrastructure, and laboratory and pharmacy capacity. Aurum achieves this by having a centralized system of support which includes the following: (1) training of all levels of healthcare workers to ensure capacity building of clinicians to be able to manage patients in resource-poor settings with remote HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive therapy (including INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child transmission and voluntary counseling and testing; (3) clinical and administrative support through site visits by staff involved in psychological support, training, clinical support and monitoring data management system; and (4) centralized distribution of medication and laboratory testing.

The S Buys group (a private company) is responsible for the centralized procurement and distribution of antiretroviral and preventive therapy. Negotiations with research-based pharmaceutical companies have ensured that GlaxoSmithKline (GSK) drugs are available at access prices and members of the community without medical insurance are able to access these medications.

ACTIVITIES AND EXPECTED RESULTS: PEPFAR funds will be used in this program area to purchase, store and distribute ARV drugs. Patients who are medically eligible for, but cannot afford, antiretroviral therapy will receive the drugs at no cost from enrolled sites. The drugs will be prescribed using the South African Government's (SAG) eligibility criteria and drug regimens. Generic medications purchased comply with the South African requirement of U.S. Federal Drug Administration approval as well as approval from the Medicines Control Council of South Africa.

The pharmacy plan comprises: 1.) Warehousing and stock control of drugs. A computerized system of stock control will ensure an audit trail and batching abilities from the warehouse to patients. 2.) National distribution of medication. Through a courier service, S Buys is able to distribute medication anywhere in South Africa within 24 hours of receiving the request. 3.) Named patient dispensing. Dispensing done centrally at the pharmacy ensures that medication is controlled and facilitates a tight audit trail to the patient. 4.) Integration with the Aurum Health Research Project. This integration will help ensure adherence to protocols, as well as communication between pharmacists and AHR. It will also allow for the integration of data from drug dispensing sites. 5.) Participation in the training of professional nurses in pharmacy skills.

Aurum's activities in ARV drugs contribute to the 2-7-10 PEPFAR goal of 2 million people receiving antiretroviral treatment.

Additional funding has been made available through a project to strengthen HIV services in small and medium sized companies.(SME Project).

INTEGRATED ACTIVITY FLAG: The Aurum Health Research (Aurum) ARV Services activity is part of an integrated HIV care and treatment program that includes HIV CT (#7299), Palliative Care (#7300), TB/HIV integration (#7298) and provision of ARV Drugs (#7297). SUMMARY: This activity provides support services at public facilities providing antiretroviral therapy as part of the national ARV rollout and HIV care and treatment at primary health centers, clinical trial sites and general practitioner (GP) practices. ART is provided in accordance with the National Department of Health (NDOH) guidelines. The emphasis areas are human resources, commodity procurement, training, quality assurance and logistics. The primary target population are people affected by HIV and AIDS, HIV-infected children, prisoners, homeless people and street youth. BACKGROUND: This is an ongoing activity funded since FY 2004. This activity takes place in the following NDOH ARV sites: (1) Madwaleni Hospital, Eastern Cape; (2) Tshepong Hospital, North West; and (3) Chris Hani-Baragwanath Hospital, Gauteng. In addition Aurum intends to provide ARV services to the Soweto primary healthcare clinics (government) to facilitate down-referral from the Chris Hani-Baragwanath clinic, and will provide similar support in two other DOH ARV sites. A number of sub-partners are involved in implementation of this activity: 1. Faranani Network is described in the Basic Health Care and Support (#7300) activity and this network supports treatment of people without medical insurance in general practitioner (GP) sites. 2. Reaction Consulting is based in the Mpumalanga Area. This is a public-private partnership with X-Strata (a FY 2007 PEPFAR partner) which provides the clinic facilities. 3. MES Impilo, a faith-based organization based in Hillbrow, Johannesburg, functions as a home-based care center for the homeless population of Hillbrow. 4. Medical Research Council (MRC) site based in KwaZulu-Natal, provides HIV services to prevention trial participants (microbicides, diaphragms) who are found on screening to be HIV-infected. 5. De Beers Consolidated Diamond Mines has developed a public-private partnership in the town of Danielskuil, Northern Cape where contractors and partners of employees are treated for HIV. In addition, new sub-partners are envisaged as follows: 6. Duff Scott Hospital is owned and managed by a local mining group, and provides healthcare services to the company's employees. A partnership with the NDOH ensures that excess bed capacity is funded and utilized by non-employees in the community. 7. Kings View clinic is a registered Mpumalanga DOH VCT site, and therefore offers free VCT. The partnership will be extended to supply ART and related services. 8. Department of Correctional Services: Aurum will provide support for HIV services including HIV counseling, laboratory monitoring and preventive therapy in two correctional facilities, the Johannesburg Correctional Facility and one other facility. The drug and laboratory costs would be funded by the SAG. Additional sub-partners involved in the implementation of central activities include: 9. S Buys will be involved with procurement, dispensing and distribution of medications and will provide pharmacy support at the Chris Hani-Baragwanath Hospital. 10. Toga Laboratories will assist with laboratory testing. Toga has negotiated with Bayer to secure reduced pricing for viral load testing for the Aurum program. Toga is piloting a new initiative to place point-of-care lactate tests at some of Aurum facilities to facilitate early recognition of ART adverse events. 11. Kimera Solutions will provide specialist HIV clinical support to doctors in the form of training and onsite mentoring with regular site visits.

ACTIVITIES AND EXPECTED RESULTS: The program activities include: ACTIVITY 1 (Wellness of HIV-infected Individuals): Human resources, laboratory monitoring and counseling services for patients who are enrolled into HIV care are included (described in other sections of the COP). Aurum provides a continuum of care from provision of counseling, preventive therapy and preparation for ART. In some sites (MRC, Reaction) patients are referred to public health facilities for initiation of ARVs. ACTIVITY 2 (Training of Healthcare Staff in ARV Care): All nurses and doctors in the program are trained on HIV basic care and ARVs. Refresher

training is offered annually. Topics include: TB/HIV interaction, pediatric HIV therapy and provision of cotrimoxazole. ACTIVITY 3 (Provision of Human Resources): GPs are reimbursed on a per capita basis for care. Primary health care clinics are funded based on the cost of essential staff needed for the program. In the public sector sites the following is provided: - Chis Hani-Baragwanath: Aurum will provide a HIV specialist once a week to assist in onsite mentoring of less experienced clinicians. To ensure smooth operation of the clinic, Aurum will initially provide a clinic manager. - Madwaleni Hospital: Human resources are limited due to reluctance of local health practitioners to work in rural areas. Aurum recruited a locum doctor initially and subsequently recruited a doctor with an interest in infectious diseases to work at Madwaleni Hospital for a year. This will reduce the clinical burden on management staff. Other human resource support includes a social worker and a professional nurse. - Tshepong Hospital: A medical doctor will visit twice a week, and a professional nurse will work on site. In addition, Aurum has recruited a doctor to build capacity at the site and to provide operational research input. ACTIVITY 4 (Provision of ARVs to Children): Provision of ARVs to children is a recent focus of the program. Aurum has partnered with Wits Paediatrics (sub-partner of Reproductive Health Research Unit) to provide training for two Aurum clinicians. These clinicians attend a pediatric clinic once a week to gain experience in pediatric care. This will help capacitate Aurum to provide ARV services at pediatric units. One of the Aurum GPs is involved in routine treatment of orphans and vulnerable children and has recently enrolled onto the Aurum program as a provider. Hopefully both Madwaleni and Tshepong will develop a reputation as centers of excellence and be able to attract other physicians to the site. ACTIVITY 5 (M&E): M&E is a central component of the Aurum program. Every patient contact is recorded on a standardized form and a unique patient identifier is allocated by the central Aurum office. The information is then couriered or faxed to the central office where the data is captured in a database. Monitoring visits take place at the sites to ensure adherence to guidelines and completeness of data collection. Quarterly reports are produced for all stakeholders. Aurum also provides a data management system for the Adult ARV clinic at Chris Hani-Baragwanath.Provision of laboratory services is per a standardized schedule of follow-up in accordance with SAG guidelines.The program started in March 2005 and has established 43 treatment sites where about 7000 patients are receiving ART and 80% achieve virological success at 6 months. The number of sites will be expanded in FY 2007 to include more GP sites, primary healthcare clinics and NGO sites. ACTIVITY 6: Small and Medium sized Enterprises (SME)Project This project seeks to enhance the access to HIV Care services including ARVs of SME Workers. The initial site of the project will be in Johannesburg. An additional 200 workers of targeted SMEs will be treated through the existing GP Network. Workers who are identified as requiring ARVs through the activities of the Project will be referred to general practitioners to receive clinical care, treatment and laboratory monitoring in line with existing Aurum treatment protocols.