INTEGRATED ACTIVITY FLAG:

Columbia University's Track 2 activity is part of a comprehensive program that receives both Track 1 and Track 2 (South Africa) funding. Columbia University's Track 1-funded submission includes ARV Services (#7964). Track 2 activities include Palliative Care (#7304), TB/HIV (#7305), CT (#7306), ARV Drugs (#7303) and ARV Services (#7302). 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:

Columbia University (Columbia) carries out activities to support implementation and expansion of comprehensive HIV treatment and care. The major emphasis area for this program will be human resources, with minor emphasis on infrastructure development, technical assistance and training, community mobilization, quality assurance and supportive supervision and strategic information. The target population will include infants, children and youth (non-OVC), men and women (including pregnant women and family planning clients), people living with HIV (PLHIV) and healthcare workers in the public and private sectors.

BACKGROUND:

Columbia, with PEPFAR funds, began supporting comprehensive HIV care and treatment activities in South Africa, in 2004. HIV palliative care has included training of healthcare workers in providing standard care for opportunistic infections (OI) management, use of cotrimoxazole prophylaxis for common OIs, and the provision of information on when and where to refer for end-of-life care. In FY 2006, in response to provincial HIV care and treatment priorities, Columbia began strengthening the down-referral of services from hospitals to primary health clinics. This resulted in a total of 36 health facilities receiving technical and financial support from Columbia, including public hospitals, community health centers, primary health care (PHC) and an NGO-run wellness center. In FY 2007 additional health facilities in KwaZulu-Natal (East Griqualand and Usher Memorial Hospital and the Kokstad Community Clinic) will receive technical and financial assistance for HIV care and treatment services.

ACTIVITIES AND EXPECTED RESULTS:

All activities are in line with South African Government (SAG) policies, and activities will be undertaken to create sustainable comprehensive HIV care and treatment programs and primarily include four activities:

ACTIVITY 1: Training and Onsite Clinical Mentoring

Currently healthcare providers rendering services at ART sites participate in ongoing didactic training events and are continuously supported with regular clinical and supportive supervision. In FY 2007 clinical training emphasis will be on the development of a comprehensive HIV nurse preceptor (NP) training and support program. These NPs will be situated at the Columbia-supported ART sites and will be focused on building the capacity and skills of facility-based nurses to deliver high quality HIV patient care and treatment including elements of the preventive care package for adults and children including OI screening and prophylaxis (including cotrimoxazole, TB screening/management), counseling and testing for clients and family members, safe water and personal hygiene strategies to reduce diarrheal disease. Initially, trained NPs would be responsible for providing daily clinical guidance and constructive feedback, using custom designed assessment and training tools, to facility-based site nurses providing basic HIV patient care and treatment. The NP program will include: (1) one-week didactic training that includes clinical material currently in development by the WHO as part of their second-level, competency-based 'Integrated Management of Adolescent and Adult Illness' (IMAI) training program; (2) onsite mentoring of patient triaging, provision of complex care and treatment, modeling on how to conduct basic and complex patient case conferences, evaluation of nurses' basic HIV care and treatment skills and developing instructional plans to address the performance gaps and assisting NPs in practicing teaching; and (3) a series

of at least three continuing education sessions lasting two to three days.

ACTIVITY 2: Community-based Support

Columbia is involved in the implementation of Peer Educator (PE) programs to enhance retention into care and to maximize adherence to treatment. More than 30 Columbia-supported PEs are currently working at St. Patrick's, Holy Cross, Frere and Cecilia Makiwane, Dora Nginza and Livingstone Hospitals. PEs work under supervision of the ART site coordinator or his/her designee to provide: elements of the preventive care package, education on HIV and AIDS care, living positively; psychosocial counseling and emotional support; adherence to care and treatment support; promoting referral linkages to clinic/hospital and other networks; where possible conduct home visits; and attend PE-specific and general PLHIV support groups. Approaches to PLHIV support were initially centralized with the development of wellness centers; the current implementation strategy through FY 2007 will be supporting the decentralization of PLHIV services.

ACTIVITY 3: Strengthening Program Integration Activities

District hospitals and public healthcare facilities have co-located TB, PMTCT and STI services, and integration activities to strengthen these services with holistic palliative care will be carried out in collaboration with the following programs at district and provincial levels:

a. PMTCT: Support early infant diagnosis through the use of dry blood spots (DBS) for PCR testing. This activity will include training PMTCT nurses in specimen collection, information gathering to assess the uptake of DBS and referral linkages of HIV-infected children to chronic care, ensure that HIV-exposed children receive cotrimoxazole. DBS training activities will be carried out in collaboration with the Local Service Area authority and the National Health and Laboratory Services (NHLS).

b. TB: Support active TB case finding and referral for TB treatment for the TB/HIV co-infected. Columbia will support the implementation of TB screening and diagnosis algorithm for HIV-infected patients to include the adaptation of a simple questionnaire for use as a screening tool for active TB at the designated HIV clinics and incorporating the questionnaire into routine clinical care.

ACTIVITY 4: HIV Care and Treatment Information System

Columbia will continue to support the implementation of a provincial information system that captures information on HIV palliative care and ART. Activities in FY 2007 will include:

a. Implementation of facility paper-based non-ART registers that captures non-ART indicators. These facility registers will be introduced mainly at the primary and community health clinics that are designated by the provinces as down-referral sites for HIV care and ART services.

b. In collaboration with the Department of Health and other partners in the Eastern Cape, support the development and implementation of standardized individualized patient records for use at health facilities.

c. Strengthen the paper-based data collection systems at HIV care and treatment sites in the Eastern Cape in preparation for computerization of a minimum set of key data elements.

d. Work with ART managers and facility site staff to support the utilization of information to improve service delivery and patient care.

By providing basic healthcare and support to people in need in Eastern Cape and KwaZulu-Natal, Columbia's activities will contribute to the realization of the PEPFAR goal of providing care to 10 million people. These activities also support efforts to meet the care and support objectives outlined in the USG Five-Year Plan for South Africa.

INTEGRATED ACTIVITY FLAG:

Columbia University's Track 2 activity is part of a comprehensive program that receives both Track 1 and Track 2 (South Africa) funding. Columbia University's Track 1-funded submission includes ARV Services (#7964). Track 2 activities include Basic Health Care & Support (#7304), TB/HIV (#7305), CT (#7306), ARV Drugs (#7303) and ARV Services (#7302).

SUMMARY:

Activities are carried out to support implementation and expansion of best-practice models for integration of tuberculosis (TB) and HIV services in public sector facilities in the Eastern Cape and KwaZulu-Natal. TB/HIV activities are implemented through technical assistance and will result in a decrease of the burden of TB in HIV-infected children and adults, increase prevention and early detection of TB in HIV-infected children and adults, and provide overall support to provincial TB/HIV activities. The major emphasis area for this program will be human resources, with minor emphasis on linkages with other sectors and initiatives, quality assurance and supportive supervision, strategic information and training. The target population will include infants, children and youth (non-OVC), men and women (including pregnant women and family planning clients), people living with HIV (PLHIV) and healthcare workers in the public and private sectors.

BACKGROUND:

Columbia University (Columbia), with PEPFAR funds, began supporting TB/HIV integration activities in FY 2006. Health facilities that were initially identified in the Eastern Cape included three TB hospitals, namely Nkqubela, Fort Grey and Empilweni Hospitals and eight HIV care and treatment sites: Holy Cross, St. Patrick's, Rietvlei, Cecilia Makhiwane, Frere, Dora Nginza and Livingstone Hospitals and the Ikhwezi Lokusa Wellness Center. In the TB hospitals inpatients are counseled and tested for HIV, initiated on cotrimoxazole prophylaxis if they are found to be HIV-infected and if they are eligible, started on antiretroviral treatment (ART). On discharge from the TB hospitals, patients are linked to primary health clinics or the nearest facility where they can access HIV and TB treatment services. Patients from Empilweni TB hospital are referred to any of the seven primary health clinics in Port Elizabeth.

In FY 2006, Columbia began supporting the training of nurses, doctors and lay health workers on TB/HIV integration in both programmatic and clinical aspects: active TB case finding in the HIV-infected patient, ART for eligible TB/HIV co-infected clients, and taking advantage of existing referral services to provide comprehensive HIV support. In FY 2007 Columbia will continue to support the implementation of these activities in these three TB hospitals and eight HIV care and treatment sites. In addition, in FY 2007, Columbia will form a new partnership with Yale University AIDS Program in support of TB/HIV integration activities in Tugela Ferry, KwaZulu-Natal. Tugela Ferry is a small rural village in the uMsinga area of the uMzinyathi district; one of the three poorest districts in KwaZulu-Natal. Since 2001, Yale University has been involved in projects that expand access to ART in TB/HIV co-infected patients in KwaZulu-Natal.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Nkqubela, Empilweni and Fort Grey TB hospitals in the Eastern Cape

Activities will include: 1. Provide ongoing TB/HIV clinical support by conducting didactic and onsite TB/HIV training for doctors, nurses and lay health staff to improve knowledge and practice around managing TB/HIV co-infected patients. Provide clinical mentorship through case presentations and discussion that will include topics on initiating ART, drug-to-drug interactions, managing side effects of ART, treatment failure and adherence to ART and TB treatment. 2. Recruitment and placement of health staff needed to efficiently deliver TB/HIV services at these facilities. Columbia will continue to support the hiring and placement of doctors, nurses, and peer educators so as to improve uptake of HIV counseling and testing and to increase enrollment of TB/HIV co-infected patients into ART.

3. Provide technical support for monitoring and evaluation (M&E) activities by continuing to support the implementation of a system to track/monitor referrals and patients between HIV and TB programs. This activity includes training and use of the pre-ART and ART facility registers. In FY 2007, in collaboration with the Eastern Cape Department of Health, Columbia will assess the flexibility of the electronic TB register (ETR.Net discussed in Activity #7365) with a view to implementing a HIV module that will link HIV testing and service data to the routine TB recording and reporting system.

ACTIVITY 2: HIV Care and Treatment Sites

Activities in the eight HIV care and treatment sites will be focused on strengthening: 1. TB case finding among clients enrolled into HIV care and ART. 2. Referral linkages with the TB program to initiate TB therapy for those in HIV care and/or ART.

ACTIVITY 3: Yale University Partnership

Columbia will partner with the Yale University to develop the following services at the Church of Scotland Hospital (COSH), Tugela Ferry (KwaZulu-Natal): 1. Increase HIV counseling and testing (CT) of clients accessing TB services in the COSH. This will be implemented through the introduction of various models of provider-initiated CT at the TB treatment programs (drawing on experiences from other settings) that is inclusive of training of TB treatment staff in HIV CT, training in HIV pre- and post-test counseling with establishment of strong linkages to laboratory HIV diagnostic services, and training of TB treatment staff in the referral of TB patients to CT services. 2. Prevent the development of multidrug-resistant tuberculosis (MDR-TB) cases by strengthening the existing TB DOTS program and integrating with HIV treatment program. 3. Prevent nosocomial transmission of MDR-TB and extreme drug-resistant tuberculosis (XDR-TB) by instituting infection control practices. 4. Implement a MDR-TB treatment program. 5. Screen for active TB among HIV-infected patients, accomplished through the development and implementation of simple, routine, standardized screening questionnaires and/or algorithms which could be used by all types of healthcare workers followed by standardized follow-up and diagnostic algorithms of TB suspects and supported by the introduction of effective recording and reporting systems for these activities. 6. Standardize protocols to evaluate and treat co-infected patients with both TB and ART and provide patients with home-based treatment support programs. 7. Conduct a targeted evaluation of the TB/HIV program consisting of baseline data and a repeat evaluation after one year.

By providing palliative care TB/HIV support to TB/HIV co-infected persons in Eastern Cape and KwaZulu-Natal, Columbia's activities will contribute to the realization of the PEPFAR goal of providing care to 10 million people. These activities will also support efforts to meet HIV and AIDS care and support objectives outlined in the USG Five-Year Plan for South Africa.

ACTIVITY 4: ICAP will implement a field-based infection control demonstration project in Motherwell Community Health Centre, Nelson Mandela Bay Metro and Cecilia Makiwane Hospital Amathole District. The goal of the project is to develop and evaluate innovative approaches focused on minimizing source infectiousness to minimize the risk of nosocomial M. tuberculosis transmission.

INTEGRATED ACTIVITY FLAG:

Columbia University's Track 2 activity is part of a comprehensive program that receives both Track 1 and Track 2 (South Africa) funding. Columbia University's Track 1-funded submission includes ARV Services (#7964). Track 2 activities include Basic Health Care and Support (#7304), TB/HIV (#7305), ARV Drugs (#7303) and ARV Services (#7302).

SUMMARY:

Columbia University (Columbia) and its identified partners in the Eastern Cape have been supporting the care and treatment of patients dually infected by HIV and tuberculosis (TB) since FY 2006. This activity focuses on HIV counseling and testing (CT) for tuberculosis (TB) patients and will be an ongoing activity for Columbia in FY 2007. The major emphasis area for this program will be human resources, with minor emphasis on development of network/linkages/referral systems, linkages with other sectors, quality assurance and supportive supervision, strategic information and training. The target population will include people infected and affected by TB/HIV including infants, children and youth (non-OVC), men and women (including pregnant women and family planning clients).

BACKGROUND:

Columbia will use FY 2007 funds to continue strengthening the Eastern Cape Department of Health's capacity to provide routine HIV counseling and testing (RCT) services to tuberculosis patients. In the latter part of FY 2006, Columbia began RCT activities in three TB hospitals: Empilweni, Nkqubela and Fort Grey. In FY 2007, PEPFAR funds will be used to screen TB inpatients for HIV, to develop and implement TB/HIV patient prevention education and to ensure that TB/HIV co-infected patients are referred for appropriate HIV care and treatment services. Referral mechanisms with adjacent health facilities (including hospitals and primary health clinics) have already been identified and established. Ongoing program emphasis area will be on the development of network/linkage/referral systems that will eventually result in retention into HIV treatment services for the TB/HIV co-infected after completing of TB treatment and improved adherence to TB and HIV therapies.

ACTIVITIES AND EXPECTED RESULTS:

In FY 2007 Columbia University will continue to implement four activities in three TB hospitals - Fort Grey, Nkqubela and Empilweni. ACTIVITY 1: Support Routine HIV Counseling and Testing for TB patients)

Columbia will provide assistance through hiring and training of additional clinical staff (nurses and peer educators) to increase the uptake of HIV testing among TB patients. Registered nurses at each hospital will be responsible for performing the HIV tests and post-test counseling, and trained peer educators will provide pre-test counseling.

ACTIVITY 2: Provide Patient HIV Prevention Education

This activity will consist of collaboration with the Eastern Cape Department of Health, community-based organizations and other local non-governmental organizations to provide information and education on TB/HIV. In addition, trained peer educators will be actively involved in one-to-one patient education.

ACTIVITY 3: Referrals for TB Patients

Practitioners will continue to take advantage of and support the existing referral systems for TB patients into HIV care and treatment activities, and where feasible, develop and promote more efficient referral linkages.

ACTIVITY 4: Monitoring and Evaluation

Data collection and reporting will be strengthened by training and hiring data staff, as needed, to collect accurate counseling and testing patient information and to provide monitoring and evaluation technical support for data interpretation and dissemination that

will result in program improvement.

By providing HIV counseling and testing to patients on TB treatment, Columbia's activities will contribute to the realization of the PEPFAR goal of providing care to 10 million people. These activities will also support efforts to meet HIV and AIDS care and support objectives outlined in the USG Five-Year Plan for South Africa.

INTEGRATED ACTIVITY FLAG:

Columbia University's in-country activity is part of a comprehensive program that receives both Track 1 and in-country funding. Columbia University's Track 1-funded submission includes ARV Services (#7964). In-country activities include Basic Health Care and Support (#7304), TB/HIV (#7305), Counseling and Testing (#7306), ARV Drugs (#7303) and ARV Services (#7302).

SUMMARY:

Columbia University (Columbia), in collaboration with the Eastern Cape Health Department (ECDOH) will support antiretroviral (ARV) drug purchase for two treatment sites and support commodity supply chain-related training, and logistics for 34 current antiretroviral treatment (ART) service delivery sites in the Eastern Cape and two new ART sites in KwaZulu-Natal. Major emphasis is given to commodity procurement, and minor emphasis areas include human resources, infrastructure, quality assurance, and training. The target population will include infants, children and youth, men and women (including pregnant women) and people living with HIV (PLHIV).

BACKGROUND:

Columbia and the ECDOH will continue to support procurement and distribution of needed ARV drugs using PEPFAR FY 2007 funds. In FY 2006 Columbia formed a partnership with the United Nations Children's Fund (UNICEF) to procure ARV drugs from local pharmaceutical companies that are licensed by the South African Medicines Control Council (MCC). These drugs are distributed to two non-governmental organizations, Ikhwezi Lokusa Wellness Center (Ikhwezi) in East London and the Cato Manor Community Health Center in Durban. Columbia purchases generic medications that are in compliance with the USG PEPFAR Task Force requirement for both U.S. Federal Drug Administration and MCC approval. Columbia provides technical assistance to improve HIV-related pharmacy practices in 34 public health facilities. In these 34 public sector sites, the relevant provincial department of health provides all required HIV drugs.

In FY 2006, Columbia conducted an assessment of the appropriate use of existing ARV pharmacy tools (computerized and/or paper-based systems) at St. Patrick's, Holy Cross and Rietvlei hospitals and their respective down referral primary health clinics. In addition, Columbia provided guidance on quantification and stock control at these three district hospitals, and this led to the submission of a proposal for training of pharmacist assistants to the education committee of South African Pharmacy Council. The submission was sent via the ECDOH Pharmaceutical Services unit. In FY 2005, Columbia started providing support at the Mthatha Depot by seconding a pharmacy depot manager to oversee the distribution of ARV drugs and in FY 2007 this will be an ongoing activity. The ECDOH will budget for this position in FY 2008. By June 2006, Columbia was supporting over 6,000 patients on ART.

ACTIVITIES AND EXPECTED RESULTS:

Specific areas of programmatic focus include: 1. Technical support for ARV stock management and distribution at the pharmacy depot (in Mthatha) and public ART sites. Activities include: a. Train pharmacists and pharmacist assistants in ARV stock management. b. Support the implementation of a province-endorsed pharmacy tracking tool to prevent ARV drug stock-outs at health facilities. c. Support the province-endorsed training of pharmacist assistants at identified health facilities. 2. Purchase and distribute ARV drugs for Ikhwezi Lokusa Wellness Center and Cato Manor community health clinic: In FY 2006, Columbia initiated discussions with the ECDOH to propose that the ARV drug procurement and distribution for Ikhwezi is managed by the ECDOH. Similar discussions with the KwaZulu-Natal Health Department (KZNDOH) are expected to begin in FY 2007 for the Cato Manor community health clinic in Durban.

Columbia will continue collaborating with the National Department of Health (NDOH) in support of ARV procurement mechanisms to ensure uninterrupted ARV supply at

Columbia-supported sites. The specific quantities of ARV drugs that would be needed will take into consideration relevant medical conditions (TB, adverse drug reactions). Columbia will continue to strengthen the ARV drug distribution system by providing technical assistance at designated pharmacy depots to coordinate distribution of ARVs with the NDOH, as well as participate in furthering the ARV quality assurances activity initiatives as developed by the NDOH.

By providing ARV drugs and related services, Columbia's activities will contribute to the realization of the PEPFAR goal of providing treatment to 2 million people. These activities will also support efforts to meet HIV and AIDS care and support objectives outlined in the USG Five-Year strategy for South Africa.

INTEGRATED ACTIVITY FLAG:

Columbia University's in-country activity is part of a comprehensive program that receives both Track 1 and in-country funding. Columbia University's Track 1-funded submission includes ARV Services (#7964). In-country activities include Basic Health Care and Support (#7304), TB/HIV (#7305), Counseling and Testing (#7306), ARV Drugs (#7303) and ARV Services (#7302).

SUMMARY:

Activities are carried out in FY 2007 to support implementation and expansion of comprehensive HIV treatment and care primarily through human resources and infrastructure development, technical assistance and training and community education and support, primarily in public sector facilities in the Eastern Cape and KwaZulu-Natal. Columbia University will support these activities by using funds for: development of network/linkages/referral systems, human resources, local organization capacity, quality assurance activities and supervision, improving strategic information and training. The degree of activity effort will vary in each site but these emphasis areas will occur in all sites. The target population will include infants, children and youth, men and women (including pregnant women) and people living with HIV (PLHIV). Columbia will continue to support the recruitment of doctors, nurses, pharmacists and pharmacist assistants.

BACKGROUND:

Columbia University (Columbia), with PEPFAR funds, began supporting comprehensive HIV care and treatment activities in FY 2004. Health facilities were initially identified in the Eastern Cape and in FY 2006, due to new boundary demarcations and additional PEPFAR funds, Columbia started providing similar assistance in KwaZulu-Natal. In FY 2006, in response to provincial HIV care and treatment priorities, Columbia began strengthening the down referral of services from hospitals to primary health clinics. This resulted in a total of 36 health facilities receiving technical and financial support from Columbia, including public hospitals, community health centers, primary health clinics and a non-governmental wellness center. In FY 2007 an additional two health facilities in KwaZulu-Natal (East Griqualand Usher Memorial Hospital and the Kokstad Community Clinic) will receive technical and financial assistance for HIV care and treatment services.

ACTIVITIES AND EXPECTED RESULTS:

All activities are in line with South African government (SAG) policies and protocols, and activities will be undertaken to create sustainable comprehensive HIV care and treatment programs, and primarily include four programmatic areas:

ACTIVITY 1: Support Recruitment and Placement of Health Staff

Since FY 2005 Columbia has been involved in the recruitment of staff to support the HIV comprehensive program at health facilities. High staff attrition rates of Department of Health (DOH) recruited personnel have been a challenge in guaranteeing a steady enrolment of eligible PLHIV into care and treatment. Columbia will continue to support the recruitment of doctors, nurses, pharmacists and pharmacist assistants through existing partnerships with University of Fort Hare, Nelson Mandela Bay Metropolitan Municipality, Ikhwezi Lokusa Wellness Center, University of KwaZulu-Natal Cato Manor, and the Foundation for Professional Development. In FY 2006, Columbia supported the recruitment and placement of approximately 15 doctors, 30 nurses (registered and enrolled nurses), 2 pharmacists and 7 pharmacist assistants. These health personnel provide direct patient care in the hospitals and clinics including: clinical assessment, screening for tuberculosis (TB) and antiretroviral treatment (ART) eligibility, opportunistic infections (OI) diagnosis and management, and offering OI prophylaxis and treatment, and ART. The health providers also develop patient treatment plans as part of the multidisciplinary team in the health facility; and assist patients to access relevant SAG social grants.

ACTIVITY 2: Training and Clinical Mentoring

Columbia has established a partnership with the Foundation for Professional Development to provide ARV didactic training in all supported health facilities. A second partnership with Stellenbosch University assists the rural health facility staff (St. Patrick's, Holy Cross and Rietlvei hospitals and their referral clinics), with the management of patients on ART by conducting case discussions on a monthly basis. Columbia has clinical advisors as part of its South African team consisting of nurse mentors, and medical officers who provide day-to-day clinical guidance on the management of patients on ART.

ACTIVITY 3: Strengthen ART Down and Up Referral Linkages Between Hospitals and Primary Healthcare Clinics

In the early phases of the ART program, all patients are evaluated and initiated on therapy at hospital-level. Within three to six months of providing support to the hospital-based ART program, designated referral clinics are integrated into the services. In the rural health facilities, a small team of health providers, usually comprising of a medical officer, professional nurse and peer educator, travel to the primary healthcare clinics (PHC) to screen patients for OIs and to determine suitability for ART. This approach has enabled expansion of ART services at PHC level and has resulted in improving and increasing access to treatment. The team of health providers has also developed capacity of the onsite health providers and the goal is to have the onsite DOH health staff eventually provide the full package of HIV care and treatment services. In FY 2007, Columbia will continue to support linkages with the public clinics and the development of a more sustainable system of service provision.

ACTIVITY 4: HIV Care and Treatment Information System

Columbia will continue to support the implementation of a provincial information system that captures information regarding HIV palliative care and ART. Activities in FY 2007 will include: a. Continued implementation of facility paper-based ART registers that capture both adult and pediatric ART indicators. b. In collaboration with the Eastern Cape Department of Health (ECDOH) and other partners in the Eastern Cape, support the development and implementation of standardized individualized patient records for use at health facilities that incorporates information on client ART use. c. Develop an ART software system. Columbia is working in partnership with Africare (a PEPFAR partner) and Health Information System Program (HISP) to customize and develop ART software that captures and collates HIV and AIDS program data. This ART database will be adapted for data entry, and then installed and tested for use. Using FY 2006 funds, the system will be piloted at three health facilities in East London: Frere, Cecilia Makiwane and Duncan Day Village hospitals. In FY 2007, after assessing results from the pilot sites, Columbia will engage the ECDOH in discussion on how the module could be added into the existing District Health Information System to efficiently generate reports on the HIV program, and thereafter implemented at more ART services outlets.

By providing support for ARV services in the public sector and two NGO sites, Columbia's activities will contribute to the realization of the PEPFAR goal of providing care to 2 million people. These activities will also support efforts to meet HIV and AIDS care and support objectives outlined in the USG Five-Year Strategy for South Africa.