INTEGRATED ACTIVITY FLAG:

This activity is part of a comprehensive range of services provided by the Department of Correctional Services. Programs are described in Other Prevention (#7373), Palliative Care (#7374), CT (#7376), ARV Services (#7378), TB/HIV (#7379) and SI (#7375).

SUMMARY:

PEPFAR funds will support the Department of Correctional Services (DCS) to raise awareness about the prevention of HIV and progression to AIDS through the procurement of posters, pamphlets, booklets and condom containers. CDC South Africa (SA) will review posters prior to printing and distribution. The appointment of six HIV and AIDS management area coordinators, eight dieticians and eight pharmacists on a contract basis of one year, will enhance the program implementation. The HIV and AIDS coordinators will coordinate, monitor and evaluate (M&E) all HIV and AIDS programs. Dieticians will ensure proper prescription of diet for ARV eligible offenders and the pharmacists will ensure procurement and proper storage of ARVs and other related treatment. The major emphasis area for this program will be human resources, with minor emphasis given to community mobilization and participation, the development of network/linkage/referral systems and information, education and communication. The target population will include men and women offenders, people living with HIV (PLHIV) and their caregivers, several most at-risk populations (e.g., men who have sex with men, injection drug users, tattooing with contaminated instruments, etc.).

BACKGROUND:

Raising awareness on prevention amongst offenders and personnel forms a critical element of the comprehensive HIV and AIDS Program in the Department of Correctional Services. The utilization of educational posters, pamphlets and booklets will indeed assist in strengthening the prevention messages. Educational posters have previously been procured and distributed to the Regions. Feedback received from the Regions with regard to the utilization of these posters was positive and encouraged procurement of more educational material by Department of Correctional Services from accredited and registered service providers. The educational material was utilized by the master peer educators and HIV and AIDS coordinators during training and awareness raising sessions in prisons.

The appointment of HIV and AIDS management area coordinators (MACs) whose function is to coordinate HIV and AIDS comprehensive programs on contract basis, with funding received in 2004/2005 has proven to be successful and has enhanced the implementation of HIV and AIDS programs and services at management area level as well as at a correctional center level. It furthermore contributed to the fact that the human resource capacity in at least five management areas was extended by converting the contract post to a permanent post.

ACTIVITIES AND EXPECTED RESULTS:

There are approximately 156,621 offenders (both sentenced 113,680 and un-sentenced 42,941) incarcerated in 241 Correctional Centers managed by the DCS, and 36,879 offenders in community corrections programs/jails (total 193,500). The average offender population of a correctional center is approximately 3,000. In addition, DCS currently employs approximately 35,000 persons. This program is designed so that every offender and every staff member will be exposed to ongoing information sessions on HIV and AIDS through awareness and prevention messages.

ACTIVITY 1: Procurement of Educational Material, e.g. posters, pamphlets, booklets

DCS will procure HIV and AIDS educational material that will be utilized during training sessions and awareness raising events. These materials will be obtained through the procurement process. The educational material will be distributed to all Correctional Centers and the utilization thereof will be monitored by the management area and correctional center coordinators. This activity it is expected to reach individuals with relevant prevention messages.

ACTIVITY 2: Appointment of HIV and AIDS Management Area Coordinators, Dieticians and Pharmacists

PEPFAR funds will also support the appointment of six HIV and AIDS management area coordinators, eight dieticians and eight pharmacists on a contract basis for one year. These posts are intended to oversee the implementation of project activities. HIV and AIDS MACs are responsible for M&E of all HIV and AIDS programs. They will coordinate with other stakeholders, procure materials, and facilitate in-service and other training of staff and offenders as peer educators and on awareness. Posts will also facilitate HIV and AIDS work sessions, coordinate meetings, assist in gathering and tabulating required HIV and AIDS data and ensure that necessary reports and documents are submitted to the Regional HIV and AIDS coordinators. The appointment of dieticians and pharmacists will contribute positively to the requirements and criteria of establishing accredited ARV sites. Dieticians will ensure proper prescription of diet for ARV eligible offenders and the pharmacists will ensure procurement and proper storage of ARVs and other related treatment.

This activity will strengthen the rendering of ARV services within the DCS, and activities will contribute to the realization of PEPFAR's goal of preventing 7 million new infections. These activities will also support efforts to meet the prevention objectives outlined in the USG Five-Year Strategy for South Africa.

INTEGRATED ACTIVITY FLAG:

This activity relates to the Department of Correctional Services activities in Other Prevention (#7373), CT (#7376), ARV Services (#7378), TB/HIV (#7379) and SI (#7375). 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:

PEPFAR funds will be used by the National Department of Correctional Services (DCS) to provide basic HIV and AIDS care and support to offenders and staff in DCS Correctional Centers in all nine provinces. The major emphasis area for this program will be the training of personnel as facilitators on the establishment and maintenance of support groups for infected and affected HIV and AIDS offenders in Correctional Centers. Special emphasis will be placed on positive living and behavior change as well as the management of psychosocial challenges. Minor emphasis will be given to community mobilization and participation; development of network/linkage/referral systems; information, education and communication; linkages with other sectors and initiatives; and local organization capacity development. The target population will include men and women offenders, people living with HIV (PLHIV), their caregivers and several most at-risk populations (e.g., men who have sex with men, injection drug users and tattooing with contaminated instruments) which are alleged to be prevalent in prisons.

BACKGROUND:

This is a new activity which falls under the Care and Support program area in the Comprehensive HIV and AIDS program for offenders. The activity will be implemented by an identified service provider registered and accredited according to the South African laws and contracted through the DCS procurement process. This activity is also one of the National Department of Health's strategies aimed at promoting positive living among people who have tested HIV-infected and who seek to support one another and to cope with their status. The activity will contribute to the core objective of the Department of Correctional Services which is rehabilitation by enhancing a rational thinking amongst offenders and allowing them to take charge of their own behavior and future.

Although the DCS is encouraging the establishment of support groups in Correctional Centers, no formal training was conducted to ensure that facilitators (personnel) are equipped with the necessary skills and knowledge to establish and maintain these support groups. Challenges have been previously experienced whereby the support groups were without a skilled coordinator, and the concept of support groups lost its meaning in terms of its objectives and core business. This activity will add value to the existing services and assist in providing an environment in which offenders who have tested positive can adequately deal with their psychosocial responses to HIV and AIDS.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

Personnel which includes, among others, nurses, social workers, psychologists, religious care workers and custodial officials, who have undergone basic HIV and AIDS training, will be trained as HIV and AIDS Support Group Facilitators.

The activity will ensure gender balance by training both males and females as HIV and AIDS Support Group Facilitators to establish and maintain support groups. Coverage will include the 36 Correctional Centers identified as Centers of Excellence by the DCS in all six of its Regions which correspond with the nine provinces of South Africa. The support groups will consist of health providers in the prisons to become comfortable with basic facts of HIV and AIDS and the care of affected and infected prisoners. There will also be groups for persons living with HIV and AIDS to provide prevention for positives and healthy living messages.

Each Correctional facility will also have a selected number of offenders who will be trained

on basic HIV and AIDS counseling as well as palliative care including screening for pain and symptoms and support for HIV-infected offenders in prisons. The basic care package and adult preventive care packages will be adapted for the prisons to be used as the standard of practice. Prisoners living with AIDS will be trained as treatment supporters and act as adherence counselors. Upon completion of the training, the offenders will work closely with the support group facilitators to form support groups and then become facilitators for sessions in support groups.

ACTIVITY 2: Provision of care

Trained offenders will provide basic palliative care and support to other HIV-infected inmates.. The basic palliative care activities will stem from those provided by the DOH as adapted for prison use. Nutritional referral, personal care, counseling (both pastoral and basic support), recognition of worsening condition such as increased pain or wasting, knowledge of when to refer to clinical providers in the prison, treatment adherence, prevention (including prevention for positives) and other holistic care activities as allowed (bathing, wound care). This will be done in collaboration with the nurses at the prison since treatment for pain can only be done with a physician's orders and under strict supervision.

ACTIVITY 3: Information, Education and Communication

Another activity will be the development of information education and communication materials on how offenders can care for other offenders infected with HIV and AIDS. Offenders will be provided with information and education materials on basic HIV care directly related to caring for other offenders.

ACTIVITY 4: Guidelines for carers in prisons

The above activity links closely with the activity of the development of procedures and guidelines of caring for carers in prisons. These guidelines will be modified to suit this special population.

The Department of Correctional Services activities contribute to the PEPFAR objective of 2-7-10 by increasing the number of people in care as well as preventing new infections.

INTEGRATED ACTIVITY FLAG:

This activity is part of a comprehensive range of services provided by the Department of Correctional Services. Programs are described in Other Prevention (#7373), Basic Health Care & Support (#7374), CT (#7376), ARV Services (#7378), TB/HIV (#7379) and SI (#7375).

SUMMARY:

PEPFAR funds will be used by the National Department of Correctional Services (DCS) to train professional nurses in the management of tuberculosis (TB) and patients who are on the antiretroviral treatment (ART) program. The major emphasis of this activity will be training, with minor emphasis on community mobilization and participation; development of network/linkage/referral systems; information, education and communication; linkages with other sectors and initiatives; and local organization capacity development. The populations will include men and women of productive age, people living with HIV (PLHIV) and their caregivers.

BACKGROUND:

This is an initial project. Currently there are about 635 professional nurses in the DCS. This project will train about half of them to provide on-site primary healthcare services in the management of TB and for patients who are on ART. South Africa has a fairly extensive and mobile correctional center population. Overcrowding in Correctional Centers creates ideal conditions for the transmission of communicable diseases such as TB.

ACTIVITIES AND EXPECTED RESULTS:

It is proposed that 317 professional nurses be trained in effective management of infectious and communicable diseases (TB, HIV and AIDS). Weakened immune systems in infected individuals have resulted in a large population requiring care and follow-up for conditions such as TB, HIV and AIDS. Lack of adherence and lack of quality and consistent care has resulted in many persons developing multi-drug resistant TB and complications of HIV disease. Therefore, an effective palliative care strategy is required for persons co-infected with HIV and other opportunistic infections. Training professional nurses will equip them with skills and knowledge to manage offenders with TB and those who are on antiretroviral (ARV) drugs. Training will include comprehensive palliative care including adherence to TB drugs, adherence to ARV, nutrition, support and prevention messages. Training will also incorporate some of the International Management of Adult Illnesses protocols developed by WHO.

This activity contributes to the Comprehensive Program for Offenders in DCS. This activity will contribute to both the vision outlined in South Africa's Five-Year Strategy and to the 2-7-10 goals training professional nurses to manage infectious diseases such as TB/HIV.

INTEGRATED ACTIVITY FLAG:

This activity is part of a comprehensive range of services provided by the Department of Correctional Services. Programs are described in Condoms and Other Prevention (#7373), Basic Health Care and Support (#7374), ARV Services (#7378), TB/HIV (#7379) and Strategic Information (#7375).

SUMMARY:

PEPFAR funds will be used by the Department of Correctional Services (DCS) to establish HIV counseling and testing (CT) services in correctional centers and to increase access and utilization of CT services in correctional centers where they already exist. The major emphasis area for this program will be training, with minor emphasis placed on mobilizing the incarcerated community and encouraging their participation; information, education and communication; logistics; and strategic information. Target populations will include prisoners and DCS staff (men and women of reproductive age, including people living with HIV (PLHIV)), and most at-risk populations (e.g., men who have sex with men, injecting drug users). To increase capacity, DCS will train nurses, social workers, psychologists and spiritual care workers in counseling and testing.

BACKGROUND:

This is an ongoing activity intended to initiate the establishment of voluntary counseling and testing (VCT) in Correctional Centers. According to the National Department of Health protocols, only nurses can be trained to give the rapid test. Social workers, psychologists, spiritual care workers and nurses, will be trained in pre- and post-test counseling. Other professionals will play a role in the delivery of pre-, post-, and ongoing counseling, which nursing personnel will be unable to do because of time constraints.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Counseling and Testing DCS Staff

Voluntary counseling and testing services will be made accessible to all DCS staff at the correctional facilities. Employee Assistance Practitioners (EAPs) will run campaigns in correctional facilities focusing on staff members and encouraging them to get tested for HIV. In facilities where the prison clinic is not suitable to offer the testing service, the EAP will collaborate with local NGOs to provide the VCT services. Couple counseling will also be strongly encouraged and the service will be made available to all DCS staff.

ACTIVITY 2: VCT services for Offenders

With FY 2006 funds, nurses, social workers and psychologists working in prisons were trained in VCT. Each correctional facility will have VCT services that are confidential. Peer educators will be used to encourage offenders to use VCT, as well as conduct other health campaigns in prisons.

ACTIVITY 3: Routine Offer of CT

DCS will pilot routine testing of HIV in six centers of excellence. Nurses in these facilities will be trained on how to routinely offer HIV testing, focusing on inmates who are infected with TB and sexually transmitted infections.

ACTIVITY 4: Training on Routine Testing

Twenty nurses will be trained on routine counseling and testing and also provided with guidelines on routine testing.

These activities will contribute to both 7 million infections averted and 10 million people in care by promoting and providing testing and counseling as an entry point for prevention, care, support and management of HIV and AIDS.

INTEGRATED ACTIVITY FLAG:

This activity is part of a comprehensive range of services provided by the Department of Correctional Services. Programs are described in Other Prevention (#7373), Basic Health Care and Support (#7374), Counseling and Testing (#7376), ARV Services (#7378), TB/HIV (#7379) and Strategic Information (#7375).

SUMMARY:

FY 2007 PEPFAR funds will be used by the Department of Correctional Services (DCS) to establish and accredit six antiretroviral (ARV) treatment sites which will facilitate the comprehensive management of HIV and AIDS. These 6 new sites, in addition to the 3 already accredited, will ensure that there is one accredited ARV treatment site per province. The major emphasis area for this program will be training, with minor emphasis given to community mobilization and participation; the development of network/linkage/referral systems; and information, education and communication. The target population will include men and women offenders, people living with HIV (PLHIV) and their caregivers, and several most at-risk populations (e.g., men who have sex with men, injection drug users and tattooing with contaminated instruments).

BACKGROUND:

DCS currently has three correctional centers that have been accredited as antiretroviral treatment (ART) sites (Grootvlei Correctional Center in the Free State/Northern Cape Region, Pietermaritzburg Correctional Centre and Qalakabusha Correctional Centre in KwaZulu-Natal Region). Other than the 3 accredited ART center, the DCS refers offenders to Department of Health public health facilities to access ART. This process is cumbersome and limits access, and there is a need to increase the number of DCS accredited ART sites available to prisoners. Once the additional sites are established and accredited, access to ARV treatment by offenders will be improved.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training of personnel as ARV Project Managers

FY 2007 PEPFAR funds will be utilized to train DCS personnel as ART project managers. Training will include management of ART services, plan development, budget planning, information and other management systems. The trained personnel will ensure adequate facility and resource management of ART service, in accordance with South African ART guidelines.

ACTIVITY 2: Training of nursing personnel in nutrition

Nursing personnel will be trained in nutrition assessment and counseling to ensure that nutritional needs of HIV-infected persons and patients on ART are adequately met, according to Department of Health nutrition guidelines. Nutrition support will be provided by the trained nurses.

ACTIVITY 3: Training of data capturers

Current administrative staff in the prison health services will be trained as data capturers to capture relevant patient information (ARV module and the electronic TB register). Data capture activities will include: maintenance of diaries for offender's appointments to attend adherence counseling and treatment readiness classes, and status of offenders on ART (e.g., deaths, withdrawals, non-compliance, releases, transfers and referrals).

ACTIVITY 4: Procurement of information, education and communication material

DCS will procure ART educational material that will be utilized during treatment literacy campaigns. The educational material will be distributed to all correctional centers and the utilization thereof will be monitored and recorded by the management area and correctional center coordinators. In addition to the distribution of pamphlets, there will be treatment literacy education to enhance the understanding of adherence.

This activity contributes to the PEPFAR objective 2-7-10 by providing information on treatment to offenders, and thereby increasing capacity to effectively provide HIV care and treatment services.

INTEGRATED ACTIVITY FLAG:

This activity is part of a comprehensive range of services provided by the Department of Correctional Services. Programs are described in Other Prevention (#7373), Basic Health Care and Support (#7374), CT (#7376), ARV Services (#7378), and TB/HIV (#7379).

SUMMARY:

PEPFAR funds will be used by the Department of Correctional Services (DCS) to conduct Regional Lekgotlas (Consultative Conferences). The activity will focus on reviewing the progress of implementing the Comprehensive HIV and AIDS Programs for offenders, on monitoring the implementation of policies and on enhancing management involvement to strengthen the commitment and interventions. It is important that consultative discussions take place at an operational level, to ensure that new developments in the field of HIV and AIDS are addressed and included in the mainstreaming of HIV and AIDS programs and services at DCS. The major emphasis area is monitoring, evaluation and reporting, and the minor emphasis area is other strategic information (SI) activities. The activity primarily targets DCS staff, in particular senior managers at a policy-making level, and Regional, Management Area and Correctional Center levels.

BACKGROUND:

The implementation of comprehensive HIV and AIDS programs and services has been prioritized by the DCS. To ensure that implementation is taking place at an operational level, it is imperative to involve management at all levels to discuss and outline future endeavors pertaining to HIV and AIDS programs in the regions. In FY 2005, funding was allocated to host a National Conference on HIV and AIDS in the DCS. It is therefore envisaged that the rollout of such conferences in the form of consultative forums (Lekgotlas) in the Regions will promote discourse on the subject and focus, in particular, on the challenges with regard to the implementation of comprehensive HIV and AIDS programs in the DCS.

Monitoring and evaluation is an ongoing activity aimed at ascertaining levels of compliance to policies, procedures and programs in correctional centers. The DCS has developed monitoring and evaluation tools for HIV and AIDS programs. These tools are to be implemented at all levels to determine compliance to policies and procedures, the interpretation of these policies, as well as the status of the implementation of the Comprehensive HIV and AIDS programs. Training was provided for all management and center coordinators in 2005 for similar purposes and was found to be useful.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Hosting of Regional Lekgotlas (Consultative Forums)

The first activity is a new activity to be hosted by the regions. The activity will target management in the regions at all levels. Management is comprised of Regional staff, Area Commissioners and Correctional Center Heads. The rationale is to enhance the level of support, accountability and commitment to HIV and AIDS programs. Staff representatives from the National Office and other partners such as community-based organizations, NGOs, government departments, donors, etc., from local, provincial and national levels will also be invited to share and participate in the events. The ultimate aim is to augment management involvement in HIV and AIDS programs through participation in plenary and work sessions, and ensure relevance and effectiveness of HIV and AIDS policies and strategies. This will result in the uniform implementation of HIV and AIDS programs within correctional centers. These Lekgotlas will take place in all six Regions.

ACTIVITY 2: Monitoring and Evaluation (M&E)

M&E will be conducted using observational visits at various levels within the DCS to monitor the progress and quality of program implementation. Regular progress reports will be submitted in terms of the South African Public Finance Management Act. These will be used to collect ongoing data which will be analyzed and fed back into the programs. Evaluation has been planned, but has not yet begun. These activities will begin once the

departmental M&E framework is approved.

All activities are in support of the USG South Africa Five-Year Strategy, especially support for the South African Government, and contribute to PEPFAR's 2-7-10 goals by monitoring and providing data for evaluation purposes on the effective rollout of HIV programs within the DCS.

Note that there are no targets because the M&E activities during this time focus on convening a meeting to discuss HIV and AIDS in the prisons and using collected data for program improvement.