PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
INTEGRATED ACTIVITY FLAG: This PMTCT activity is linked to Prevention/Other Prevention (#7569), Counseling and Testing (#7573), Basic Care and Support(#7570) and Treatment (#7575) as part of the Department of Defense Comprehensive Management, Prevention, Care and Treatment Program.
SUMMARY: The South African Department of Defense (SA DOD) Prevention of Mother-to-Child Transmission (PMTCT) program will focus on training military healthcare workers with standardized educational materials based on World Health Organization (WHO) and South African National PMTCT guidelines to ensure appropriate and uniform PMTCT services for HIV-infected mothers and their babies. Healthcare workers in all military hospital and clinic settings throughout all nine provinces will be trained. The program will include counseling and testing of mothers as part of antenatal care, the provision of antiretroviral treatment for PMTCT, in line with national policy, appropriate management of infant deliveries, follow-up support for infant feeding practices, and linkages with treatment, care and support for HIV-infected women. It is envisioned that PMTCT will serve as an entry point for male partners and other family members to access counseling, testing, care and treatment services. The major emphasis area is training, with minor emphasis on information, education, and communication, and policy and guidelines. Target populations include adults, pregnant women, HIV-infected pregnant women, people living with HIV and AIDS, HIV-infected infants, military personnel, and public doctors, nurses, laboratory workers, pharmacists, and other healthcare workers.
BACKGROUND: Since 2000, the SA DOD has provided a comprehensive care, management and treatment plan for HIV and AIDS to members of the military and their families that includes PMTCT as a mode of intervention. This PMTCT intervention has served as an entry point to treatment and care, thereby ensuring access to treatment for women. Although this intervention has already been integrated into the HIV and AIDS program, it has never received PEPFAR funding and is not standardized across all military units in all nine provinces. It is envisaged that future management of the DOD PMTCT project will include more vigorous PMTCT training for military healthcare workers and ensuring that healthcare workers are able to link PMTCT and antiretroviral treatment programs. In addition, healthcare workers will also be trained see PMTCT as a HIV and AIDS service delivery entry point for the whole family, including mothers, fathers, infants and other children. This expansion requires standardization of protocols, more vigorous implementation of a comprehensive package of PMTCT services according to WHO and national guidelines, and monitoring and evaluation of the PMTCT program.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Training SA DOD will modify PMTCT clinical practice guidelines to be implemented in PMTCT programs. Existing guidelines will be reviewed annually during a PMTCT workshop attended by SA DOD doctors and nurses. The goal of this workshop will be to ensure that current WHO PMTCT guidelines and NDOH PMTCT guidelines are being incorporated into all SA DOD communication tools and educational aids for practitioners and patients and that PMTCT services available for whole families (including mothers, fathers, and babies) are standardized across all military health units in all nine provinces. SA DOD will provide standardized PMTCT training to healthcare providers using these evidence-based clinical practice guidelines as part of a comprehensive package of PMTCT services. Dependent upon human resource capacity within SANDF, the Director of the SA DOD HIV/AIDS Program will decide whether the training will be centralized within SA DOD or will need to be outsourced to an accredited training institution.
ACTIVITY 2: Service Delivery SA DOD will provide a comprehensive package of PMTCT services to every pregnant woman. A large component of this PMTCT package is counseling and testing. All pregnant women will be counseled and offered HIV testing using the opt-out testing approach. Women who test positive will be post-test counseled and antiretrovirals for PMTCT will be provided. An important component of the comprehensive package of PMTCT services includes the referral of HIV-infected women to treatment, care and
support services. SA DOD will ensure that all women are supported post discovery of HIV status. This includes support on appropriate infant feeding practices. The SA DOD PMTCT program will ensure that PMTCT does not stop at delivery and an infant follow-up system will be implemented to ensure that the HIV status of the HIV-exposed infant can be determined and the infant can be referred to treatment, care and support services. This follow-up system will also ensure that HIV-exposed infants are monitored for signs and symptoms of HIV infection and that cotrimoxazole prophylaxis is provided appropriately. The SA DOD program will support HIV-infected pregnant women such that they are in a position to disclose their HIV status to their families and can encourage their families to participate in the program. This will be done by providing ongoing counseling and support to these women. SA DOD will also offer counseling and testing to other family members, and family members who test positive will be referred to treatment facilities as well. Presently, procurement of antiretrovirals for this purpose will be funded by PEPFAR as managed by USAID.
The PMTCT package also includes micronutrient supplements (multivitamins, iron therapy, folic acid) and recommendations for a well-balanced nutritious diet for pregnant and lactating women. Nutritional supplements will be procured through the SA DOD budget. Guidelines will be given to all health units on the provision of PMTCT and the SA DOD Monitoring and Evaluation Director will track women who receive this PMTCT package of services through the SA DOD health informatics system.
These activities will directly contribute to the PEPFAR 2-7-10 goals by averting HIV infection in children, increasing access for people living with HIV to counseling, testing, care treatment, and support in the South African Department of Defense, and increasing the capacity of healthcare providers.
INTEGRATED ACTIVITY FLAG:
The activity also relates to activities described in Condoms and Other prevention (#7569), CT (#7573), Basic Health Care and Support (#7570) and ARV Services (7575).
SUMMARY: The South African Department of Defence's (SA DOD) activities are complementary to the other prevention and care components within the Masibambisane program. The focus of Abstinence and Be Faithful (AB) prevention for this funding is the training of chaplains as trainers in the value and ethical-based program (addresses amongst other things gender equity, the role of men as partners, as well as violence and coercion), facilitation of the value and ethical-based program to members of the SA DOD, training of chaplains in the pastoral care and counseling, and the provision of pastoral care and counseling to HIV infected and affected members. In addition, workshops are conducted with unit commanders to ensure buy in and to address stigma and discrimination. Mass awareness and targeted intervention programs will also address abstinence and being faithful components of prevention. The activity has been expanded to include training of SADC chaplains. Specific target populations include military personnel, HIV-infected pregnant women, people living with HIV (PLHIV), religious leaders and public health workers.
BACKGROUND:
The AB component of the Masibambisane program is an integral part of the Chaplaincy HIV program of the Department of Defence. This ensures more focused prevention messages in terms of abstinence and/or faithfulness. The program was developed with FY0 2004 funding with the aim to expose all members of the SA DOD to the training. In order to achieve this objective all regular force chaplains as well as a number of reserve force chaplains were trained. The training was reviewed and redesigned in a three day training program. This training will continue in order to reach the optimal number of Defence Force members.
Since 2005, all chaplains are further trained in the Pastoral, Care and Support program to enable them to render the appropriate care and support services to HIV infected and affected individuals and families. It will continue to be implemented by the chaplaincy of the SA DOD.
All these activities are monitored through the monitoring and evaluation (M&E) plan for Masibambisane with focused program evaluation of the training courses. The chaplaincy will also involve reserve force chaplains and liaise with the broader religious community to market the training programs to the broader community in an effort to mobilize civilian faith-based organizations.
The chaplaincy completed the development of both courses and has trained the majority of chaplains within the SA DOD. They have also trained a group of chaplains from SADC countries and chaplains at the NATO chaplains' conference. Training of Reserve Force Chaplains has resulted in the expansion of the program to civilian faith-based organizations.
The AB Program will continue with specific focus on highly vulnerable target groups such as the Military Skills Development (basic training) intake of young recruits between the age of 18 and 25 years.
ACTIVITY 1:
This activity will provide training to chaplains of the SA DOD, Southern African Development Community (SADC) and the North Atlantic Treaty Organization (NATO) in the values and ethical based intervention program to empower them to facilitate HIV prevention through abstinence and being faithful. This requires updating and customization of the training curriculum and the printing of training material.
ACTIVITY 2:
The activity aims to execute the value and ethical based program within the SA DOD as part of unit workplace programs to members of the SA DOD. This requires the development and printing of facilitation manuals.
ACTIVITY 3:
The SA DOD will support the establishment of unit workplace programs through workshops with commanders to ensure targeted abstinence and faithfulness interventions within units as well as to address stigma and discrimination in the units.
ACTIVITY 4:
The SA DOD will provide pastoral care and counseling to HIV-infected and affected individuals and families within the SA DOD with the secondary aim to prevent HIV infection through interventions that focus on abstinence and faithfulness. This activity will further seek to establish support networks for PLHIV in units in conjunction with activities listed in the Basic Health Care and Support (#7570) program area and also to provide support to other healthcare providers.
ACTIVITY 5:
SA DOD will create ass awareness campaigns to address abstinence and faithfulness through media and mass awareness activities with the development and printing of information and education material.
ACTIVITY 6:
SA DOD will assimilate innovative ways of spreading AB information through attendance of PEPFAR prevention partner meetings, publications in military and peer reviewed magazines and journals and oral and poster presentations on effective and innovative programs at conferences and seminars.
These activities will contribute to the prevention of HIV infection through increased pastoral care and counseling in the SA DOD for PLHIV and increased support to healthcare providers thus contributing to the PEPFAR goal of preventing 7 million new infections.
The activity is linked to AB (#7568), CT (#7573), Basic Health Care and Support (#7570) and ARV Services (#7575) as part of the South African Department of Defence (SA DOD) Plan for the Comprehensive Care, Management and Treatment of HIV and AIDS.
SUMMARY:
This prevention activity mainly addresses workplace programs and includes a spectrum of activities such as mass awareness; peer education on HIV prevention and gender equity [through experiential learning and theories of behavior change (following adult behavior theory)]; substance abuse prevention; training of SA DOD members to develop and conduct prevention programs; and reducing stigma and discrimination [through guided introspection about participants' sexuality, case studies about people living with HIV (PLHIV), fact sheets addressing myths, and confronting topics such as fear, stigma, isolation, discrimination and marginalization]. The primary emphasis area for this activity is training while minor emphasis will be given to information, education and communication (IEC), strategic information, workplace programs policy guidance, quality assurance and community mobilization/participation. Target populations include public health workers, doctors, laboratory workers, adults, people living with HIV and AIDS, military personnel, out-of-school youth and factory workers.
Masibambisane is an integrated prevention, care and treatment program in the SA DOD, addressing the management of HIV and AIDS within the Department by interventions that target South African military personnel and their dependants. The prevention programs include mass awareness; workplace programs that includes condom distribution through condom containers in military units and sickbays (container supplies monitored by workplace managers); information, education and training; gender equity and substance abuse programs (delivered by social workers, psychologists, occupational therapists, peers and peer educators) . The program uses communication and education through a wide range of media such as pamphlets, posters, industrial theatre (dramatic plays that address coping with stigma and discrimination in the workplace) and videos.
The overall activities are ongoing and in FY 2007 the activities will be continued and expanded upon by broadening the curriculum and reaching more SA DOD members. The activities are implemented in a decentralized manner in military units throughout South Africa by various role players and coordinated on a regional level by Regional HIV and AIDS Coordinators in the Masibambisane Program. A Knowledge, Attitudes and Practices (KAP) survey (SA DOD, 2006) indicates that there is an overall increase in knowledge about prevention; however work still remains on preventing risk behavior practices related to HIV infection. Community awareness and education programs include celebrations of World AIDS day and other HIV-related international and national days, exhibitions and displays, sport and recreation activities that focus on HIV prevention and healthy living and unit competitions with HIV prevention as a focus. All HIV training packages are centrally-developed by the SA DOD HIV Advisory Committee and the Social Work Research and Development Department. Training aims are tailored to target groups (i.e. - healthcare workers, peer educators, or occupational therapists).
Due to the scope of the program area, the SA DOD will carry out eight separate activities.
Establishment of effective workplace programs through the training of unit commanding officers, workplace program managers and the establishment of military community development committees through which workplace programs will be implemented. Workplace programs include discussions of safer sex practices with demonstrations of the correct use of male and female condoms and the distribution of condoms via workplace-manager monitoring of condom containers placed in each military unit and military sick bay. Condoms are obtained through the National Department of Health
(NDOH) via their distribution mechanism. This activity will be linked with the values and ethics based intervention in the Abstinence and Being Faithful program area and the gender equity training discussed under Activity 4 in this narrative.
This activity will focus on peer educator training and training of peers. This includes training during mobilization and preparation for mission readiness as well as training in the operational area. Other components of this program are: knowledge and attitudes about HIV, skills required to act as peer educators, and to run HIV peer group training. This is accomplished through adult learning. Activities include information about sexuality and occupational exposure to HIV.
SA DOD will focus on the prevention and management of occupational exposure to HIV infection, including medical transmission and injection safety through the placement of first aid kits in all workplaces; provision of personal protective equipment, training of healthcare workers and cleaning staff on occupational health and safety, and the development and publication of relevant IEC material.
This activity will address gender equity and HIV through gender equity training, women empowerment and men as partner projects; workshops, seminars and awareness campaigns on gender equity as well as the development and printing of IEC material in this regard. This activity will be linked with the values and ethics based intervention in the Abstinence and Being Faithful program area and the peer education and training discussed earlier in this narrative.
The development of a model and strategy and implementation of a substance abuse prevention program will be the focus of this activity. This will consist of training of line commanders on the link between HIV and substance abuse and a substance abuse summit for services and divisions.
Expansion of the pilot study on the use of brief motivational interviewing as a prevention strategy with a particular focus on the prevention of HIV transmission from HIV-infected individuals.
ACTIVITY 7:
Diffusion of innovation through attendance of PEPFAR prevention partner meetings, publications in military and peer reviewed magazines and journals and oral and poster presentations on effective and innovative programs at conferences and seminars.
ACTIVITY 8:
SA DOD will conduct mass awareness activities at regional level that focus on celebrations of World AIDS day and other HIV related international and national days, exhibitions and displays, sport and recreation activities that focus on HIV prevention and healthy living and unit competitions with HIV prevention as a focus.
Program implementation will be supported and supervised through staff visits to the regions and monitoring and evaluation through the HIV and AIDS Monitoring and Evaluation Program of the SA DOD to ensure performance. Most of the activities and interventions are well established and the challenge in this regard is to expand interventions to reach an optimal number of members in the SA DOD. The activities will be scaled-up to reach more dependants; including children of military members.
The activity is related to The South African Military Health Service activities in Counseling and Testing (#7573) and Orphans and Vulnerable Children (#7571). 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.
The palliative care program focuses on training of clinic, hospital, hospice and community-based health workers for HIV-infected and affected individuals and their families. Program activities include training of health care workers and home-based care volunteers to effectively manage HIV-infected individuals, expanding terminal care facilities, establishing a home-based care database, and distributing home-based care kits. The care and support is multi-professional and includes psychosocial, nutritional, spiritual and people living with HIV and AIDS (PLHIV) support. In addition, the program will address the issue of stigma in the workplace through a targeted program evaluation and contribute to effective and innovative palliative care programs through attendance of PEPFAR palliative care partner meetings and conferences. Overall, the program supports the development and implementation of a comprehensive palliative care plan as part of the South Africa Department of Defense (SADOD) Plan for the Comprehensive Care, Management and Treatment of HIV and AIDS.
The South African Military Health Service provides care to the military and their families. Training of health care professionals in the provision of holistic palliative care has been performed since the inception of PEPFAR, but the development of a strategy for terminal care to HIV-infected members is fairly new and was established through PEPFAR funding in FY 2005 following a needs assessment. Some of the main components of the terminal care strategy are the development of infrastructure, including the upgrading of hospices, of which one was included in the FY 2005 budget. Further hospices have been upgraded with in FY 2006 and it is anticipated that unit based facilities for the care and support of terminal HIV-infected members will be established during FY 2007.
ACTIVITY 1: Human Capacity Development
The primary aim of this training is to equip health care workers with the knowledge, skills and attitudes required to conduct HIV pre and post-test counseling interviews. Training of health care professionals will be conducted through the Health Care Workers Course developed by the South Africa Military Health Service This is a four-day course, of which two days are dedicated to developing interviewing skills and practicing pre and post test counseling scenarios. Some time will be spent on issues of sexuality, policy and legislation, and occupational exposure. This will enhance the ability of health care professionals to manage HIV-infected individuals.
ACTIVITY 2: Provision of care
Expansion of terminal care facilities through the establishment of regional step down care facilities within military communities Is planned in FY 2007. This may include upgrading or sourcing of hospice services according to need towards management of individuals with terminal HIV disease. The package of services also includes basic pain and symptom management and facility-based support for adherence to opportunistic infections medications (including cotrimoxazole prophylaxis and TB treatment) and antiretroviral therapy (ART).
Support to individuals providing home-based care through training aimed at optimizing quality of life and effective management of terminal family and community members living with HIV, sourcing of home-based care packages (inclusive of items like gloves) and IEC material to ensure appropriate care to terminal HIV-infected individuals and to prevent
transmission of HV to caregivers. The establishment of a home-based care provider data base will help to ensure quality support to HIV-infected members and their dependants when home-based care is required.
Referral to PLHIV support networks and workshops will help to address stigmatization and discrimination and will be a useful strategy to ensure healthy living.
ACTIVITY 3: Addressing stigma
As a result of findings of KAP survey (SA DOD, 2006), which suggest continuing stigmatizing attitudes of individuals surveyed, the SADOD requested a program evaluation, using qualitative methodology, to address stigma within the South African National Defense Force associated with HIV-testing and HIV-infected in an effort to modify existing prevention of stigma in the workplace programs and the Health Care Workers Course. The Director of Nursing will work with the Military Psychological Institute (MPI) in the development of the methodology for this evaluation.
ACTIVITY 4: Dissemination of innovation
The SADOD will disseminate innovation through attendance of PEPFAR palliative care partner meetings, publications in military and peer reviewed magazines and journals and oral and poster presentations on effective and innovative programs at conferences and seminars.
Program implementation will be supported by supervision and quality assurance through staff visits to the regions and monitoring and evaluation through the HIV M&E programs to track performance. Technical assistance will be provided to the South African National Defense Force by the U.S. Naval Health Research Center/Naval Medical Center San Diego.
The activities will contribute to the PEPFAR 2-7-10 goals by increasing the number of individuals receiving palliative care and support.
INTEGRATED ACTIVITY FLAG: This South African Department of Defense Military Health Services (SA DOD) Orphans and Vulnerable Children (OVC) activity is related to Prevention/Other Prevention (#7569), Counseling and Testing (#7573), Basic Health Care and Support (#7570), and ARV Services (#7445) program areas and is an integral part of the SA DOD Plan for the Comprehensive Care, Management and Treatment of HIV and AIDS as a sub-component of the generic disease management process of Rehabilitation.
SUMMARY: The SA DOD Orphans and Vulnerable Children (OVC) program is a relatively new development in the Masibambisane program with a focus on establishing a data base and referral system for OVC of military members. A needs assessment and pilot projects in four sites during FY 2006 will provide the direction for the future focus and strategy of this program to include support services for HIV-infected infants, children and caregivers in the military communities and capacity building of these services within the military through the assistance of NGOs near these communities. The major emphasis area is linkages with other sectors and initiatives and minor emphasis areas are infrastructure and community mobilization and participation. The target populations are OVC and their caregivers, HIV-infected infants and children, military personnel, volunteers and community leaders.
BACKGROUND: The Masibambisane program initiated the OVC program in FY 2005 with an institutional focus in terms of establishing a database on military OVC and the initiation of projects at four sites as a pilot to determine the need and direction in terms of services to OVC. The underlying principle was to establish networks within communities to address the needs of OVC in general, address stigma and discrimination through access to comprehensive services and military OVC specifically through collaborative partnerships. Due to the extensive community involvement and leadership by the communities themselves, the four pilot projects have had varying levels of success during implementation in FY 2006. This has provided valuable information that will guide future strategies in this regard. Lessons learned at the pilot sites confirmed that the approach towards the management of OVC will differ from site to site and need to address activities that include training caregivers, increasing access to education, economic support, targeted food and nutrition support, legal aid, as well as psychosocial support and palliative care. Collaboration with local NGOs will be encouraged in all communities.
The OVC project is coordinated by the Directorate Social Work in the Military Health Service as a sub-program of Masibambisane and has been initiated at the four sites through a local coordinator and collaborative workgroups from the communities. The projects at the four sites will be expanded to other appropriate regions and integrated with terminal care activities where appropriate. The program will support the activities of a military site in Phalaborwa (Limpopo province) while local NGOs will be targeted for funding through USAID in the other three sites (KZN, EC, NW). This program will address beliefs and myths about HIV infection, prevention and treatment versus "cures". Self-help resources that include books about military separation and its affect on families will be provided.
ACTIVITY 1: OVC Tracking System The SA DOD will development of a tracking system to identify and monitor orphans of military members in order to provide these orphans with the healthcare services and support to which they are entitled.
ACTIVITY 2: OVC Service Site The SA DOD will renovate a library at the Phalaborwa military site in Limpopo province to provide a place for children to learn and foster their education after school. This library will provide an educational atmosphere that emphasizes learning and a healthy lifestyle for OVC. References will address beliefs and myths about HIV infection, prevention, and treatment and will include myths about "cures". In addition information will be provided that deals with family separations and the stress that places on the family including age-appropriate strategies to address these concerns.
ACTIVITY 3: Sharing Information The SA DOD will sharing information and experiences through attendance of PEPFAR OVC partner meetings, publications in military and peer reviewed magazines and journals and oral and poster presentations on effective and innovative programs at conferences and seminars. The SA DOD and other African countries will benefit from the information presented in peer-reviewed journal and at professional conferences.
All these activities will be monitored and evaluated with close supervision and support for quality assurance and the identification of best practices in this program area. Technical assistance will be provided to SANDF by the Naval Health Research Center/Naval Medical Center San Diego in order to continue the participatory project begun in 2004, to assist with selection of additional province to begin OVC military community mobilization and participatory action and to support the participatory process as it evolves.
These SA DOD OVC activities will contribute to the PEPFAR goal of providing 10 million people with care, including OVC.
This SA Military Health Service Project is linked to Condoms and Other Prevention (#7569), Basic Health Care and Support (#7570), Strategic Information (#7572), Policy/System Strengthening (#7572) and ARV Services (#7575). Counseling and testing is a critical point of entry to care and treatment services, supports HIV prevention, and is a pivotal component in the South African Department of Defense (SA DOD) plan for the Comprehensive Care, Management and Treatment of HIV and AIDS.
The SA Military Health Service has a scheduled health monitoring program that includes HIV testing with pre- and post-test counseling. Many of the regions have opted for the establishment of a centralized health assessment and counseling and testing center. Routine counseling and testing (RCT) will be offered as an expansion to counseling and testing (CT) for individuals as part of STI consultations, pregnant women and couples who plan a family, and CT performed as part of differential and TB diagnoses. Voluntary counseling and testing (VCT) requests will be made by individuals themselves.
Due to the positive impact of CT on HIV prevention, and the advantages of early identification and management of HIV-infected individuals, this program area is supported through the development and sourcing of media items, pamphlets and posters to encourage members and dependants to request or accept an HIV test if they do not know their status or if they have been exposed to an activity with a high risk of HIV transmission.
One of the major obstacles to requests for and acceptance of CT is stigma and discrimination, and further support towards this program area is provided through the development and sourcing of media items, pamphlets and posters towards the establishment of a non-discriminatory organizational environment. This includes media products aimed at informing members of the SA DOD on the organizational HIV and AIDS policy and strategy, as well as the management of HIV and AIDS in the SA DOD.
The primary emphasis area of this activity is infrastructure development, and minor emphasis is given to human resources, strategic information and training. Specific target populations include military personnel,children and youth (non-OVC), men and women of reproductive age, doctors, nurses and healthcare workers.
The military community is considered a high risk group due to various factors that include foreign deployments and high mobility. CT provides an opportunity for prevention to both HIV-infected and HIV-uninfected individuals. This activity is ongoing. FY 2006 PEPFAR funds were used for renovations and upgrade of three centralized counseling and testing centers, and for training of healthcare workers. These activities will continue during FY 2007 and FY 2008. Counseling and testing also takes place at all military health care facilities and therefore it is essential that all healthcare workers are trained in CT.
ACTIVITY 1: Offering of Routine Counseling and Testing
SA DOD will upgrade healthcare facilities that will be used to provide confidential and effective HIV counseling and testing in highly populated military areas. Healthcare workers will be trained on RCT which will be supported by the development and printing of training material. SA DOD will develop information education and communication (IEC) materials which will encourage members to accept an HIV test if they do not know their status, or, if they have been exposed to an activity with a high risk of HIV transmission. Best practices will be shared through attendance of PEPFAR CT partner meetings, publications in military and peer reviewed magazines and journals and oral and poster presentations on effective and innovative programs at conferences and seminars.
Counseling and testing centers will be established using PEPFAR funding. These centers
will enable confidential and effective CT for HIV, and in addition, will provide venues for the training of healthcare professionals in CT. Training will continue during FY 2007 and FY 2008. Supportive media campaigns will be established, and these campaigns will encourage voluntary requests for, and uptake of HIV testing. Uptake of counseling and testing services will be monitored and evaluated through the HIV Monitoring and Evaluation (M&E) plan of the SA DOD HIV and AIDS program. The impact of media on the reduction of stigma and discrimination is monitored through the annual Knowledge, Attitudes, and Practices (KAP) survey that is a sub-component of the M&E plan.
SA DOD activities will contribute towards PEFPAR's goals of caring for 10 million people.
The activity is linked to the Department of Defence's (DOD) Counseling and Testing (#7573), PMTCT (#7574), Basic Health Care and Support (#7570) and Orphans and Vulnerable Children (#7571) program areas.
The South African Department of Defence (DOD) has an existing HIV and AIDS program that includes antiretroviral treatment (ART) services. FY 2007 funds will be used to improve and expand ART and related services. The main emphasis is human resources, and minor areas include commodity procurement, quality assurance, information, education and communication (IEC) and training. The main target is people living with HIV (PLHIV) in the military and their families.
The activity commenced in FY 2005 with PEPFAR funding and was mostly focused at the preparation of pharmacies at the first rollout sites for ART, supplementing DOD funding for phased rollout of ART in the military. Six ART sites have been accredited with the aid of PEPFAR funding, and further funding will be utilized towards addressing human resource deficiencies that delay implementation of ART at these sites. FY 2007 activities will focus on the acquisition of commodities in support of ART, laboratory costs associated with ART, continued human resource support and activities that encourage adherence. Limited uptake of current ART services may be addressed through a media campaign to educate members and dependants on ART. To date only two of the accredited ART sites are operational due to staffing issues, and this will thus be a major area of focus in FY 2007.
Activity 1: Capacity development in terms of management systems strengthening, training of staff, improvement of quality assurance and technical assistance for modest renovation of proposed ART sites.
Activity 2: Continued development, modification, and printing of media, including posters and pamphlets, towards the provision of information and education on ART to members of the DOD and their dependants.
Activity 3: Interventions aimed at increasing treatment adherence by utilizing, and adapting, where necessary, available adherence tools.
Activity 4: A needs assessment will be conducted at each accredited ART site to determine gaps in staffing, and develop and implement a plan to address these gaps. The DOD will ensure through its own budgeting process that each position created will be funded by the DOD according to the planned schedule.
Activity 5: To ensure quality monitoring and evaluation, the DOD will build on the HIV and AIDS database developed in FY 2006 in order to capture all relevant patient data for tracking and reporting purposes.
These activities will contribute to the number of persons receiving treatment and care in the military, and support the PEPFAR 2-7-10 goals.
This activity is related to all other program areas for the South African National Defense Forces PEPFAR program, including, PMTCT (#8049), AB (#7438), Other Prevention (#7439), Basic Health Care and Support (#7440), OVC (#7441), Counseling and Testing (#7443), ARV Services (#7445), and Policy and Systems Strengthening (#7916) as it provides the mechanisms for monitoring and evaluation for all the program components of the "Masibambisane" HIV and AIDS program.
Strategic Information (SI) for the South African National Defense Force (SANDF) has been documented in the Monitoring and Evaluation (M&E) plan that was recently developed. This plan addresses all components necessary for a comprehensive M&E system for an HIV and AIDS program. PEPFAR funding in FY 2007 will be used to expand the current health data management systems used for the South African Military Health Systems (SAMS) to encompass HIV and AIDS specific data. Activities will include: developing data collection tools, updating the software package to allow the current health information management system (HMIS) to track HIV and AIDS data, and training at all levels of SAMS to implement and use M&E.
The development of a more comprehensive M&E system for the SAMS Masibambisane program has been supported by PEPFAR since its inception in FY 2004. This plan has continued to develop over the past few years as the HIV and AIDS program continues to expand. The health information system used by the SAMS is quite robust; however, it has taken significant work to incorporate all relevant HIV and AIDS data that is required by PEPFAR, the National Department of Health and the SAMS program managers. Strengthening M&E activities will continue as an integral part of the SANDF program.
Activity 1: Review development of data management system
Review ongoing development of the data management system through an interface with the Health Informatics System of the South African (SA) Military Health Service.
Activity 2: M&E and SI Training
Training of relevant role-players in M&E and SI and ensuring that all have internet and information technology access to improve reporting capability. This activity will include training of regional and unit level data collectors in data quality management and reporting. An NGO (outside contractor) is being considered to assist with training and improving of reporting capability.
Activity 3: Seroprevalence study
Perform an organizational seroprevalence study to determine an epidemiological baseline for impact measurement of the SA DOD HIV and AIDS program.
Activity 4: Audits
Internal audits and site visits to verify data, services and facilities.
These activities will enable the SA DOD to report effectively the contribution of the Masibambisane program elements and targets that contribute to the overall PEPFAR objectives for prevention, care and treatment.
Data obtained through the M&E plan as developed with the support of PEPFAR funding is utilized to determine successful program components and to identify program gaps to be addressed.
The establishment of the data management system developed in FY 2006 is in the final testing stage, and gaps identified are being addressed.
IINTEGRATED ACTIVITY FLAG:
This activity also relates to Masibambisane's activities in Basic Healthcare and Support (#7570), OVC (#7571), Strategic Information (#7572), CT (#7573), PMTCT (#7574), ARV Services (#7575), AB (# 7568) Condoms and Other Prevention (#7569).
The main components of this program area are planning and coordinating workshops for all the relevant role players, and building the capacity of those role players to strengthen this program. Most of the training provided within the South African Department of Defense (SA DOD) HIV and AIDS Training program has been developed internally by utilizing the knowledge and skills of members in the organization. Training development workshops are now needed to update training content. The major emphasis areas of these activities are policy and guidelines and training. The target population is public healthcare workers.
The Masibambisane program was established in 2001, and has received PEPFAR funding from FY 2004. The funding allowed the program to expand and to address program elements that were not possible before. The program currently consists of an excess of 35 program components, with various sub-program and project coordinators and members of the HIV and AIDS Management Structure that facilitate program development, planning, execution, monitoring and evaluation. As the program expands, various additional role players become involved that need to be provided with induction training, and existing role players need to be provided with strategic guidance towards comprehensive planning and effective coordination to ensure an integrated approach to HIV an AIDS management in the SA DOD. This is done through workshops and training.
SA DOD will conduct training for regional and national HIV coordinators and sub-program and project coordinators in the strategic objectives of the program. This training will consist of a workshop that reviews the results of the Knowledge, Attitude, and Practices (KAP) study and discusses strengths and weaknesses of the program to help plan for the following year's activities.
SA DOD will conduct strategic and operational planning work sessions to ensure integrated program development and coordinated execution of program elements. These work sessions will be led by the Monitoring and Evaluation (M&E) Director at South Africa Military Health Services. Representatives from all provinces that collect data will be invited to participate. The sessions will address strengths and weaknesses of the M&E processes and will include training in new M&E activities and guidelines issued by PEPFAR.
SA DOD will hold training development workshops to assist in the establishment of new HIV-related training courses and updating of training contents in existing HIV-related training curriculums. Training development will include courses specifically targeted at mid- and upper-level leadership concerning the prevention of and identification and remediation of stigma and discrimination (key legislative issue) in the workplace.
A number of training opportunities and workshops have been funded since the inception of PEPFAR and these opportunities have contributed to the success of the Masibambisane program. The Masibambisane program is implemented through a cascade of national and regional program coordinators, trainers and sub-program and project coordinators. These individuals are responsible for the development, planning and execution of the program to address all the components necessary to ensure a comprehensive HIV and AIDS Program
in the South Africa Department of Defense, thereby supporting accomplishment of the PEPFAR 2-7-10 goals.
