INTEGRATED ACTIVITY FLAG:

This PMTCT activity relates to other activities implemented by Management Sciences for Health/Integrated Primary Health Care Project (IPHC) in Basic Health Care and Support (#7554), OVC (#7555), CT (#7556), ARV Services (#7553), and TB/HIV (#7666). Technical assistance is provided by Management Sciences for Health/Rational Pharmaceutical Management (RPM Plus) project in ARV Services (#7559), PMTCT (#7854), and TB/HIV (#7856).

SUMMARY:

Management Sciences for Health/Integrated Primary Health Care Project (IPHC) in collaboration with the National Department of Health (NDOH) will support the expansion of Prevention of Mother-to-Child Transmission (PMTCT) services at 150 public health facilities (hospitals and clinics) in eight districts in five provinces (Eastern Cape, Mpumalanga, KwaZulu-Natal, Limpopo and North West) by building human capacity of health workers to provide comprehensive PMTCT care. IPHC capacity building activities will include training, mentoring, coaching and supporting healthcare providers to provide quality PMTCT services to all antenatal care (ANC) clients. Providers' skills will be enhanced to promote better practices around infant feeding and contribute to a reduction in HIV transmission from mother to infant in line with South African Government (SAG) guidelines. The target populations include adults, pregnant women, HIV-infected pregnant women, HIV-infected infants (zero to five), nurses, other healthcare workers, community leaders and traditional healers. The major emphasis area is quality assurance and supportive supervision, with minor emphasis on community mobilization/participation and training.

BACKGROUND:

IPHC will continue activities initiated in FY 2006 in support of the National Department of Health (NDOH) PMTCT program and in line with the NDOH Comprehensive Plan for HIV and AIDS. IPHC will work with department of health (DOH) service providers at the facility level to increasthe uptake for HIV counseling and testing during antenatal care; increase the number of HIV-infected mothers and infants on prophylactic treatment; and to increase support for infant feeding practices and referral to antiretroviral treatment (ART) when required. IPHC will improve the quality of the service by integrating PMTCT into routine Maternal, Children and Women's Health (MCWH) services. IPHC will give special attention to HIV-infected mothers who fall pregnant after the first positive baby, through an integrated approach strengthening maternal and women's health and family planning programs. These programs will ensure HIV-infected women are aware of the risks associated with mother-to-child-transmission and are able to make informed choices about conception. Increasing partner testing and male support is also envisaged in this integrated approach. IPHC will strengthen the community support of HIV-infected mothers. Rational Pharmaceutical Management Plus (RPM Plus) will partner with IHPC to provide support with PMTCT drug logistics.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

IPHC Project will train healthcare providers (both professional and non-professional) in eight districts in five provinces on comprehensive PMTCT service delivery using the South African NDOH national PMTCT training guidelines. The training will be a participatory activity with the district management teams to ensure that the training is fully integrated into the provincial PMTCT training plans. Health service providers will be trained to counsel and test pregnant women and their partners, promote infant feeding for prevention of HIV transmission from mother-to-child, conduct clinical staging of the HIV-infected pregnant mother, tuberculosis (TB) screening and treatment of opportunistic infections (OI). They will also receive training on appropriate client screening mechanisms and referrals for antiretroviral (ARV) triple therapy and provision of ARV prophylaxis to HIV-infected mothers who do not qualify for triple therapy. IPHC will train service providers from the eight districts in five provinces, increasing the number of health service providers with PMTCT skills and improving the quality of PMTCT care. IPHC will coordinate

with provincial governments in each province to ensure the training is supportive of on-going provincial PMTCT training efforts and may include co-funding workshops to avoid duplication. The newly acquired skills will be strengthened through on-site mentoring and coaching by IPHC technical staff and in-service training of facility staff on specific interventions for increasing PMTCT uptake. These may include compulsory individual counseling and routine offering of HIV testing (opt-out) to all ANC clients.

ACTIVITY 2: System Strengthening

The focus of this activity will be to improve the quality of counseling services, logistics and commodity management to ensure adequate supply of PMTCT-related commodities such as HIV test kits, nevirapine and infant formula. Emphasis will also be placed on record keeping and reporting systems to improve data accuracy and the quality of reports. In addition IPHC will integrate PMTCT services into routine maternal and child health services to broaden the use and availability of PMTCT services and will focus on improving mother-baby follow-up to track the infants born to HIV-infected mothers. This is in line with the South African Government (SAG) policy of testing babies born to HIV-infected mothers at specified intervals. DOH Program managers and supervisors will be supported to strengthen referral systems between the three healthcare levels (e.g. Primary Health Care, district, and tertiary hospitals) and to ensure that ongoing support and mentoring is provided to facility staff. IPHC will provide technical assistance support, mentoring and coaching to the facility health service providers in the eight districts to standardize referrals and ensure that all referrals are followed up and monitored to ensure that the client has received the required service.

ACTIVITY 3: Building Community Networks

IPHC Project will support community groups to encourage couple counseling and testing (CT) and to encourage more men to get tested. Traditional leader forums, community-based organizations, and NGOs will identify community sources of supportive encouragement and follow-up for HIV-infected mothers and their infants. Traditional leaders will be trained to increase and mobilize male/partner understanding of HIV and AIDS and the need for CT and PMTCT and so strengthen the support network for the mother. Community healthcare workers will be trained to promote and counsel for exclusive infant feeding practices among HIV-infected women, tracking infants to ensure follow-up and nutrition support for mothers. IPHC will assist districts to implement and strengthen counseling and support for HIV-infected pregnant women.

The IPHC Project will assist PEPFAR in reaching the vision outlined in the USG South Africa five-year strategy by increasing access to PMTCT services, improving the quality of PMTCT care services and increasing the awareness and demand for PMTCT services, thereby contributing to the 2-7-10 goal of 7 million HIV infections averted. These prevention outcomes are in line with the USG goal of integrating maternal and child services into the primary healthcare system in South Africa.

INTEGRATED ACTIVITY FLAG:

This activity relates to Management Sciences for Health/Integrated Primary Health Care Project activities PMTCT (#7557), OVC (#7555), CT (#7556), ARV Services (#7553), and TB/HIV (#7666). 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:

Management Sciences for Health/Integrated Primary Health Care Project (IPHC) in collaboration with the National Department of Health (NDOH) will support the provision of basic care and support to those are HIV-infected adults in 350 public health facilities (hospitals and clinics) in 8 districts in 5 provinces (Eastern Cape, Mpumalanga, KwaZulu-Natal, Limpopo and North West). The IPHC Project will provide technical assistance to both provincial and district managers for HIV and AIDS programs to strengthen basic care and support services to HIV-infected clients. The target populations are men and women of reproductive age, family planning clients, pregnant women, nurses and other health care workers. The major emphasis area for this activity will be quality assurance and supportive supervision and minor emphasis area will be on linkages with other sectors and initiatives as well as training.

BACKGROUND:

This activity is a continuation of activities initiated in the FY 2006. All activities will be supported directly by IPHC Project in collaboration with district and provincial counterparts from the Department of Health. IPHC Project will also work closely with service providers at facility level to ensure quality, comprehensive service is delivered. This activity will build on IPHC Project's past activities conducted at current sites and with an additional focus on gender-related activities (key legislative area). Family centered counseling will be a major part of the activities that will be implemented. To ensure integration of programs, IPHC will strengthen the formation of district level HIV and AIDS, STI and TB (HAST) committees. This will ensure that People Living with HIV (PLHIV) are offered a comprehensive package of care that takes into consideration opportunistic infections (OI) at the facilities mentored and supported by IPHC.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

The objective of training will be to develop skills on appropriate screening and provision of the preventative care package. IPHC Project will strengthen human capacity development by training health care providers (both professional and non-professional) on basic care and support of HIV-infected clients and ensuring delivery of the preventive care package. This will include screening for and treatment of opportunistic infections including cotrimoxazole prophylaxis. Training will also include the clinical staging of clients using the WHO clinical staging guidelines. Healthcare providers will also be trained on screening STI and screening TB clients for HIV and AIDS. Nutritional counseling will focus specifically on the nutritional needs for HIV-infected and TB clients will also form part of the training. IPHC will provide training to home-based caregivers using the Department of Health (DOH) curriculum for home-based care providers. The training of home-based caregivers will include the counseling component so that they can provide ongoing counseling to those infected and affected by HIV and AIDS, to ensure a holistic family-centered approach.

ACTIVITY 2: Mentoring and Support for Service Providers

IPHC Project will continue to mentor and support health service providers in exiting IPHC-supported facilities to provide basic care and support and expand to additional facilities in all 5 provinces. The focus of this activity will be on clinical management of HIV. All CT sites supported by the project will offer palliative care to the HIV-infected clients. This service will begin at facility level with referral to home-based care (HBC) services when necessary for continuity of care. Increase access to quality basic care and support

services within communities will be encouraged and supported. IPHC will also establish/strengthen the referral system between health facilities and community/household level. The IPHC project will establish linkages and facilitate networks with community organizations, local municipality and health facilities to increase access to palliative care. IPHC will assist community-based organizations (CBO), non-governmental organizations (NGO) and faith-based organizations (FBO) to access other sources of funding for home-based care programs, strengthening the capacity of local municipalities to monitor local organizations.

ACTIVITY 3: Integration of Services

This activity will focus on the integration of HIV and AIDS services into routine Primary Health Care (PHC) services to ensure a holistic approach to basic care and support to the HIV-infected client at the facility level. Integration of services is importance for the clinical management of the HIV and AIDS client. All IPHC-supported PHC facilities will be strengthened to provide a basic health care package that includes routine screening for opportunistic infection, staging for those clients who are ready to go on the ART program, and on-going counseling and support for those that are not yet ready. IPHC Project will also focus on strengthening the referral system to and from facility level to home-based care services. Service providers from health facility and HBC services will be trained on the referral system and how to refer clients appropriately. The IPHC project will support a wellness program for clients who are not yet ready to be on an ART program at the 350 IPHC-supported DOH health facilities.

IPHC activities will increase the public health facilities capacity to deliver quality basic health care and support services and expand access to quality palliative care services, thereby addressing the priorities set forth in the USG Five-Year PEPFAR Strategy for South Africa. IPHC will assist PEPFAR to achieve its goal of caring for 10 million people.

Original activities remain unchanged. MSH/IPHC will use Plus up funds to provide aasitance and support in the faciliation of care support groups at all IPHC-supported facilities in the 8 districts in 5 provinces of South Africa. At the facility level IPHC will focus on ensuring that clients are counselled on prevention for positives and family members are provided with counseling and HIV testing. IPHC will focus on the following activities; prevention with positives, wellness programs and care for the caregivers activities. At the facility level the preventive care package will be implemented at all IPHC-supported facilities. IPHC will support health providers to ensure stronger links between palliative care, counselling and testing, family planning, prevention of mother to child transmission and anti-retroviral therapy at the facility level. IPHC will also address gender sensitivity during the care support groups to address issues of behaviour change, violence and disclosure.

INTEGRATED ACTIVITY FLAG:

This TB/HIV activity relates to other activities implemented by Management Sciences for Health/Integrated Primary Health Care Project (IPHC) activities in PMTCT (#7557), OVC (#7555), CT (#7556), ARV Services (#7553), and Basic Health Care and Support (#7554). Technical assistance is provided by Management Sciences for Health/Rational Pharmaceutical Management (RPM Plus) project in ARV Services (#7559), PMTCT (#7854), and TB/HIV (#7856).

SUMMARY:

Management Sciences for Health/Integrated Primary Health Care Project (IPHC) in collaboration with the NDOH will support the provision of basic care and support to those who have tested positive in 350 public health facilities (hospitals and clinics) in 8 districts in 5 provinces (Eastern Cape, Mpumalanga, KwaZulu- Natal, Limpopo and North West). IPHC project supports the mission of the South African Government -National Department of Health (NDOH) in the prevention of the spread of HIV, STI and TB infections as well as the mitigation of the impact of dual infection of HIV and AIDS and TB epidemic in the country. The target population will be men and women (of reproductive age), family planning clients, pregnant women (including HIV-infected women), PLHIVs, HIV and AIDS affected families, caregivers of OVC and PLHIV, and nurses and other health care workers. The major emphasis area for this activity is quality assurance and supportive supervision with minor emphasis on linkages with other sectors and initiatives, and training.

BACKGROUND:

This is a new activity. IPHC project will be guided by the NDOH Comprehensive Plan for HIV and AIDS to ensure improvement of HIV and AIDS, STI and TB (HAST) collaboration. IPHC will support districts to develop and strengthen HAST committees by training the committees to conduct regular reviews of the HAST program; to screen HIV-infected clients for TB; to offer CT to TB clients and to ensure that the number of TB clients who are tested is increased. IPHC will support the eight districts in the 5 provinces in improving the TB management by training the supervisors to assess the TB/HIV and AIDS programs. This will provide in-depth reviews and identify gaps that can be addressed to improve the quality of care. The IPHC project will partner with TASC-II TB Project in implementing these activities.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

IPHC will train health providers in 8 districts on screening for TB, HIV counseling and testing of TB clients, treatment and adherence to treatment by PLHIV with active TB, and strengthening the Directly Observed Treatment Support (DOTS) program. TB screening and treatment is initiated at primary healthcare facilities. The continuity of care provided through the DOTS program will be strengthened by ensuring the availability of treatment regimes at facility level is included in the training workshops. IPHC will provide HIV, AIDS and TB clinical management training to health care workers using the national treatment guidelines and the treatment care and support policy of the NDOH.

ACTIVITY 2: Integrating Services

Integration of services through the HAST committees will be strengthened with DOTS supporters' full participation as members of HAST committees. IPHC will ensure that TB and HIV and AIDS programs are not stand alone services but are fully integrated with other Primary Health Care (PHC) services. Training on TB treatment adherence will be given to the DOTS supporters. Working with managers and supervisors at the primary, secondary and tertiary level IPHC project will strengthen the referral system to ensure supportive referrals for clients.

ACTIVITY 3: Human Capacity Development

Human capacity development of professional and non-professional staff will be a focal

area to ensure professionals and non-professionals are kept up to date on recognizing and detecting drug interaction and improving record keeping of all TB clients. Since every TB client has to be tested for HIV, record keeping is critical in monitoring the status of each client. Training and on-site mentoring will be provided to facilitate rapid scaling-up of HIV CT of TB clients and also to encourage sustainability of these activities. The quality of the TB management will be monitored on an on-going basis to ensure that the clients continue with their TB treatment and are tested, and if positive, monitored so they can access ARVs.

Plus Up funding will be used to strengthern, expand and intensify TB/HIV assitstance in all Management Sciences for Health/Integrated Primary Health Care Project (IPHC) supported facilities in 8 districts in 5 provinces. IPHC staff will work with the health providers in 8 districts to ensure effective management of TB/HIV co-infection at the facility level. IPHC will provide supportive follow up to ensure that the health providers are implementing the TB/HIV infection control policy guildines. IPHC will also strengthern supervision of facilities through training and support of district and facility-level supervisors.

IPHC activities contribute to the PEPFAR goal of providing care to 10 million HIV-affected people. In addition, these IPHC activities will address the priority area of increased linkages between TB/HIV services and health systems networks from the USG Five-Year Strategy for South Africa.

INTEGRATED ACTIVITY FLAG:

This OVC activity relates to other activities implemented by Management Sciences for Health/Integrated Primary Health Care Project (IPHC) activities in PMTCT (#7557), TB/HIV (#7666), CT (#7556), ARV Services (#7553) and Basic Health Care and Support (#7554).

SUMMARY:

Management Sciences for Health/Integrated Primary Health Care Project (IPHC), in collaboration with the National Department of Health (NDOH), will support the expansion of OVC program in 5 provinces (Eastern Cape, Mpumalanga, KwaZulu-Natal, Limpopo and North West). IPHC has provided small grants to seven South African non-governmental organizations (NGOs) namely; Inwanca Home-Based Care, Ikwezi Lomso Child and Welfare Organization, National Peace Accord/Khanyiselani Development Trust, Makhuduthamaga Home/Community-Based Care Umbrella NPO, Makotse Women's Club, Thibela Bolwetsi HIV and AIDS Project and Maluti Skills HIV and AIDS Intervention, to provide care and support to OVC in 8 districts in 5 provinces. The OVC activities supported aim to strengthen communities to meet the needs of OVC and their families; supporting community-based responses, helping children and adolescents to meet their own needs and creating a supportive social environment. The activities under this program aim to assist OVC with access to education, economic support, provision of food and or nutrition, legal assistance, healthcare, psychological support, and protection from abuse. The target populations for this activity are OVC and their caregivers, HIV and AIDS affected families, South African-based volunteers. Community-based organizations, Faith-based organization and Non-Governmental/Private voluntary organization will also be targeted. The major emphasis area is community mobilization and participation with minor emphasis on the development of networks, linkage and referrals; and local organization capacity development.

BACKGROUND:

The activity is on-going and continuing from activities initiated in FY 2006. IPHC will be working with NGOs and community-based organizations (CBOs) that are implementing activities aimed at improving the lives of OVC. All NGO/CBO activities are integrated into the plans of the Departments of Health and Social Development. With FY 2007 PEPFAR funding, the IPHC Project will also establish/strengthen the referral system between the NGOs/CBOs, health facilities and organizations, local municipality and health facilities to increase access to health services e.g. provision of childhood immunization, routine examination, health education, clinical monitoring and management and ARV therapy when necessary. IPHC and its sub-partners will strengthen collaboration between Department of Justice, The South African Police Services and Child Protection Units to report cases of abuse and rape especially in child headed households. IPHC will engage traditional leaders (amakhosi) to raise awareness and address the abuse of girl children in their communities.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Community Mobilization and Participation

With FY 2007 funds, IPHC will increase the number of NGOs providing care and support to OVC in the 5 provinces. The aim is to increase the number of caregivers and OVC that receive support. IPHC will build the capacity of the NGOs and CBOs to effectively and efficiently implement integrated programs that are responsive to the needs of OVC at local level.

IPHC will facilitate an increase in the number of caregivers trained in psychosocial aspects of working with OVC understanding their particular developmental needs and support requirements. IPHC will also assist with the identification of accredited service providers to provide training for NGOs on technical aspect related to OVC care, working with CBO that have creches; and raise the knowledge related to children's needs and rights in line with the Department of Social Development's Early Childhood Development guidelines. This will take place through workshops and training that will be held at district level. IPHC will also provide mentoring and technical support to NGOs in the areas of administration, financial management, monitoring and evaluation.

ACTIVITY 2: Technical Support

With FY 2007 PEPFAR funding, IPHC will provide technical support to NGOs and CBOs to enable them to provide a comprehensive package of care and support to OVC. The package includes support to OVC to obtain birth certificates and identification documents, social security grants, legal aid to prevent social neglect and stigma, psychosocial support that includes trauma, bereavement and basic counseling, emotional and spiritual support, counseling and debriefing of caregivers to prevent burnout, referral to clinics and hospital for pediatric ARV treatment and adherence, immunization, prevention of HIV infection messages, support for child-headed households and protection from rape, land grabs and security of inheritance, access to education, child protection units and life skills education.

ACTIVITY 3: Linkages and Networks

IPHC will link NGOs and CBOs with other PEPFAR partners operating in the same geographical area to facilitate learning from one another and sharing experiences. The project will also link and encourage NGOs participation in the local coordinating structures such as District/Local Aids Councils (DACs/LACs), District Action Committee for Children affected by HIV and AIDS (DACCA). IPHC will also encourage and support NGOs to establish Child Care Forums to ensure that OVC receive appropriate services. IPHC will advocate for the inclusion of OVC care and support service into the Local Government's Integrated Development Plans (IDPs).

IPHC will assist PEPFAR to achieve its goal of caring for 10 million people, including OVC, by increasing OVC access to government support, expanding linkages and referral systems with other health and social services, and strengthening and expending OVC policies and guidelines.

INTEGRATED ACTIVITY FLAG:

This activity relates to other activities implemented by Management Sciences for Health/Integrated Primary Health Care Project (IPHC) activities in PMTCT (#7557), TB/HIV (#7666), OVC (#7555), ARV Services (#7553), and Basic Health Care and Support (#7554).

SUMMARY:

Management Sciences for Health/Integrated Primary Health Care Project (IPHC) in collaboration with the National Department of Health (NDOH) will support the provision and referral of basic care and support to those who have tested HIV positive in 350 public health facilities (hospitals and clinics) in eight districts and five provinces (Eastern Cape, Mpumalanga, KwaZulu-Natal, Limpopo and North West). This activity will support the HIV voluntary counseling and testing (VCT) services for men, women, university students and the youth with specific focus on out-of-school youth in facilities supported by IPHC. IPHC will prioritize the provision of these services to men as this is an area which needs improvement. The Youth Advocacy program will be central to all interventions on increasing awareness and providing youths with the VCT services. The primary emphasis area is quality assurance and supportive supervision, additional emphasis on training and the development of networks/linkages/referrals. This activity also targets testing pregnant women and facilitating access to PMTCT and ARV services. The target population is secondary school students, university students, adults, family planning clients, pregnant women, nurses and other healthy care workers.

BACKGROUND:

CT is the building block for all HIV and AIDS programs and it is an important activity in all IPHC-supported facilities. This activity is a continuation of activities initiated in the FY 2006. All activities supported directly by IPHC Project, working closely with counterparts from the health departments both at district and provincial levels and will focus on increasing the number of service outlets/points for VCT. Activities will include training of healthcare providers (professional and non-professional) on VCT, couple counseling and methods of integrating routine counseling and testing (RCT) into primary healthcare services such as tuberculosis (TB), sexually transmitted infections (STI), Antenatal Clinic (ANC) and Family Planning (FP). There will be a special emphasis on expansion of VCT services to both in- and out-of-school youth. IPHC has trained Clinic Youth Mentors on HIV and AIDS so they can work closely with the health facility personnel to encourage other youths who come to the health facilities to be tested for HIV.

ACTIVITIES AND EXPECTED RESULTS:

IPHC will carry out three separate activities in this Program Area. ACTIVITY 1: Training

IPHC Project will train healthcare providers (professional and lay) in VCT skills. The project will use training material developed by the NDOH. A focus of the training will be on enhancing the quality of VCT provided to clients through mentoring supervision and increasing the number of health facility staff that can provide VCT. IPHC will build the capacity of health providers to go beyond VCT, to encourage clients to form pre- and post-test clubs to support those that have tested HIV negative and to encourage a reduction in risky behavior. Clients that have tested HIV positive will be encouraged to join a support group to focus on maintaining their health. Training will be tailored to address specific district needs including areas of high transmission e.g. migrant workers and truck drivers. IPHC will work with district managers to allow designated facilities provide VCT after hours, which will promote couple testing for workers.

ACTIVITY 2: Increasing VCT among Youth

IPHC has recently started a program aimed at training Clinic Youth Mentors in HIV and AIDS. The Mentors are 18-23 year olds who are placed at the health facilities to work with other clinic staff, and that aim to encourage other youth who visit the facilities to take up services. They also visit schools and give talks to other youth on the advantages of testing

and motivation for young people to take up VCT for HIV, so they will know their status. IPHC places one male and one female in each facility. The male Clinic Youth Mentors are critical in motivating other male youth to use VCT. Using additional USAID health funds, the Clinic Youth Mentors have also been trained on routine offer of HIV, to encourage those who come to the facilities for FP, STI and ANC to take up CT. IPHC will implement the Clinic Mentor Program in the health facilities they are working in, and special attention will be placed on the skills and attitudes of healthcare providers to the youth. This will be done through training on interpersonal relationships, understanding of how cultural and social differences impact on the youth's access to health services. Training of youth from the communities and their work with in-school and out-of-school youth will increase community awareness. IPHC will facilitate community mobilization, networking and establishment of linkages between community structures, health facilities and universities to ensure greater community participation. Establishment of support groups to ensure greater participation of people living with HIV (PLHIV) will increase access to VCT through community awareness and reduction of stigma and discrimination.

ACTIVITY 3: Improving the Quality of VCT

This activity will focus on continuous improvement in the quality of the VCT services provided at the 350 facilities that IPHC supports. Evidence from IPHC-supported facilities indicate that a large number of ANC clients are not tested for HIV. Various factors affect the quality of VCT; these include the training of the VCT providers, the physical settings in the facilities as well as burnout in the counselors. IPHC will build human capacity at district level and will provide ongoing supportive supervision and mentoring to ensure an improved quality of services. Supervision and mentoring will focus primarily on clinic supervisors and program managers, thus building their capacity to mentor and supervise other healthcare providers. IPHC will also train the members of the HIV, AIDS, STI and TB (HAST) committee, clinic committees and hospital boards to monitor and evaluate these services.

IPHC will contribute to the PEPFAR goals of providing care to 10 million HIV-affected people, and ultimately will assist in meeting PEPFAR's goal of providing treatment to HIV-affected people. In addition, these IPHC activities will address the priority area of increased linkages between VCT services and health systems networks as laid out in the USG Five-Year Strategy for South Africa.

INTEGRATED ACTIVITY FLAG:

This ARV Services activity relates to other activities implemented by Management Sciences for Health/Integrated Primary Health Care Project (IPHC) in Basic Health Care and Support (#7554), OVC (#7555), Counseling and Testing (#7556), PMTCT (#7557), and TB/HIV (#7666). Technical assistance is provided by the Management Sciences for Health/Rational Pharmaceutical Management (RPM Plus) project in ARV Services (#7559), PMTCT (#7854), and TB/HIV (#7856).

SUMMARY:

Management Sciences for Health/Integrated Primary Health Care Project (IPHC) in collaboration with the National Department of Health (NDOH) will support the provision of ART services to those who have tested positive in 350 public health facilities (hospitals and clinics) in 8 districts in 5 provinces (Eastern Cape, Mpumalanga, KwaZulu-Natal, Limpopo and North West). IPHC will assist the districts in implementing the National Department of Health Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa (Comprehensive Plan) by assisting designated sites to meet the ARV accreditation requirements. IPHC will mentor and support the management team at facility and district level to implement the ARV program in accordance with the norms and standards of the Comprehensive Plan to increase access to ARV therapy through increased number of service points for ARV services. IPHC will build on its success of supporting accredited facilities and will continue to support others within the same district through the accreditation process. Integration of the ARV program into the routine primary health care (PHC) services will also be a key focal area to ensure that client adherence to ARV therapy is improved.

The primary emphasis area is quality assurance and supportive supervision, with additional emphasis on training and the development of networks/linkages/referrals. The target population will be men and women (of reproductive age), family planning clients, pregnant women (including HIV-infected women), people living with HIV (PLHIV), affected families and caregivers of orphaned and vulnerable children (OVC), and healthcare providers (nurses) and other healthcare workers.

BACKGROUND:

This is an ongoing activity continuing from FY 2006. IPHC will continue to support the districts to address the increasing demand for ARVs in South Africa. IPHC will support health facilities in providing a continuum of care through the primary, secondary and tertiary level. The project will build the human capacity to provide ART services at the three levels of care. The ARV program will be integrated with other HIV and AIDS services as well as PHC services to ensure sustainability. IPHC will continue to increase the number of accredited sites that are able to provide clients with ARV treatment who will be supported to mentor other sites, increasing access to ARV treatment. Training will include monitoring drug interactions, ongoing counseling and support for adherence and well-being, as well as down referral to community networks and home-based care service providers. IPHC will ensure adherence to the NDOH policy and drug protocols through supportive supervision and onsite mentoring. IPHC will visit each facility at least twice a month to provide onsite mentoring and support to facility staff. This will facilitate the improvement of staff skills in providing quality clinical and counseling services.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Supporting the ARV Accreditation Process

Activities will include: preparing designated sites for the accreditation process; working with the DOH site ARV task team to develop an ARV implementation plan for the site; training of healthcare providers in assessment and screening of patients for ARV therapy; screening for and treatment of opportunistic infections, adherence counseling, and nutrition counseling; training of community health workers as treatment supporters, on nutrition counseling, and adherence counseling; training healthcare providers to recognize adverse drug events and assist districts to develop an algorithm for continuum of care from counseling and testing to treatment, care and support and preparing healthcare

providers at clinic level to assess clients for ARV; and implementing patient readiness program for ARV therapy. This will result in an increased number of eligible clients on ARV therapy, and increased capacity of healthcare workers trained in the delivery of ARV services.

Activity 2: Linkages and Referrals

IPHC Project will facilitate linkages and referrals with other institutions such as TB hospitals, hospice and other home-based care services to ensure their clients are also screened for ARV treatment and are referred to the appropriate service delivery point for ARV initiation and follow-up. Activities will include: conducting an assessment of referral systems between public and private sector and community-based initiatives; determining gaps in the referral system (if they exist), developing referral systems with the various stakeholders; training service providers in other sectors; training service providers in follow-up care; and ongoing monitoring of the patient on ARV therapy. The result will be functional integration of ARV services with other health services within the district.

Activity 3: Mentoring

To ensure sustainability, the IPHC Project utilized an innovative approach to accreditation and implementation of ARV services in the Eastern Cape Province and thus accelerated the uptake of ARV services. This approach centers on using one hospital, Frontier Hospital, (an established accredited site, successfully implementing ARV services in Queenstown) to mentor identified health facilities in the Chris Hani district to implement ARV services.

The mentoring process involved staff from the other hospitals preparing for accreditation, spending at least two days at Frontier Hospital, observing and participating in ARV services under the guidance and supervision of staff at Frontier Hospital. Staff from Frontier Hospital also conducted site visits to the newly accredited facilities to mentor ARV service providers and offer treatment advice. During the preparation phase for accreditation, Frontier Hospital staff assisted the designated health facilities to prepare for accreditation. Once these facilities were accredited, they were able to take over the management of ARV clients and thus allowing quick start-up of the program at these new facilities. This process was facilitated by staff from the IPHC Project and helped to increase the number of accredited sites as well as numbers of clients on treatment, but most importantly to avoid overburdening a few sites in a district. With FY 2007 funding IPHC will roll out this mentoring approach to districts in other provinces using the Eastern Cape experience as a model.

IPHC activities contribute to the PEPFAR 2-7-10 goals by increasing access to ARV treatment.