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: The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) carries out a number of activities using both Track 1 and In-Country funds. These include In-Coutnry activities in ARV Services (#7653), ARV Drugs (#7655), Basic Health Care and Support (#7654), TB/HIV (#7968) and Track 1 activities in ARV Services (#7650).
SUMMARY: EGPAF will use FY 2007 PEPFAR funds to continue prevention of mother-to-child transmission (PMTCT) support for its existing partners as well as expanding its geographic coverage during FY 2007 to include direct support to provincial and district health departments. The key objective is to expand the coverage of PMTCT services, and thus ensure provision of quality PMTCT services, and increase the uptake of PMTCT services. The primary emphasis area is training, and minor emphasis areas are quality assurance, supportive supervision, development of networks, linkages, referral systems and local organization capacity building. Primary populations to be targeted include infants, men and women, pregnant women, HIV-infected pregnant women, people living with HIV (PLHIV), and public and private healthcare providers.
BACKGROUND: The long-term goal of the EGPAF Call to Action (CTA) program in South Africa is to decrease transmission of HIV from mother to child. This is to be achieved through an intensive focus on increasing: the capacity of health facilities to deliver high quality PMTCT services in antenatal care (ANC), including screening and staging of HIV-infected pregnant women at EGPAF-supported sites; the uptake of voluntary counseling and testing (VCT) through the implementation of the opt-out policy at all EGPAF-supported sites; and the referral of eligible HIV-infected pregnant women to care and treatment at all EGPAF-supported sites.
USG support for the PMTCT program was initiated in 2003. This support was provided to McCord Hospital in KwaZulu-Natal, Hlabisa sub-district through the Africa Centre in KwaZulu-Natal, Mothers to Mothers (M2M) in KwaZulu-Natal and Mpumalanga, and the Johannesburg Metro District through the Perinatal HIV Research Unit (PHRU) in Gauteng. The Africa Centre, M2M and PHRU programs have been transitioned to the KwaZulu-Natal Department of Health (KZNDOH) and to direct USAID support, respectively.
McCord Hospital implements best practices for PMTCT through highly active antiretroviral therapy (HAART) for prevention/treatment, AZT from 28 weeks and nevirapine in labor, nevirapine for pregnant women who first present in labor, as well as a stat dose of nevirapine and AZT seven days post delivery to the HIV-exposed infant. This is different from the national protocol. This resulted in a vertical transmission of <2% in 2005. McCord uses a family-centered approach for PMTCT.
New partnerships created at the end of FY 2006 include working directly with the Tshwane-Metsweding Region in Gauteng, and the Free State, North West and KwaZulu-Natal provincial health departments. To improve quality of PMTCT service delivery, EGPAF will continue to support the national and provincial Departments of Health by providing technical support, human capacity development, and infrastructure rehabilitation, where applicable.
Priority areas for the CTA/South Africa program that are implemented through the activities include:
a) Follow-up of HIV-exposed infants and referrals to care and treatment for HIV-infected infants. b) Explore strategies for fast-tracking pregnant women to treatment services (better integration between PMTCT and antiretroviral (ARV) services). c) Improve partner (i.e., couple) testing and increase male involvement in the PMTCT program. d) Work directly with Government sites to strengthen PMTCT services. e) Strengthen monitoring and evaluation (M&E) activities. f) Encourage routine (opt-out) testing. g) Tuberculosis (TB) screening, identification of eligible pregnant women for HAART and referral to care and treatment sites.
h) Integrating PMTCT into existing maternal and child health and family planning services. i) Infrastructure rehabilitation, e.g., renovations to existing structures, acquisition of park homes.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: McCord PMTCT Program Activities a) Implement the family-centered model encouraging couple counseling, providing partner testing and testing of other siblings. b) Use the "opt-out" approach in the counseling and testing (CT) program c) Provide polymerase chain reaction (PCR) testing at six weeks for early infant diagnosis and thus improve HIV-exposed infant testing and follow-up. d) Strengthen the referral system between PMTCT and the wellness clinic or care and treatment services. This is achieved by offering routine CD4 testing to HIV-infected pregnant women and HIV-infected infants to identify those eligible for HAART. e) Provide TB screening for HIV-infected pregnant women. f) Offer complex ARV regimens depending on the clinical and immunological (CD4) staging. g) Provide HIV and AIDS training to local community-based organizations such as churches and youth organizations to raise community awareness. h) Provide cotrimoxazole prophylaxis for mothers and children.
ACTIVITY 2: Free State, Gauteng, KwaZulu-Natal and North West Provincial Departments of Health
a) Conduct needs and site assessments to identify gaps and address the needs of human resources, infrastructure, training of healthcare workers (HCW), technical support, monitoring and evaluation, commodity, and ways to strengthen PMTCT services. b) Provide training in early infant diagnosis (PCR) to improve follow-up of HIV-exposed infants. c) Incorporate CD4 testing of HIV-infected pregnant women and HIV-infected infants in the PMTCT program, and fast-track those eligible to care and treatment sites or wellness clinics. d) Facilitate the provision of antiretroviral treatment for eligible HIV-infected women within the PMTCT program. e) Develop comprehensive referral systems to care and treatment sites.
ACTIVITY 3: Support to National PMTCT Staff Capacity and Training; Participate in the National Pediatric AIDS Working Group
a) Provide training to the nine provinces on early infant diagnosis, antiretrovirals in pregnancy, clinical and immunological staging of HIV and AIDS in infants and children, and clinical manifestations of HIV and AIDS in infants and children. b) Place a technical advisor within the National Department of Health. c) Participate in the National Pediatric Working Group to discuss and advise on policy with regard to pediatric treatment guidelines and access to pediatric treatment services.
The EGPAF PMTCT activities contribute to the PEPFAR 2-7-10 goals by strengthening PMTCT at the provincial and national level.
INTEGRATED ACTIVITY FLAG:
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) carries out a number of activities using both Track 1 and Track 2 funds. These include Track 2 activities in PMTCT (#7969), TB/HIV (#7968), ARV Services (#7653), ARV Drugs (#7655) and Track 1 activities in ARV Services (#7650). 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:
EGPAF will use FY 2007 PEPFAR funds to continue Palliative Care support for its existing partners in KwaZulu-Natal. EGPAF aims to increase life expectancy among people living with HIV (PLHIV) through palliative care services. The primary emphasis areas are human resources, with minor emphasis on the development of networks, infrastructure, policy and guidelines, and on strategic information and training. Primary populations to be targeted include infants, men and women, both pregnant and not, people living with HIV (PLHIV), and public and private healthcare providers.
BACKGROUND:
The long-term goal of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) care and treatment program in South Africa is to increase life expectancy among HIV-infected persons. This will be achieved through an intensive focus on increasing access to care and treatment services, as well as service utilization (demand). To achieve these goals and objectives, project Help Expand Antiretroviral Treatment (HEART) will expand the geographic coverage of services during FY 2007. HEART/South Africa is part of a larger worldwide initiative by EGPAF to support care and treatment services. The program has maintained a focus on integrating PMTCT services to provide a family-centered model of care that includes access to treatment for HIV-infected pregnant women, couple counseling, partner testing and screening for TB. EGPAF utilizes external resources to complement those of the Department of Health (DOH) and private partners, such as faith-based organizations (FBOs) and other non-governmental organizations(NGOs) providing health care services.
These resources are utilized to fund staff, infrastructure, drugs, laboratory testing and provide technical support. EGPAF will identify gaps/needs in the program at the individual site level and implement activities to address the needs. The intent is to facilitate national and provincial plans and work together with the government and other partners to ultimately transition programs to South Africa Government (SAG) support.
EGPAF has partnerships with a private NGO, namely the AIDS Health Care Foundation (AHF). This is a cost-sharing relationship (drugs and staff) to support the AHF care and treatment program. In addition, McCord Hospital, a faith-based organization, is a sub-grantee of EGPAF. The EGPAF partnership with the DOH includes support for human capacity development, infrastructure rehabilitation and technical support for sites in KwaZulu-Natal (KZN).
The existing sites are: 1. McCord Hospital, Durban 2. AHF (Ithembalabantu Clinic), Umlazi, Durban 3. KwaZulu-Natal Department of Health (KZNDOH), Pietermaritzburg Up/Down-referral program (Edendale Hospital and four feeder clinics, Northdale Hospital and five feeder clinics) 4. KZNDOH, KwaMsane Clinic in the Hlabisa Sub-district of uMkhanyekude District 5. KZNDOH, Vryheid Hospital plus three feeder clinics, Benedictine Hospital and three feeder clinics, and Edumbe Community Health Centre (CHC) plus 1 feeder clinic, in Zululand District
New HEART partners include the KZNDOH at Ceza Hospital, Nkonjeni Hospital, St Francis Hospital, Itshelejuba Hospital and two feeder clinics per hospital, in Zululand District.
The HEART program works to improve the quality, availability, and accessibility of antiretroviral treatment (ART) services by focusing on the delivery of a family-centered model of care and treatment to increase a pediatric focus, couple counseling, partner testing and an added emphasis on testing for siblings to increase the number of children on treatment. EGPAF works to expand the coverage of care and treatment services to reach mothers, fathers, and children who would not otherwise have access to these services. Effort will be made to ensure equitable access to care services for both males and females (key legislative area).
EGPAF works with partners to increase access to elements of the preventive care package, counseling an testing (CT), integration of PMTCT services with care and treatment (to improve the referral of eligible pregnant mothers, partners and HIV-infected infants and children to treatment sites), screening and management of opportunistic infections (e.g. polymerase chain reaction (PCP) prophylaxis), clinical monitoring, related laboratory services (CD4 counts), nutritional support, training and support of caregivers, ongoing counseling and support, assist the primary healthcare clinics to implement a downward and upward referral system by building capacity and providing technical assistance.
Activities undertaken in order to achieve the program objectives include:
1. Conducting site assessments to identify gaps or needs to be addressed to increase the number of patients on palliative care.
2. Improving the quality of counseling and testing by providing ongoing support to lay counselors and health care professionals.
3. Assessing quality of the program and supportive supervision to staff.
4. Providing technical assistance to enhance family centered approach to clinical screening and opportunistic infection prophylaxis in community settings.
5. Training and capacity building for appropriate referral at sites for implementation and management of the palliative care program.
6. Providing M&E support with a focus on data management systems to enhance data quality
7. Developing linkages and referral systems between Care, CT, TB and STI, ART sites (including wellness clinic) and community-based organizations (home-based care; faith-based care; support groups)
8. Identifying eligible pregnant women for highly active antiretroviral therapy (HAART), laboratory and clinical staging and referral to care and treatment sites.
9. Screening and treatment of opportunistic infections e.g. TB screening, cotrimoxazole prophylaxis).
10. Strengthen referral systems to improve the access to care and treatment of children.
11. Technical assistance for the creation of outreach programs to build capacity at primary healthcare clinics for down-referral of patients who are stable on ART from accredited ARV sites and up referral of those eligible for initiation of ART at the accredited sites, thus decongest treatment sites that have reached capacity. This will also be aligned closely with access to HIV-related palliative care.
In FY 2007, the HEART program will increase the percentage of HIV-infected patients with palliative care by 30%. EGPAF plans to embark on a growth strategy - building on the experience and success achieved in FY 2006. This growth in patient numbers will be achieved through a combination of expanding the efforts of existing HEART programs, enrolling new sub-partners, and supporting the efforts of South African government Departments of Health at provincial and district level.
By supporting HIV care and treatment services, EGPAF contributes to the 2-7-10 goals of PEPFAR and the USG South Africa Five-Year Strategic Plan.
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) carries out a number of activities using both Track 1 and Track 2 funds. These include Track 2 activities in PMTCT (#7969), ARV Services (#7653), ARV Drugs (#7655) and Basic Health Care & Support (#7654), and Track 1 activities in ARV Services (#7650).
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will support all of its care and treatment partners in addressing the barriers to increasing case detection and cure rates in TB co-infected HIV-infected patients. The program intends to strengthen collaboration between TB control initiatives and HIV and AIDS programs at EGPAF supported sites in KwaZulu-Natal. EGPAF receives both Track 1 and Track 2 (South Africa) PEPFAR funding. The primary emphasis areas for activities are human resources, with minor emphasis on the development of networks, infrastructure, policy and guidelines, and on strategic information and training. Primary populations to be targeted include infants, men and women, both pregnant and not, people living with HIV (PLHIV), and public and private healthcare providers.
Tuberculosis (TB) poses a serious threat to the public health and economic well-being of South Africans and in the advent of HIV, affects the most productive segments of the population, as well as disproportionately affects the poor. The HIV and AIDS epidemic in South Africa has further complicated control and treatment of TB. Although the South Africa National TB Control Program (NTCP) has made significant progress over the past several years, it still faces challenges in increasing case detection and cure rates. Key barriers include a lack of community understanding about the disease, limited access to services, inadequate provider knowledge and compliance with DOTS, and patient adherence to treatment.
The program's key focus will be at the district, municipal, and community levels. EGPAF will:
1. Assist stakeholders and partners to strengthen local capacity to detect, treat, and prevent TB.
2. Develop community-based strategies to identify potential TB cases and ensure early referrals for diagnosis and treatment.
3. Assist sites to integrate TB services with HIV and other healthcare services.
4. Support and develop community-based approaches to ensure treatment adherence.
EGPAF will strengthen linkages between healthcare centers and community DOT supporters to reduce treatment interruption rates and improve treatment adherence. EGPAF will establish mechanisms for collaboration between TB and HIV services by providing counseling and testing within TB services, and screening HIV-infected individuals for TB.
EGPAF will assist in strengthening the technical capacity at the sites where the comprehensive care management and treatment programs are being supported. The key activities will involve the integration of TB services, VCT services, and antiretroviral treatment (ART) services, at primary health care and hospital level. These activities will be included in the site TB control and evaluation plans.
Mechanisms for integration are:
1. Support the district/site TB/HIV coordinator to expand and improve the referral linkages between TB and VCT.
2. Assist in the development and implementation plan for TB/HIV at sites at which EGPAF will be providing comprehensive HIV and AIDS services.
3. Assist in monitoring and evaluation of referral systems for TB/HIV related activities.
4. For monitoring and evaluation, a core set of indicators, based on national guidelines for monitoring and evaluation of collaborative TB/HIV activities will be used to measure the success of the program.
EGPAF will support the following activities to reduce the burden of HIV in TB patients (adults and pediatrics):
1. HIV counseling and testing for all TB patients
2. Increased screening rates of TB for all HIV-infected patients within existing care and treatment sites and services.
3. Provision of cotrimoxazole preventive therapy to TB patients with HIV infection as part of the comprehensive care and treatment program.
4. Provision of antiretroviral therapy to eligible TB patients with HIV infection.
5. Provision of care and support services to TB patients with HIV infection.
6. Intensified TB case finding at all HIV and AIDS program sites and among higher risk groups, with a strong referral system between HIV and TB services.
7. Provision of isoniazid preventive therapy as part of the package of care for PLHIV when active TB is excluded.
EGPAF will assist the National TB Control Program to strengthen information systems, supervision, and program management. EGPAF will work with provincial, district, municipal, and community health systems to build or strengthen capacity to prevent, detect, and treat TB. The emphasis will on strengthening linkages with home-based care organizations and community healthcare workers to identify suspected TB cases, ensure early referrals for diagnosis and treatment, as well as support treatment adherence. EGPAF will provide human resources, training, and M&E support to the TB/HIV program.
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) carries out a number of activities using both Track 1 and in-country funds. These include in-country activities in PMTCT (#7969), ARV Services (#7653), Palliative Care: Basic Health Care and Support (#7654), TB/HIV (#7968) and Track 1 activities in ARV Services (#7650).
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will support all of its care and treatment partners in increasing access to antiretroviral treatment (ART) and care by those that need it. The primary emphasis area for this activity is commodity procurement, with minor emphasis in logistics, quality assurance and supportive supervision, strategic information and training. Primary populations to be targeted include infants, men and women, people living with HIV (PLHIV), and public and private healthcare providers. The geographic focus is on KwaZulu-Natal (KZN).
The long-term goal of the EGPAF care and treatment program in South Africa is to increase life expectancy among HIV-infected persons. This will be achieved through an intensive focus on increasing access to care and treatment services as well as the service utilization (demand). To achieve these goals and objectives, project Help Expand ART (HEART) will expand the geographic coverage of services during FY 2007. HEART/South Africa is part of a larger worldwide initiative by EGPAF to support care and treatment services, and receives both Track 1 and in-country PEPFAR funding. The program has maintained a focus on integrating PMTCT services so as to provide a family-centered model of care that includes access to treatment for HIV-infected pregnant women, couple counseling, partner testing and screening for TB.
EGPAF utilizes external resources to complement activities carried out by the KwaZulu-Natal (KZN) Department of Health (DOH) and private partners, such as faith-based organizations (FBOs) and other non-governmental organizations (NGOs). These resources are utilized to fund staff, infrastructure, drugs, laboratory testing and provide technical support. EGPAF will identify gaps in the program at the individual site level and implement activities to address the needs. The intent is to facilitate national and provincial plans and work together with the government and other partners to ultimately transition programs to South Africa government (SAG) support.
EGPAF has a partnership with a private NGO, the AIDS Health Care Foundation (AHF); this is a cost-sharing relationship (drugs and staff) to support the AHF care and treatment program. In addition, McCord Hospital, a faith-based organization, is a sub-grantee of EGPAF. The EGPAF partnership with the DOH includes support for human capacity development, infrastructure rehabilitation and technical support for sites in KwaZulu-Natal.
The existing sites are:
1. McCord Hospital, Durban 2. AHF (Ithembalabantu Clinic), Umlazi, Durban 3. KZNDOH, Pietermaritzburg Up/Down referral program (Edendale Hospital and four referral clinics, Northdale Hospital and five referral clinics), 4. KZNDOH, KwaMsane Clinic in the Hlabisa Sub-district of uMkhanyekude District 5. KZNDOH, Vryheid Hospital plus three referral clinics, Benedictine Hospital and three referral clinics, and Edumbe Community Health Centre (CHC) plus one referral clinic, in Zululand District
New HEART partners include the KZNDOH, at Ceza Hospital, Nkonjeni Hospital, St Francis Hospital, Itshelejuba Hospital and two referral clinics per hospital, in Zululand District.
ACTIVIES AND EXPECTED RESULTS:
ACTIVITY 1: ARV Drug Procurement
ARV drug procurement will be undertaken for one Track 1 partner (McCord Hospital) and for one in-country partner, AIDS Health Care Foundation. All DOH sites use the DOH ARV drug procurement systems. Generic medications purchased comply with the USG PEPFAR Task Force requirement of FDA approval as well as approval from the Medicines Control Council of South Africa.
ACTIVITY 2: Pharmacy
McCord and AHF are both national DOH accredited ARV sites, and each have a dedicated pharmacist for the HIV and AIDS treatment program. This has resulted in uninterrupted supply of antiretrovirals and individualized adherence counseling to the increasing number of patients.
Systems are in place to select, procure, store, track and distribute the drugs privately. Drugs can be sourced at short notice from private suppliers. McCord Hospital has two purchasing systems currently in operation: 1. Rolling Forecast System - GlaxoSmithKline access program drugs, that are purchased monthly according to a three-month committed, and nine-month open forecast updated monthly. This forecast is determined by the program batching systems. 2. Demand Dependant System - 24 hour order to delivery system based on demand and maintained with minimum and maximum stock levels.
Monitoring of purchases and distribution is done both manually and electronically (Pro-Clin and Trakhealth Systems) and produce statistical and detailed reports. If stock-outs (less than five days) occur, stock can be purchased from an alternative source.
As the AHF/Ithembalabantu clinic is a national DOH accredited ARV site, the KZN Department of Health provides the clinic with two fulltime VCT counselors. AHF Ithembalabantu clinic has an onsite pharmacy, and the clinic has the capacity to serve all of its clients pharmacy needs. AHF has developed pharmaceutical and health commodities management systems to ensure a sustainable supply of ARVs and other relevant supplies.
The clinical and psychosocial support staff at the Ithembalabantu clinic uses a locally developed, highly effective treatment education and adherence program that has resulted in outstanding, sustained rates of therapy success. Treatment adherence and education classes, social service support and counseling, as well as skills development and capacity building classes are all provided onsite. Medication adherence training and support is given before clients begin ART. Adherence counseling is also monitored by self-reporting, pill counting, and follow up with patients, dedicated family members or friends.
The EGPAF drug procurement program contributes to the PEPFAR 2-7-10 goals by ensuring adequate supply of ARV drugs for patients in treatment.
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) carries out activities using Track 1 and in-country funds. These include in-country activities in PMTCT (#7969), ARV Drugs (#7655), Palliative Care: Basic Health Care and Support (#7654), TB/HIV (#7968) and Track 1 activities in ARV Services (#7650).
BACKGROUND: The long-term goal of the EGPAF care and treatment program in South Africa is to increase life expectancy amongst HIV-infected persons by increasing access to care and treatment services and service utilization. Project Help Expand ART (HEART) will expand geographic coverage of services in FY 2007. HEART/South Africa is part of a larger worldwide initiative by EGPAF to support care and treatment services, and receives both Track 1 and in-country PEPFAR funding. The program's focus is on integrating PMTCT services to provide a family-centered model of care that includes access to treatment for HIV-infected pregnant women, couple counseling, partner testing and screening for TB. EGPAF utilizes external resources to complement those of the KwaZulu-Natal (KZN) Department of Health (DOH) and private partners, such as faith-based organizations (FBOs) and other non-governmental organizations (NGOs). These resources fund staff, infrastructure, drugs, laboratory testing and provide technical support. EGPAF will identify gaps in the program at the site level and implement activities to address the needs. The intent is to facilitate national and provincial plans and work with the government and partners to transition programs to South Africa government (SAG) support. EGPAF has a partnership with a private NGO, the AIDS Health Care Foundation (AHF); this is a cost-sharing relationship (drugs and staff) to support the AHF care and treatment program. McCord Hospital, a faith-based organization, is a sub-grantee of EGPAF. The EGPAF partnership with the DOH includes support for human capacity development, infrastructure rehabilitation and technical support for sites in KZN. The existing sites are: 1. McCord Hospital, Durban 2. AHF (Ithembalabantu Clinic), Umlazi, Durban 3. KZN DOH, Pietermaritzburg Up/Down-referral program (Edendale Hospital and four referral clinics, Northdale Hospital and five referral clinics), 4. KZN DOH, KwaMsane Clinic in the Hlabisa Sub-district of uMkhanyekude District. 5. KZN DOH, Vryheid Hospital plus three referral clinics, Benedictine Hospital and three referral clinics, and Edumbe Community Health Centre (CHC) plus one referral clinic, in Zululand District. New HEART partners include KZNDOH at Ceza Hospital, Nkonjeni Hospital, St Francis Hospital, Itshelejuba Hospital and two referral clinics per hospital, in Zululand District.
ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Human Capacity Development EGPAF will support training of healthcare providers on the following: 1. Screening and treatment of TB/HIV and opportunistic infections, ART in pregnancy, and referral systems (between PMTCT and ART) 2. Supporting systems to improve access to care and treatment of children (including early infant diagnosis) 3. Capacity building at sites for implementation and management of the comprehensive care, management and treatment support program 4. M&E 5. Project management 6. Completing a HIV and AIDS Diploma at the University of KwaZulu-Natal. In addition EGPAF will provide technical assistance for the creation of outreach programs to build capacity at primary healthcare (PHC) clinics for downward and upward referral in order to maintain patients on ART, initiate new patients on therapy, and decongest treatment sites that have reached capacity. ACTIVITY 2: Down Referral Process The KwaZulu-Natal Health Department (KZNDOH) started providing comprehensive care and treatment services to HIV-infected patients in May 2004 at hospital level. PHC clinics will be capacitated so that they are able to manage stable patients on ART referred down from the hospitals or community health centers (CHCs), and also up refer those that are eligible for initiation of ART to hospital or CHCs that are ARV rollout sites. The KZNDOH aims to make ART accessible to all by expanding and strengthening existing
HIV and AIDS care and treatment service delivery. A number of CHCs have been accredited by the national and provincial health departments and will initiate ART. The PHC clinics conduct rapid HIV testing, CD4 testing and provide the first, second and third adherence counseling sessions, which is also done at CHC and hospital level, and then refer patients to accredited CHCs or hospitals for initiation. The KZNDOH has identified the Pietermaritzburg and Zululand Districts as areas needing immediate support as they are poorly resourced with high HIV seroprevalence rates. The KZNDOH has requested that EGPAF support be extended to these districts. The districts will identify clinics where stable patients on treatment can be referred to continue management. ACTIVITY 3: Pediatric Care and Treatment EGPAF's goal is to ensure that 10 percent of all patients on treatment are children, which has not been achieved in the Zululand district. To strengthen pediatric HIV care and treatment, EGPAF will provide training on early infant diagnosis, pediatric HIV clinical staging and diagnosis and ART in children, in addition to provision of staff, strengthening the linkages between PMTCT and care and treatment. The Edendale and Northdale pediatric HIV clinic has the largest cohort of pediatrics in the province on ART. The hospital down refers stable patients to the care of the PHC clinics to free up space for new pediatric patients. EGPAF aims to: 1. Increase the rate of down referral of stable children on ART 2. Increase the up referral of new eligible children for initiation of therapy 3. Improve linkages between PMTCT programs and care and treatment programs EGPAF will provide financial and technical support to eight PHC clinics in the catchment area of the Edendale and Northdale hospital in Pietermaritzburg, thus capacitating them to: (1) receive and manage transferred stable pediatric patients on ART from the pediatric HIV clinic; and (2) provide screening and preparation of eligible HIV-infected patients at these PHC facilities for up referral and initiation of ART at Edendale Hospital Pediatric HIV clinic. ACTIVITY 4: Counseling and Testing The focus will be strengthening comprehensive HIV and AIDS care and treatment services using a family-centered approach to increase access to VCT, by fast-tracking TB, STI, and family planning patients to VCT; to integrate PMTCT with HIV and AIDS care and treatment; to improve referral of eligible pregnant mothers, partners, family members, and HIV-infected infants and children to treatment sites; to screen for opportunistic infections. With this focus, EGPAF will increase pediatric care and treatment, couple counseling, partner testing, and testing for siblings. The overall goal is to expand coverage of HIV and AIDS care and treatment services to reach mothers, partners and children who would not otherwise have access to these services. Plus-Up funds will be used to expand EGPAF program activities viz. human capacity development, down-referral process, pediatric care and treatment as well as counseling and testing activities to Gauteng, Limpopo, Free State, and the Northern Cape provinces. In each province, EGPAF plans to initiate support in at least 2 ARV initiating sites and 4 feeder primary health care (PHC) facilities. In addition, EGPAF will strengthen M&E systems at all levels of service delivery. A memorandum of understanding (MOU) between EGPAF and the Free State Department of Health (DOH) was signed on the 12th April 2007, and a strategic planning meeting is scheduled for mid-May 2007. MOU drafts have been submitted to the Gauteng, Limpopo and Northern Cape DOH offices, and we will continue to follow up with the relevant DOH personnel.
