SUMMARY:

The South African Department of Defense (SA DOD) Prevention of Mother-to-Child Transmission (PMTCT)

program is an integral component of the SA Department of Defense Comprehensive Management,

Prevention, Care and Treatment Program. It focuses 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,

HIV-infected infants, doctors, nurses, laboratory workers, pharmacists, and other healthcare workers within

the military.

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 SA 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 to 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 and AIDS Program will decide whether the training

will be centralized within SA DOD or will need to be outsourced to an accredited training institution. The

PMTCT training program was included for FY 2007 into the ARV training program, which is outsourced to

the University of Pretoria. One hundred eighty six healthcare workers have been trained since April 2005. It

is expected that another 56 healthcare workers will attend this training in August 2007. Due to human

resource shortage and capacity within the SAMHS, the FY 2007 PMTCT funding has not been utilized, yet

this is still an unmet need.

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 antiretroviral treatment 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 fully supported once the HIV status has been established.

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 antiretroviral drugs 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 team will track women who receive this

PMTCT package of services through the SA DOD health informatics system. It must be noted at this stage it

is not possible to report on the numbers of pregnant women receiving PMTCT services as the SA DOD only

reports on cumulative numbers of adult patients on treatment as agreed. This will be further explored with

the US and SA DOD M&E teams for future reporting in this financial year.

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

Activity Narrative: African Department of Defense, and increasing the capacity of healthcare providers.

SUMMARY:

The South African Department of Defence's (SADOD) activities are complementary to the other prevention

and care components within the Masibambisane program (the HIV Prevention and Awareness Program of

the SADOD). The focus of this abstinence and being faithful (AB) activity is the training of chaplains as

trainers in the moral, values and ethics-based program, which addresses gender equity, the role of men as

partners, and violence and coercion. This activity will facilitate transferring the value and ethics-based

program to members of the SADOD, training chaplains in pastoral care and counseling, and providing

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 AB components of prevention. The activity has been

expanded to include training of Southern African Development Community (SADC) chaplains. Specific

target populations include HIV-infected pregnant women, people living with HIV (PLHIV), religious leaders

and health workers as well as all other personnel within the military.

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 FY 2004 funding to expose all members of the SADOD to the

training. In order to achieve this objective, all regular Defence 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 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. This activity will

continue to be implemented by the chaplaincy of the SADOD.

All these activities are monitored through the monitoring and evaluation (M&E) plan for Masibambisane. The

M&E plan includes a 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

civilian communities to mobilize faith-based organizations.

The chaplaincy developed both courses and trained the majority of chaplains within the SADOD. They have

also trained a group of chaplains from Southern African Development Community (SADC) countries and

those chaplains attended the North Atlantic Treaty Organization (NATO) chaplains' conference for the last

three years. 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.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1:

This activity will provide training to chaplains of the SADOD, SADC, and the NATO in the values- and ethics

-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 values- and ethics-based program within the SADOD as part of unit

workplace programs to members of the SADOD, focusing on activities that promote abstinence; for

instance, development of skills in unmarried individuals for practicing abstinence and adoption of norms that

supports delaying sex until marriage and that denounce forced sexual activity among unmarried individuals.

This requires the development and printing of facilitation manuals.

ACTIVITY 3:

The SADOD will support the establishment of unit workplace programs through workshops with

commanders on the AB programs to ensure targeted abstinence and faithfulness interventions within units.

The commanders are the chiefs of the units, they have much influence on the military personnel in their

units, therefore their buy in is critical for the success of the program. The workplace program will also

address stigma and discrimination.

ACTIVITY 4:

The SADOD will provide ongoing pastoral care and counseling to HIV-infected and affected individuals and

families within the SADOD with the secondary aim to prevent HIV infection through interventions that focus

on abstinence and faithfulness. This will ensure that the spread of HIV within the SA DOD is contained.

ACTIVITY 5:

SA DOD will conduct community outreach campaigns to address abstinence and faithfulness through media

and awareness activities which includes the development and printing of information and educational

material. Awareness activities are an important component of the SA DOD Abstinence and Be faithful

Prevention Program targeting new recruits who are vulnerable group aged 18 - 25 years.

ACTIVITY 6:

SA DOD will assimilate innovative ways of spreading AB information through attending PEPFAR prevention

partner meetings, publications in military and peer-reviewed magazines and journals and oral and poster

Activity Narrative: 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 seven million new infections.

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 in adults; substance abuse prevention; training of South African Department of

Defense (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. Due to new

evidence, safe male circumcision practices will be integrated as part of the HIV prevention program. Target

populations include military health workers, doctors, laboratory workers, adults, people living with HIV and

AIDS, and out-of-school youth within the military.

BACKGROUND:

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 SA DOD personnel and

their dependants. The prevention programs include mass awareness; workplace programs with 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

theater (dramatic plays that address coping with stigma and discrimination in the workplace) and videos.

The overall activities are ongoing and in FY 2008. 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).

ACTIVITIES AND EXPECTED RESULTS:

Due to the scope of the program area, the SA DOD will carry out nine separate activities.

ACTIVITY 1: Workplace Programs

Workplace programs will be established through the training of unit commanding officers, workplace

program managers and military community development committees. 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.

ACTIVITY 2: Peer Education

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 how to run HIV peer group training. This is accomplished through adult learning. Activities

include information about sexuality and occupational exposure to HIV.

ACTIVITY 3: Medical Transmission and Injection Safety

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.

ACTIVITY 4: Gender Equity

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.

ACTIVITY 5: Substance Abuse Prevention

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.

ACTIVITY 6: Brief Motivational Interviewing

Activity Narrative:

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: Information Sharing

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: Awareness Campaigns

SA DOD will conduct mass awareness activities at the 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.

ACTIVITY 9: Male Circumcision

No male circumcision training or service delivery will take place without the express consent of the National

Department of Health. In the absence of such approval and based on discussions with the PEPFAR South

Africa team, funds could fully or partially be reprogrammed. Should the approval for safe clinical male

circumcision activities be given, the following male activities are proposed:

The demand for circumcision must be matched by provision of adequate equipment and training of

personnel to conduct safe, voluntary and affordable male circumcision. Increased provision of accessible

safe adult male circumcision services should increase opportunities to educate men in areas of high HIV

prevalence about a variety of reproductive and sexual health topics, including hygiene, sexuality, gender

relations and the need for ongoing combination prevention strategies to further decrease risk of HIV

acquisition and transmission.

Four main sub-activities will be included in the HIV prevention program:

-Review of policy on male circumcision in the SA DOD;

- Development of clear, consistent and accurate mass awareness messages that promote safe male

circumcision within the context of broader approaches promoting male sexual and reproductive health and

responsible sexual behavior;

- Capacity building of health care professionals to provide safe male circumcision services; and,

- Increasing access for the provision of safe male circumcision service delivery.

Training and messaging would be coordinated with the NDOH and with JHPIEGO, EngenderHealth, and the

NDOH TBD program on male circumcision.

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.

SUMMARY:

The palliative care program focuses on training of clinic, hospital, and hospice health workers for SANDF,

and HIV-infected and affected individuals and their families. Program activities include training of health

care workers to effectively manage HIV-infected individuals, expanding terminal care facilities, establishing

a home-based care database, and distributing home-based care kits. OI prophylaxis, TB screening, and

identification of individuals who qualify for ART as services are available, will be addressed, following

National guidelines. 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 (SA DOD) Plan for the

Comprehensive Care, Management and Treatment of HIV and AIDS.

BACKGROUND:

The SA DOD 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 were planned for upgrade in FY 2007 and it is anticipated

that unit-based facilities for the care and support of terminal HIV-infected members will be established

during FY 2008.

ACTIVITIES AND EXPECTED RESULTS:

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 SA DOD. 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. Target health care workers will include physicians, nurses, social workers, and psychologists.

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 2008. 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.

Patients will be identified for ART and referred, as additional ART services are expanded. 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 SA DOD requested a program evaluation, using qualitative methodology, to

address stigma within the SA DOD 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 SA DOD 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 SA DOD by the U.S. DOD.

The activities will contribute to the PEPFAR 2-7-10 goals by increasing the number of individuals receiving

palliative care and support.

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 SA DOD 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 (KwaZulu-Natal, Eastern Cape and North West provinces). 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.

ACTIVITIES AND EXPECTED RESULTS:

The implementation of activities that were planned for FY 2007 was delayed due to the staff restructuring in

the SA DOD. These activities will therefore be continued in the FY 2008.

ACTIVITY 1: OVC Tracking System

The SA DOD will develop 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 Ba-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 SA

DOD by the US DOD 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.

SUMMARY:

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 (SADOD) plan for the

Comprehensive Care, Management and Treatment of HIV and AIDS. The South African 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 sexually transmitted infection (STI) consultations,

pregnant women and couples who plan a family, and CT performed as part of differential and TB diagnoses.

Individuals themselves will make voluntary counseling and testing (VCT) requests.

CT has a positive impact on HIV prevention, and the advantages of early identification and management of

HIV-infected individuals has been shown. 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 SADOD on the organizational HIV and AIDS

policy and strategy, as well as the management of HIV and AIDS in the SADOD.

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.

BACKGROUND:

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 infected and 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 takes place at all military health care

facilities and therefore it is essential that all healthcare workers are trained in CT.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Offering of Routine Counseling and Testing/ Provider-initiated Testing and Counseling (PITC)

SADOD 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 PITC and

RCT which will be supported by the development and printing of training material. SA DOD will develop

information education and communication materials, which will be used to 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 attending 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 SADOD 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.

SUMMARY:

The South African Department of Defence (SADOD) has an existing HIV and AIDS program that includes

antiretroviral treatment (ART) services. FY 2008 funds will be used to improve and expand ART and related

services. The main emphasis area is human capacity development. The main target is people living with

HIV (PLHIV) in the military and their families.

BACKGROUND:

This activity commenced in FY 2005 with PEPFAR funding and was mostly focused on the preparation of

pharmacies at the first rollout sites for ART, supplementing SADOD funding for the 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 2008 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 six accredited ART sites are operational due to staffing issues,

and thus FY 2008 funding is focused on addressing the needs of the four sites that are accredited, but not

operational.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1:

Training of personnel to strengthen management systems, improve the quality of service through training of

healthcare workers in ARV service provision.

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 SADOD 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 the four focus ART sites to determine gaps in staffing, and a plan

to address these gaps will be developed and implemented by SADOD, with some support from PEPFAR

funding.

ACTIVITY 5: To ensure quality monitoring and evaluation, the SADOD will implement the HIV and AIDS

database developed in FY 2006 in order to capture all relevant patient data for tracking and reporting

purposes at the four focus ART sites.

These activities will contribute to the number of persons receiving treatment and care in the military, and

support the PEPFAR 2-7-10 goals.

SUMMARY:

The Monitoring and Evaluation (M&E) plan for the South African National Defence Force (SANDF)

Masibambisane program addresses all components necessary for a comprehensive M&E system for an HIV

and AIDS program. One major component is the health management information system (HMIS), which

was expanded during FY 2007 to encompass HIV and AIDS specific data. During FY 2008 the focus will be

on enhancing the system by developing data collection tools, updating the software package to enable the

efficient tracking of HIV and AIDS data, and training in M&E.

BACKGROUND:

The development of a more comprehensive M&E system for the 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 HMIS used by SANDF is quite robust;

however, it has taken significant work to incorporate all relevant HIV and AIDS data that are required by

PEPFAR, the National Department of Health and the SANDF program managers.

ACTIVITIES AND EXPECTED RESULTS:

During FY 2007 a total of 25 HIV and AIDS regional program managers were trained on M&E in order to

strengthen reporting at the regional level. During FY 2008 this base of training will be enhanced in terms of

quality as SANDF's Strategic Information (SI) requirements continue to expand.

Activity 1: Review development of data management system

In FY 2008 the SANDF SI team will review the ongoing development of the HIV program HMIS with the

larger SANDF HMIS. Systems enhancements will be undertaken as per this review.

Activity 2: M&E and SI training

The focus of this activity is the continued SI training for SANDF staff and ensuring that all have internet and

information technology access to improve reporting capability. It is important to note that internet and

information technology access is extremely important in light of PEPFAR/South Africa's dependence upon a

web-based reporting system for the quarterly, semi-annual, and annual reporting of results. To date SANDF

has had difficulty meeting USG reporting deadlines due to connectivity constraints. Moreover, data quality

is potentially compromised when results that should be reported electronically must first be manually

transposed and then reported in an altered format. This SI activity will also include training of regional and

unit level data collectors in data quality management and reporting. This is important because currently the

extent to which SANDF data management systems are capable of aligning with the reporting requirements

of PEPFAR is not consistent across data collection points, thus affecting reliability of reported results. An

NGO (outside contractor) has conducted an initial consultation and is being considered as the contractor to

implement a systems-wide data quality evaluation with associated training and mentoring.

Activity 3: Seroprevalence study

The partner will conduct an organizational seroprevalence study to determine an epidemiological baseline

for impact measurement of the SANDF's HIV and AIDS program. The key step toward enabling a useful

evaluation to occur during later years is the establishment of a robust baseline of seroprevalence within SA

DOD populations. This baseline will be the main activity in this area during FY 2008.

Activity 4: Data Quality and Managerial Audits of M&E Systems

During FY 2008 a series of internal audits and site visits will be conducted in order to verify data, services,

and facilities. These activities will enable the SANDF 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.

SUMMARY:

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.

BACKGROUND:

The Masibambisane program was established in 2001, and has received PEPFAR funding from FY 2004. It

is an integrated prevention, care and treatment program in the SADOD, addressing the management of HIV

and AIDS within the Department by interventions that target SADOD personnel and their dependants. The

prevention programs include mass awareness; workplace programs with 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 theater

(dramatic plays that address coping with stigma and discrimination in the workplace) and videos.

The funding allowed the program to expand and to address program elements that were not possible

before. The program currently consists of seven generic disease processes each with various projects and

sub-projects, namely: prevention, promotion, diagnostics, treatment, rehabilitation, palliative care, research

and development. These are managed by the HIV and AIDS management structure in the office of the

Surgeon General with the Director HIV and AIDS, advisory board, coordinating committee and regional

program managers in each province and each military hospital. The SA DOD HIV and AIDS Management

Structure that facilitate program development, planning, execution, monitoring and evaluation. As the

program expands, various additional role players (new personnel that are coming onto the program, e.g.

doctors, nurses, psychologists, social workers, and nurses) 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.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1:

SA DOD will conduct training for regional and national SA DOD 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.

ACTIVITY 2:

SA DOD will conduct strategic and operational planning work sessions to ensure integrated program

development and coordinated execution of program elements (e.g. PEPFAR M&E training which members

of SA DOD attend and then cascade to other regional coordinators). 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.

ACTIVITY 3:

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 curricula for SA DOD. 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 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.