SUMMARY:

The American International Health Alliance (AIHA) will conduct activities to support strengthening national

and organizational policies and systems to address human resource capacity development through two

major activities: twinning and volunteers. The first twinning activity is a partnership to develop nurse case

manager systems in four selected ARV sites located in Gauteng province. The second twinning activity is

building capacity for TB/HIV integration policy, program, and training. The volunteer activity will result in

placing public health specialists in primary healthcare clinics in Gauteng province to help develop those

clinics' capacities to deliver high-quality HIV care. The primary emphasis areas for the twinning and

volunteer activities is local organization capacity development and the minor emphasis areas are training,

human resources, and quality assurance, quality improvement and supportive supervision. The specific

target populations for these activities are public and private healthcare providers and host country

government policy makers.

BACKGROUND:

The two twinning partnerships continue and build upon activities that began in July 2007, through an

existing collaborative relationship between FPD and AIHA and our experience in HIV/TB management,

which developed during a Twinning Center-facilitated partnership between FPD and Brits District Hospital

cross reference. The twinning activities are implemented through a sub-grant to either one or both partners,

with partnership development, management and evaluation provided by the Twinning Center. The Twinning

Center South Africa Regional Office will manage, monitor and evaluate the volunteer activities.

ACTIVITIES AND EXPECTED RESULTS:

Three activities will take place as a result of this partnership:

ACTIVITY 1: TB/HIV

Building on the accomplishments of the partnership in FY 2007, AIHA will support scaling up opportunities

in TB/HIV, focusing on the development of a model TB/HIV Center to be housed at a TBD university in

South Africa, such as the University of Free State, with technical assistance from local TB/HIV research

centers such as CHSR&D, with the goal to support the South African National Department of Health

(NDOH) and provincial DOHs with various training and capacity building activities. The US partner will work

with South African stakeholders from the university, national and provincial DOH, and other identified

stakeholders to asses the feasibility of implementing a model center(s), using experts from US TB/HIV

centers as technical consultants, and determine the needs and priority areas for the partnership. It is

anticipated that this will result in a proposal outlining the steps necessary for the development and

management of a model TB/HIV center. Included in this assessment will likely be feasibility studies,

exchanges, identification of center goals, recommendations regarding center management and staffing, and

identification of collaborative funding opportunities The partnership will also create links between model TB

and HIV centers in the US, particularly the Regional Tuberculosis Training and Medical Consultation

Centers regions of the US, and the regional AIDS Education and Treatment Centers in order to develop the

centers' programs, which may include clinical training, mentoring and medical consultation (programs to be

defined based on needs assessment. Linking South African universities with experience in the social

science aspect of TB with model TB and HIV Centers in the US, which are more focused in the provision of

clinical services and training, will provide this partnership with the necessary resources and technical

assistance for the development of a model National TB/HIV Center.

ACTIVITY 2: Nurse Case Management

The second twinning partnership is between University of California-San Francisco School of Nursing and

FPD. The aim of this partnership is to develop nursing case management systems in four selected clinics,

and this will garner support for this approach within the nursing profession.

The objectives of this partnership are:

1. Train a cadre of nurses, nurse leaders, nurse educators and key clinic management personnel from

selected clinics, associations, and schools in HIV nursing case management;

2. Implement HIV nursing case management in selected ARV clinics identified by FPD and USG;

3. Create organizational and management support for nursing case management systems;

4. Implement a training/mentoring model of "nurses supporting nurses" to institute and support HIV nursing

case management and to expand the model to additional clinics/down referral sites; and

5. Develop an HIV Nursing Case Management Module to use for in-service training of nurses and hospital

and clinic management personnel.

These twinning activities support effective and efficient case management in selected clinics, and training

on nursing case management is incorporated into in-service/continuing education course offerings. Both of

these outputs contribute to improved quality of HIV care by South African nurses. In the first year of the

partnership, it is developing and implementing a training/mentoring model of "nurses supporting nurses",

focusing on HIV-nursing case management, that will reach about 30 nurses. In the second year, the

partnership will expand the model to additional clinics/down referral sites, training about 80 nurses. In

addition, the HIV Nursing Case Management Module for in-service training for nurses and hospital/clinic

management personnel, piloted in the first year, will be expanded in FY 2008. As a result, effective and

efficient case management will be cascaded to other clinics and the HIV Nursing Case Management

Module will be added to in-service/continuing education course offerings to reach a wider nurse audience.

ACTIVITY 3: Volunteer Health Care Corps

The Twinning Center will place up to six public health specialists (physicians and nurses) for up to three

months in selected primary care clinics in Gauteng province. This activity complements the current

volunteer recruitment and placement activities in KwaZulu-Natal, North West, Northern Cape and

Mpumalanga. Depending on the capacity and needs at the identified sites, volunteers will be assigned to

work in just one clinic for the entire time, or to rotate between clinics in a designated area. The volunteers

are expected to support at least five health professionals per site. The volunteers will quickly determine the

Activity Narrative: training and systems management gaps at the clinics and help find solutions to fill the gaps, provide training

and ongoing mentoring to staff, help to cement relationships between the hospitals and the down-referral

sites, ensure that supplies and systems are in place to handle an increased patient load, and provide

encouragement and support to clinic staff. The volunteer activities are expected to increase the knowledge

and expand the skills of health-care professionals in primary care clinics who deliver HIV services. The

volunteer activities will contribute to the implementation of functional down-referral systems. It is also

expected that the volunteers will continue to provide technical assistance, via electronic and telephone

communication, to their host clinics after their return to the U.S.