SUMMARY:

The Eastern Cape Regional Training Center (RTC) will use FY 2008 funds in the Eastern Cape for

sustainable human capacity development for all health workers through provision of support and training for

improvement of health systems of HIV and AIDS care in the Eastern Cape. RTC staff will also continue to

improve their knowledge and skills by having weekly academic clinical discussions, internal workshops, and

ongoing mentoring and Performance improvement meetings with staff of partner facilities and their feeder

clinics and in so doing, creating a "learning" network across all the LSAs of operation. This will facilitate

health workers to deliver quality HIV and AIDS palliative care and enhance their capacity to participate

effectively in all levels of HIV and AIDS care. Three teams from RTC will each support a facility and its

feeder clinics for a period of four months to initially evaluate the HIV and AIDS palliative care training needs

and provide targeted didactic training, ongoing mentoring and coaching using standardized procedures

manuals and tools that are in line with the national guidelines. A performance Improvement officer will

continuously mentor and improve performance of the trained personnel while the teams move on to cover

other clinics. Community support groups will be supported and trained in delivering the basic Care package

to PLHIV and their families in their respective communities. The primary emphasis will be given to core

activity of training, with minor emphasis to quality assurance and supportive supervision for health systems

improvement in HIV and AIDS care, information, education and communication (IEC). The primary target

groups are public and private health care workers. FY 2008 activities will be expanded to include continuous

performance improvement of facilities and feeder clinics There will also be a central information officer

supporting the three teams, information systems strengthening at facility and feeder clinic levels, thus

building information management and reporting capacity of these clinics. Teams will ensure all team data

collection is captured into the main RTC M&E systems.

RTC will also train local PLHIV groups on the Basic Care Package and mentor these in the areas of support

to implement the Basic Care Package. RTC will be responsible for the accreditation and production of the

training material for this purpose. The Basic Care Package will include: Acceptance of status, disclosure,

prevention with positives, nutrition assessment and counseling, What is HIV, progression of illness,

treatment literacy and adherence counseling.

BACKGROUND:

Since 2004 RTC has developed two care support centers in two hospitals and nine clinics and generated a

model and protocols which will be introduced at new sites in FY 2007. A system of improvement cycles

have been introduced in one sub-district.

RTC has been working with ECDOH managers in developing and disseminating care protocols and will be

providing support and working closely with the district and facility managers to increase skills capacity to

improve the quality of HIV treatment and support services at facilities and community level.

ACTIVITIES AND EXPECTED RESULTS:

In FY 2008 RTC activities will continue to address activities related to training; local organization capacity

development; quality assurance; and supportive supervision. Funding will be used to train and mentor

health care providers on HIV and AIDS related palliative care and support programs. This will include the

preventive package of care including prevention with positives, screening for opportunistic infections

according to national guideline for management of HIV; WHO clinical staging and provision of cotrimoxazole

prophylaxis, screening for and treating TB in PLHIV and provision of INH prophylaxis. RTC will also seed

accreditation of training curriculum for the Basic Care Package for PLHIV in conjunction with NASTAD and

train PLHIV in implementing the basic care package. Target personnel will include physicians, nurses and

nurse practitioners and other hospital and clinic staff.

ACTIVITY 1:

RTC will through the 4 clinical teams assess the palliative care training needs of health care providers at

selected hospital and feeder clinics sites in the Eastern Cape province. Palliative care training will be

designed according to the needs of the care providers. The areas to be covered are: basic prevention

including prevention with positives, clinical screening and monitoring of the PLHIV, treatment of

opportunistic infections, cotrimoxazole and INH prophylaxis and pain and symptom management. These

training will be in the form of case discussions, ward rounds, targeted didactic training, mentoring and

coaching. This will be followed up with quality assurance interventions by the QA team to ensure transfer of

skills into practice.

ACTIVITY 2:

RTC will in conjunction with NASTAD's sub-partners (JRI and SA Partners) seek accreditation for the

training curricula for the Basic Care Package for PLHIV. RTC will also produce the training material for this

training and train PLHIV to form and facilitate support groups to deliver the Basic Care Package. This

package will cover the following: acceptance of HIV status, disclosure, prevention with positives, and

treatment of opportunistic infections (with a special focus on TB/HIV co infection and the provision of

cotrimoxazole), ARV and adherence and nutrition assessment and counseling. RTC will form support

groups for PLHIV and their families in each of the sites they support to deliver the basic care package.

These activities will contribute to the PEPFAR goal of reaching 10 million HIV-infected and affected

individuals with care.

SUMMARY:

The Eastern Cape Regional Training Center (RTC) will use FY 2008 funds in the Eastern Cape to

strengthen the capacity of health care workers (HCW), facility managers, social workers, doctors, nurses,

lay counselors and community health workers (CHW), including DOT supporters, to deliver quality TB/HIV

services. Three teams from RTC will each support a facility and its feeder clinics for a period of four months

to initially evaluate the TB/HIV training needs and provide targeted didactic training according to the NTP

policies and guidelines, ongoing mentoring and coaching using standardized procedure manuals and tools.

NGO facilitators will be trained to implement a level four comprehensive community health worker

curriculum incorporating HIV and TB. Primary emphasis will be given to training, quality assurance and

supportive performance improvement supervision, and information and reporting systems strengthening at

facility level.

BACKGROUND:

RTC was established through a service agreement between the prime partner Eastern Cape Department of

Health (ECDOH) and the Walter Sisulu University (WSU) to provide ongoing training for quality

improvement in HIV and TB care programs.

The function of RTC has been to develop accredited training modules and care protocols for different

categories of health workers based on National Department of Health guidelines. RTC has demonstrated

and evaluated the HIV, TB and STI best practices continuum of prevention, care and treatment model in

selected facilities, providing direct patient care and the opportunity for HCW to receive practical training.

RTC provides technical assistance to the ECDOH regarding the expansion of its HIV intervention programs

supporting Eastern Cape hospital/clinic site readiness for accreditation to provide comprehensive HIV care

and treatment.

During the past three years ECDOH has introduced a comprehensive program for HIV care. From

observations during RTC activities in clinics and communities, more than 70 percent of TB patients are HIV-

infected and there seems to be a gap in screening all TB patients for HIV and early identification of TB in

HIV patients who are presenting in facilities. Patients present late for care, already with severe

complications. No clinical prophylaxis of TB is currently provided. There is limited awareness and skill

among the communities to enable early entry into the care system. There are known drug-drug interactions

in patients with co-treatment of ARV and TB drugs. There is an opportunity to combine follow-up of TB

patients with patients on ARVs at community level.

RTC has been working with ECDOH managers in developing and disseminating care protocols and will be

providing support and working closely with the district and facility managers to increase skills capacity to

improve the quality of TB/HIV treatment and support services at facilities and community level.

ACTIVITIES AND EXPECTED RESULTS:

In FY 2008 RTC will continue to address the following areas: training; local organization capacity

development; quality assurance; and supportive Supervision and performance improvement. Funding will

be used to enhance the RTC strategy of training preparation of new provincial sites for accreditation as ARV

sites and providing clinical mentoring to increased sites. RTC will continue supporting training administration

and logistics of a comprehensive care training team allocated to provide dedicated support to three district

hospital sites and at least five feeder clinics, for a period of four months, which will then move to the next

three sites for the next four months, completing three cycles a year. The intensity of support and

Performance Improvement supervision will Increase with introduction of a performance improvement officer,

a critical efficiency improvement position in the teams. Information and reporting improvement will be

achieved by appointing an information officer, whose primary responsibility will be facility information and

reporting systems improvement.

During this period the team will work with and support the facility managers to initially evaluate the TB/HIV

palliative care services training needs, adapt standardized protocols and procedures for local facilities, and

provide targeted didactic training, ongoing mentoring and coaching using standardized protocols and

operating procedure manuals. The activity will address the priority areas of human capacity development,

improving skills of a care team including managers, doctors, social workers, health promoters, CHW, DOT

supporters and nurses at a facility and its feeder clinics through targeted didactic, case discussions,

mentoring and community follow-up of patients with facility staff while considering and reviewing relevant

local system issues. Focus will also be given to building patient information and reporting capacity at

facilities. This activity is aimed at strengthening the recording and reporting system for TB and TB/HIV at

facility level; coaching clinic staff on correct data entry and reporting. Ongoing support will continue through

telephone consultations and special need visits after 4 months. RTC will train and mentor 35 facilitators

from 7 NGOs who will cascade the training of a comprehensive level four curriculum for community health

workers who will be providing community awareness for TB/HIV symptoms and follow-up of both patients

for HIV and TB treatment adherence.

RTC will hold three-monthly sessions with three local CBOs at each facility to articulate their role and

function in TB treatment services and enhance their knowledge and skills required to function in that role.

The RTC team will develop simplified TB screening algorithms for HIV patients at clinics and support the

improved provision of INH prophylaxis, early detection and better management of TB/HIV in clinics. RTC

training and mentoring will address the establishment of wellness programs at each facility to encourage

community follow-up, nutrition advice, infection control, referrals to clinics and social support at community

level. RTC through its M&E function will strengthen records management and reporting in TB/HIV clinics,

RTC will continue to piloting the Patient information database management systems at IDC -Mthatha with a

view of rolling it out to other partner hospitals and clinics to Improve patient tracking and records

management.

RTC training and mentoring will address data collection, maintaining accurate records, feedback and usage

through quality improvement cycles to address early presentation, and follow-up and referral of patients on

TB treatment.

Activity Narrative:

RTC is an ECDOH initiative based at the Walter Sisulu University and conducts training at public facilities.

RTC has and will continue to provide technical assistance to the province through regular meetings and

assignments from province managers as well as training for managers.

The PEPFAR funding is helping to establish the program on a firm footing where it can continue with

ECDOH funding.

The primary objective of the project is sustainable targeted human capacity development for all health

workers. RTC staff will also continue to improve their knowledge and skills by having weekly academic

discussions, two internal workshops, attending relevant conferences and ongoing mentoring from another

PEPFAR partner, I-TECH.

This activity contributes to the PEPFAR objective of 2-7-10 by increasing the number of people in care and

strengthening the linkages between HIV and TB programs.

SUMMARY:

The Eastern Cape Regional Training Center (ECRTC) will use FY 2008 funds in the Eastern Cape to

strengthen the capacity of healthcare workers (HCW), facility managers, social workers, doctors, nurses, lay

counselors and community health workers (CHW); prepare new sites for accreditation; and provide

mentoring to strengthen the provision of quality antiretroviral treatment (ART). Activities in this program area

will expand by recruiting an extra centrally based physician and pharmacist to strengthen the existing teams

and continue supporting the original 2 hospitals and 11 clinics in Mthatha. Three training, mentoring and

support teams from ECRTC will be strengthened by recruiting an additional 2 clinical training officers, and

will each continue to support a facility and its referral clinics for a period of four months to initially evaluate

the treatment services training needs and provide targeted didactic training, ongoing mentoring and

coaching by performance improvement officers on a continuous basis using standardized procedures

manual and tools, when the lead training teams have moved on. The creation of a learning network will

expand community support groups where PWAs will be trained to implement a basic HIV and AIDS care

package including ART. The emphasis areas are human capacity development and local organization

capacity building.

BACKGROUND:

The ECRTC was established through a service agreement between the prime partner Eastern Cape

Department of Health (ECDOH) and Walter Sisulu University (WSU) to provide ongoing training for quality

improvement in HIV care and treatment programs.

The function of the ECRTC has been to develop accredited training modules and care protocols for different

categories of health workers based on National Department of Health guidelines. ECRTC has demonstrated

and evaluated the HIV, TB and STI best practices continuum of prevention, care and treatment model in

selected facilities, providing direct patient care and the opportunity for HCW to receive practical training.

ECRTC provides technical assistance to the ECDOH regarding the expansion of its HIV intervention

programs, and supports hospital and clinic site readiness for accreditation to provide comprehensive HIV

care and treatment.

The primary target populations are the facility managers, doctors, nurses, social workers, lay counselors,

CBO staff and community health workers.

During the past three years ECDOH has introduced a comprehensive HIV care and treatment program.

After workshops alone HCW were unable to implement programs. A number of patients have been started

on ART at hospital level, but there is a gap in preparing primary clinics to continue supporting patients

(down-referral). Many eligible patients are started late on ARVs which results in poor outcomes. There is

limited awareness and skill among clinics to enable early diagnosis and entry into the care system. There

are known drug-drug interactions in patients with co-treatment of ARVs and other drugs and a number of

side-effects and complications are beginning to emerge. There is a need to provide facility-level mentoring

support from more experienced clinicians.

The ECRTC has been working with provincial ART managers in developing and disseminating care

protocols and will be providing support and working closely with the district and facility managers in

introducing the process to increase skills capacity to improve the quality of HIV treatment.

ACTIVITIES AND EXPECTED RESULTS:

In FY 2008 ECRTC activities will continue to address the following activities: training; local organization

capacity development; quality assurance; and supportive performance improvement supervision. Funding

will be used to enhance the ECRTC strategy of training, preparation of new facilities for accreditation as

ARV sites, and providing clinical mentoring to selected sites but also building patient Information

management and training. ECRTC will use funds to employ and support administration and logistics of a

comprehensive care training team consisting of a clinical director, three doctors, three nurse clinicians and

three administrative assistants (for three teams), one each placed at the three satellite sites (Mthatha, Port

Elizabeth, and East London). Each team will provide dedicated support to three district hospital sites and

their referral clinics for a period of four months, and then move to the next three sites for the next four

months, completing three cycles a year.

ECRTC will use funds to employ a research and M&E manager, information systems officer and a central

information officer supporting the 3 teams and continued facility/clinics records management and reporting

capacity building. The M&E team be responsible for monitoring and evaluation of all ECRTC activities,

through accurate measurement of results, designing M&E tools for the teams/clinics and knowledge

database maintenance The activity will address the priority areas of human capacity development,

improving skills of a care team at facilities (doctors, nurses, managers, social workers, health promoters and

CHW) through targeted didactic training, case discussions and mentoring in assessing, initiation, follow-up

and monitoring of patients on ARVs while considering and reviewing relevant local system issues. Ongoing

support will continue with telephone consultations after the four months. ECRTC will train and mentor 35

facilitators from 7 NGOs who will cascade the training of a comprehensive curriculum for community health

workers to include ART.

ECRTC training and mentoring will address data collection, maintaining accurate records, feedback and

usage through quality improvement cycles to address early presentation, follow-up of patients for

adherence, complications and pharmacovigilance.

Training of facility staff, a CBO and community health workers will emphasize follow-up and tracking

mothers from the PMTCT program to enable PCR screening, early detection and referral of children into the

care and treatment programs.

The primary objective of the project is sustainable, targeted human capacity development for the HCWs.

ECRTC staff will also continue to develop and improve their knowledge and skills by having weekly

academic discussions, attending relevant conferences and ongoing mentoring from local experts and

visiting experts through collaboration with partners I-TECH and the Owen Clinic.

Activity Narrative:

In the past twelve months with PEPFAR funds, ECRTC has developed protocols and models which have

been introduced in the province as new sites are supported for accreditation. More than 27 treatment sites

have been supported for accreditation and the ECRTC will continue to support accreditation of new sites in

FY 2008. A system of improvement cycles has been introduced. A pharmacovigilance program has been

piloted in two hospitals and nine clinics, which highlighted a number of complications as well as drug-related

problems, which will be addressed through the training and mentoring program.

This activity contributes to the PEPFAR objective 2-7-10 by increasing the capacity of the public sector to

effectively provide HIV care and treatment services. These activities are not at the site level but are more

system strengthening activities and constitute what is considered ‘indirect' support in the Eastern Cape

province. Therefore there are no direct targets for numbers of people reached.