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.
Years of mechanism: 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In late 2006, BroadReach Healthcare (BRHC) began capacity-building work with South African government
(SAG) sites, initially with four hospital systems in KwaZulu-Natal. As of June 2008, BRHC was reporting
data from 110 sites, including 11 hospitals, 62 private General Practitioner (GP) practices and 37 SAG
clinics. Almost 20,000 patients are receiving treatment, care and support services at BRHC-supported sites
as of 30 June 2008. At the request of a district Department of Health (DOH), BRHC has committed to
continued expansion and plans to be supporting 19 complete hospital systems by September 2009. With
FY 2009 funds, BRHC expects to be active at 250 sites, including 25 SAG hospital systems.
In FY 2009 BRHC will focus on the following enhancements:
SCALE UP OF DUAL THERAPY PMTCT: In FY 2009 BRHC will aim to scale up PMTCT significantly by
working with provincial and district DOH in line with the revised PMTCT policy (dual therapy). Dual therapy
has only been recently introduced in South Africa based on revised policy and guidelines. BRHC was one of
the first partner agencies asked to roll out training on dual therapy and training has been done in one sub-
district of Gauteng province for 92 health workers, primarily doctors and nurses.
ROUTINE OFFER OF COUNSELING AND TESTING, INFANT PCR AND IMPROVED LINKAGE AND
REFERAL: BRHC will continue to support the offering of group education sessions and routine offer of
counseling and rapid testing at the nearly 200 SAG sites supported by the organization. BRHC will also
support the roll out of re-testing of women who tested negative earlier in their pregnancy at 32 weeks.
Partner testing is encouraged and BRHC uses a number of health education modalities centered on a
family model of care to promote this (e.g., educational videos in local language, flip chart tools for small
group presentations, counseling sessions and community mobilization model).
An additional critical area of focus will be to increase coverage of infant polymerase chain reaction (PCR)
testing where currently the major bottleneck is training of nurses to perform the test. A key weakness of the
current system is that women are tested with relatively good coverage, however, there remains a systematic
gap in follow up and tracking between the hospitals (where delivery occurs) and the originating clinics that
referred them. For example, almost all HIV-infected women who deliver, receive a CD4 test at the hospital,
but the results tend to arrive after they have been discharged. These results typically accumulate at the
hospital and are not returned to the originating clinic which the mother will visit for subsequent follow up
maternal-child health (MCH) services and immunization. Furthermore, in addition to sub-optimal levels of
infant PCR (due to lack of training), it is systematically difficult to link a child born to an exposed mother to
the mother's medical record. Currently policy does not allow the mother's status to be reflected on the
baby's road-to-health card, which would allow the child to be identified as at risk and monitored during other
interactions with the health system like well-baby visits and immunization. BRHC, under its data
management initiative, will work to ensure that the mothers' and children's data is linked between hospitals
and clinics to effective referral both ways and subsequent follow-up of mothers and children in their local
clinics and communities. Treatment eligible women will be fast tracked into antiretroviral therapy (ART) at
whatever point in the patient flow that they are identified or captured.
CARE AND TREATMENT FOR WOMEN AND CHILDREN: A major area that BRHC is supporting is the
scale up of ART and care at hospitals and supporting clinics (through a down referral model). Within this
scale up, pregnant women and children are prioritized. This includes the provision of highly active
antiretroviral therapy (HAART) per national and new WHO guidelines for children, opportunistic infections
management, treatment of TB co-infection, cotrimoxazole prophylaxis, support for optimal feeding options
(promoting replacement feeding if acceptable, feasible, affordable, sustainable and safe (AFASS) or
exclusive breast-feeding) and improved linkages and referral to other child survival interventions such as
the Expanded Program on Immunization and nutritional and micro-nutrient support.
PREVENTION: BRHC has always emphasized prevention with HIV-infected clients and views treatment,
care and prevention as an inextricably linked and integrated package of services. Patient and client health
education will continue to be provided through the BRHC Information, Education and Communication
program (an area of key distinction for BRHC having developed the first treatment-related integrated
messaging to support HAART rollout in Botswana). This package includes education to encourage testing
for HIV, TB and sexually transmitted infections (STIs) (individual and partner testing), appropriate condom
use (male and female), importance of avoiding re-infection, provision of psychosocial support via facility-
based staff and community-based support groups and linkage/referral to and from services such as family
planning, STI clinic services and other MCH and primary care programs (e.g. IMCI).
COMMUNITY LINKAGES: BRHC is developing a signature community mobilization program through which
a large array of community- and home-based services will be delivered, monitored and reported. In each
geographical area where BRHC works, the community mobilization program will be the vehicle through
which the defined care package will be delivered and home- and community-based follow-up and patient
tracking and monitoring accomplished. The aim of this model will be to ensure that every single patient can
be reached reproducibly through defined and stereotyped channels. This will involve non-governmental and
community, local leader and traditional healer partnerships. BRHC has already pioneered a model whereby
Community Support Organizations such as churches are formally capacitated to serve as an extension of
the care team and to assist in monitoring and provision of support for patients at community and home level.
BRHC will be extending this model across new high potential partners to provide comprehensive community
coverage. A critical function of the community model will be to provide referral and linkage services to and
from other critical social welfare services (e.g., Department of Social Development programs, income
generation projects, gender and legal support services, etc.).
HEALTH SYSTEMS STRENGTHENING: As mentioned, BRHC approaches prevention, treatment and care
in an integrated fashion. In this regard, BRHC has been strengthening health systems through key initiatives
such as augmenting Department of Health staff and infrastructure (across all cadres), training (didactic and
mentorship, including training on rapid tests and infant PCR), strengthening data management and
Activity Narrative: monitoring, evaluation and reporting systems, and providing management and leadership training at
national, provincial, district and health facility level. BRHC is also leading the development of a centralized
disease control and monitoring hub for the country of South Africa (and ultimately the region) through a
separate project with Virgin Unite and the National Department of Health.
-------------------------------
SUMMARY:
BroadReach Healthcare (BRHC) supports integrated ARV services that include PMTCT, doctor
consultations, lab testing, adherence support, patient counseling, remote decision support, quality
assurance (QA), and data management. The main emphasis area is capacity building, with minor emphasis
on strategic information and human capacity development (training). The primary target population is
pregnant women.
BACKGROUND:
PEPFAR funds support BRHC initiatives that provide HIV and AIDS clinical management, care and support
services to HIV-infected individuals in areas where the SAG rollout has not yet been implemented and
assists ART rollout in the public sector. The BRHC PEPFAR program began in May 2005 and now operates
across 5 provinces. BRHC is supporting approximately 5000 individuals directly with care and treatment and
15,000 indirectly. BRHC taps private sector health professionals to provide comprehensive care and
treatment, fostering capacity-building initiatives within the public health system, and supporting community-
based programs. BRHC leverages PLHIV support programs to identify and assist with treatment literacy,
adherence support and ongoing community mobilization, prevention education activities, and positive living
initiatives. BRHC also works to build capacity in public health facilities, focusing efforts on human capacity
development (HCD) activities, including clinical didactic training, clinical mentorships, patient training and
operational assistance training. BRHC is expanding its provision of staff and infrastructure support to SAG
facilities. Finally, BRHC is expanding its involvement in the design of scaleable down referral models in
partnership with faith-based organizations (FBOs), community-based organizations (CBOs), and public-
private partnerships (PPPs).
ACTIVITIES AND EXPECTED RESULTS:
To ensure that patients are armed with accurate and practical HIV prevention strategies, BRHC will carry
out the following activities:
ACTIVITY 1: Clinical Services
BRHC patients will be treated in accordance with national guidelines by ensuring that all elements for
effective treatment are provided in a coordinated manner. Patients see doctors regularly, and will receive
laboratory tests, HIV and AIDS education (complete with prevention messages), management of sexually
transmitted infections (STIs), adherence support, counseling, cotrimoxazole prophylaxis and linkage to
other support and wellness services. Pregnant women identified through the BRHC program and partner
sites will be offered PMTCT services in line with SAG guidelines. PMTCT services include counseling and
testing (see subsequent activity); counseling and support for maternal and infant nutrition; access to ARV
treatment and safe infant feeding practices. Linkages will be made to pediatric treatment. At each facility a
"tracer" will be employed full time to ensure that appointments are kept, opportunistic infections are treated,
CD4 counts monitored and referrals completed.
ACTIVITY 2: Human Capacity Development (HCD)
BRHC will provide comprehensive HIV and AIDS training that includes PMTCT to its network of providers
including doctors, nurses, pharmacists and other healthcare professionals through a variety of initiatives
including remote decision support, telemedicine, web-based training, didactic training, and clinical
mentoring from experienced clinicians. Comprehensive HIV and AIDS training for health professionals
includes prevention and management of sexually transmitted infections, PMTC, ART management,
tuberculosis (TB), adherence, management of complications and side-effects, and pediatric HIV
management. BRHC will continue to train patients and support group facilitators on topics including
prevention and PMTCT, HIV and AIDS, ART, adherence, living positively, and accessing psychosocial
support in communities.
ACTIVITY 3: Counseling and Testing
BRHC will work with partner sites to ensure that pregnant women are counseled and tested for HIV, and
offered access to PMTCT. This will be done by both private general practitioners who are in the BRHC
network and at the government facilities where BRHC works.
ACTIVITY 4: Support to SAG
BRHC will conduct an initial needs assessment at each SAG partner facility. The assessments will identify
problems that impact overall capacity and efficiency. Solutions for each institution include recruitment and
salary support for doctors, nurses, and pharmacy staff. BRHC general practitioners provide part-time
services at SAG facilities, and train SAG staff in HIV care and treatment and related management. Other
support may include infrastructure, such as refurbishment, equipment and supplies procurement. This will
also include strengthening linkages between essential HIV support services such as PMTCT to ensure clear
referral procedures, patient tracking, and reporting of intervention results.
These activities directly contribute to the PEPFAR 2-7-10 goals by attempting to prevent new infections
among infants.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13700
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13700 13700.08 U.S. Agency for Broadreach 6576 416.08 $824,500
International
Development
Emphasis Areas
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $40,711
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $3,884
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In FY 2009, funding is requested to maintain and build on activities described in the FY 2008 COP.
BroadReach Healthcare (BRHC's) approach will be to strengthen prevention within the scope of its existing
programs and activities by selecting appropriate and targeted messages to deliver sustained behavior
change. Selected interventions with general populations outside of treatment settings will be undertaken to
address clear gaps and needs in prevention programming in the catchment areas of BRHC sites.
BRHC approaches all of its work with the concept of developing scalable solutions which can help to bolster
the South African Government's (SAGs) HIV/AIDS efforts across the country. To do this, BRHC breaks
down the problem into demand-side and supply-side. Demand-side addresses the patients and
communities to ensure that solutions are in place to mobilize, generate demand for testing, provide
education including treatment literacy, provide ongoing adherence and psychosocial support to PLHIV and
the affected/unaffected community members. BRHC generally does this by training and capacitating
community organizations such as PLHIV support groups, faith-based organizations (FBOs), non-
governmental organizations (NGOs) and SAG facilities to carry out these activities. The supply-side
addresses the provider of services such as hospitals, clinics, healthcare workers, labs, pharmacies, etc. and
focuses on solutions such as training, service delivery integration and re-engineering, operations
improvement, equipment and infrastructure upgrade, etc. The goal is to build capacity in a scaleable way to
address the demand for HIV/AIDS services. It is BRHC's philosophy that solutions cannot be scalable if
they do not address both demand and supply sides and work to balance both.
ACTIVITY 1: Prevention Training (HCD)
Training in the provision of other sexual prevention services will be extended to community-based
organizations (CBOs), NGOs and community health workers in the catchments areas of BRHC-supported
SAG sites. Training will aim to alleviate capacity building and human resource constraints faced by the local
NGOs, CBOs and community health workers with which BRHC builds partnerships.
ACTIVITY 2: Strategic Prevention Partnerships with SAG and NGOs/CBOs
BHRC will partner with district and provincial Directorates of Health Promotion, Directorates of Social
Mobilization and HIV/AIDS/STI/TB (HAST) units to support and strengthen existing prevention programs in
the districts where BRHC supports SAG sites in the provision of antiretroviral (ARV) treatment. Technical
assistance will be provided to ensure coordinated, multi-level prevention programming is provided at the
scale and intensity required to achieve behavioral objectives in specific populations. Building capacity to
design, implement, monitor and evaluate comprehensive prevention programming will lead to sustainable
programming. Before launching new prevention initiatives or developing new materials, BRHC will conduct
a thorough review of materials and activities already at local, provincial and national levels. BRHC will also
ensure any interventions are evidenced-based, draw on best practices in South Africa and the region, and
are consistent with the latest epidemiological evidence of the drivers of HIV transmission in that
geographical area. Formative assessments and situational analysis will be used to identify any missing data
on local context. We will provide added value by identifying gaps (geographical, target population, technical,
human resource) and filling them through partnership building and technical assistance.
Community health workers (lay and volunteer) present an ideal opportunity to bring prevention messages
and materials directly into the home, while also providing a direct linkage to screening for HIV and
tuberculosis (TB). BRHC will coordinate with local NGOs and CBOs to provide the deep penetration and
coverage of prevention messaging in critical areas. Finally, BRHC will assist NGO and CBO programs to
standardize prevention messages and align local activities with national mass-media campaigns and
education programs.
BRHC is launching a new large scale comprehensive community mobilization program within which
provision and support of wellness at community level is the key priority. Prevention will be a central tenet of
this model. This model will be scaled up through new programs such as workplace, door to door campaigns,
engagement of local traditional leadership and traditional healers, improved referral systems for social
welfare services and partnering with local agencies to jointly provide as comprehensive a set of care
interventions as possible. The community mobilization model will become the large scale distribution
platform for an array of prevention programs now aimed at the general public that BRHC is in the process of
developing.
Under the above described programs BRHC will continue production and dissemination of existing IEC
materials including condom leaflets, patient education videos and patient education flipcharts. The patient
education videos and flipcharts include various prevention messages within the context of comprehensive
care and treatment services. Messages emphasize the important of testing and disclosure, couples
counseling and testing, prevention messages for positive people and sero-discordant couples and positive
living.
BRHC is currently embarking on an evaluation of risk perceptions and vulnerabilities of our current
constituents to guide us in determining new, innovative and impactful prevention interventions that actually
work. These will be scaled up and continuously evaluated for efficacy. BRHC has also been requested by
North West province to assist them in developing and rolling out a prevention strategy for their high risk
populations and this will be a signature initiative in FY 2009.
Activity 3: Condom Distribution
Activity Narrative: Increasing condom availability and condom distribution networks will be an important component of all
BRHC other sexual prevention activities. Condom distribution will be coupled with comprehensive
prevention messages (ABC), and education on correct and consistent condom use as a method of
preventing HIV infection. BRHC will work with SAG sites and distribution centers to ensure a consistent
supply of quality condoms, addressing issues of proper handling and storage where necessary. Community
mobilization activities involve male and female condom demonstrations, and involve the dissemination of
informational materials on proper condom use.
Activity 4: Prevention Integration
In FY 2009 prevention integration activities will be expanded to include other departments and hospital
wards including ante-natal clinics, inpatient medical wards, TB clinics, and maternal and child health
services. Prevention messages will be culturally appropriate and address the risks of multiple, concurrent
partnerships and abuse of alcohol and drugs. Women in their twenties will also be targeted for messages
around transactional and cross-generational sex. New prevention messages will be developed to assist
patients who have been successful on treatment for a long period of time to prevent complacency. BRHC
will use quality assurance/quality improvement methodologies to monitor the consistency and accuracy with
which prevention messages are integrated into clinical encounters. Activities will also include referrals for
counseling and testing and for the diagnosis and treatment of sexually transmitted infections.
--------------------
BroadReach Healthcare (BRHC) supports integrated ARV services that include doctor consultations, lab
testing, adherence support, patient counseling, prevention, remote decision support, quality assurance
(QA), and data management. BRHC's emphasis areas are capacity building (major); with minor emphasis
on strategic information and human capacity development (training). Primary target populations include
adolescents, adults, and people living with HIV.
The BRHC PEPFAR program began in May 2005 and now operates across five provinces. BRHC is
currently supporting approximately 5000 individuals directly with care and treatment and 15,000 indirectly.
Prevention is a new activity area for BRHC. BRHC will endeavor to understand SAG priorities around
prevention, including those articulated in the new National Strategic Plan (NSP), and formulate site-specific
prevention plans that reflect SAG priorities and facility needs. BRHC prevention activities will take two
forms: first, as stand alone prevention interventions; and second, as integrated interventions within BRHC
treatment program activities. In response to site specific needs, BRHC prevention activities will support
ongoing prevention activities within SAG facilities, as well as support new initiatives that fill gaps in
prevention priorities identified by the site and SAG guidelines.
BRHC will provide HIV and AIDS prevention training to its network of healthcare providers including doctors,
nurses, pharmacists and other healthcare professionals, as well as public sector health professionals at its
partner sites through a variety of initiatives including remote clinical decision support, telemedicine, web-
based training, didactic training, and clinical mentoring from experienced clinicians. More specifically, the
topic of HIV prevention is covered in the three day training for Nurses and Lay Counselors; in the five day
University of KwaZulu-Natal training for Professional Nurses; the 10 module HIV/AIDS Clinical Training
online course for Doctors; and the 1-3 day HIV Treatment Literacy training for ARV Coordinators and
Counselors. In addition BRHC will integrate a prevention module into the one day quarterly Adherence
Training for BRHC patients.
ACTIVITY 2: Strategic Prevention Partnerships (Outreach)
BRHC will form strategic partnerships with local CBOs and FBOs and companies that are actively engaged
in prevention activities in the BRHC catchment area in order to support existing activities that are aligned
with SAG policy, and to help create new programs should any gaps exist. Support to CBOs/FBOs may
include provision of resources to support approved prevention activities (human resources, funds,
equipment). BRHC will also leverage these strategic partnerships for condom distribution and educational
materials on the proper use of condoms.
ACTIVITY 3: Condom Distribution
BRHC will distribute condoms and materials on proper condom use through a variety of channels.
Distribution channels will include GP offices (~50 outlets); public sector hospitals and affiliated clinics (~100
sites); and through the BRHC IEC program to patient support groups (~10). As stated previously, BRHC will
also provide condoms to partner CBOs/FBOs that are active in prevention activities in the community. The
BRHC IEC team will run prevention outreach campaigns to local companies and engage them in prevention
activities such as the distribution of condoms and prevention messages to employees.
ACTIVITY 4: Prevention Integration
BRHC will integrate prevention activities and messages into its treatment program activities. This will be
Activity Narrative: accomplished in two principle areas: 1) Prevention with Positives (PwP) in the Clinical Setting; and 2)
Prevention in the Counseling Setting. PwP activities will be coordinated through BRHC public sector sites
and GP offices, and will involve the distribution of targeted prevention messages [printed materials] for HIV-
infected individuals by the BRHC IEC team; prevention education sessions for patients, buddies and family
members conducted by the BRHC IEC team; and condom distribution at all clinical service outlets. Second,
BRHC will also utilize the CT setting to distribute targeted prevention materials [printed materials] and will
review counseling guidelines to ensure that prevention messages are delivered during counseling sessions.
This will be made available at all sites where BRHC supported CT services are offered. Condoms will also
be supplied and made available to individuals undergoing counseling and testing services.
These activities directly contribute to the PEPFAR 2-7-10 goals by attempting to prevent new infections.
Continuing Activity: 13699
13699 13699.08 U.S. Agency for Broadreach 6576 416.08 $776,000
Estimated amount of funding that is planned for Human Capacity Development $66,552
Table 3.3.03:
In FY 2009, BroadReach Health Care (BRHC) will expand on and strengthen existing capacity building
activities all conducted at the request of and in partnership with the South African Government (SAG). The
FY 2008 narrative primarily describes activities under BRHC's general practitioner (GP) program with
private providers which offers services to HIV-infected persons through three different treatment models.
This program was designed to ease the burden on the public sector to provide treatment services by
strategically leveraging capacity in the private sector in underserved areas. The GP program will be
maintained in FY 2009, but the majority of funding requested under this program area will be for the
intensification of BRHC's program to build capacity in public sector (SAG) health facilities. All proposed
activities will be aligned with the National Strategic Plan (NSP), national antiretroviral (ARV) guidelines and
other national guidelines governing care and treatment of HIV-infected and affected people. BRHC's overall
goal under this program area is to promote creative, sustainable and comprehensive treatment programs
that improve the quality of life of people living with HIV (PLHIV) and increase resilience in the public health
care system.
In late 2006, BRHC began capacity building work with SAG sites and was initially assigned to four hospital
systems in KwaZulu-Natal (KZN). As of June 2008, BRHC was reporting data from a total of 110 sites in five
provinces. Almost 20,000 patients are receiving treatment, care and support services at BRHC-supported
sites as of 30 June 2008 which exceeds the September 2008 target by nearly 250%. At the request of the
district DOH, BRHC has committed to continued expansion and plans to be supporting 19 complete hospital
systems by September 2009. With FY 2009 funds, BRHC expects to be active at 250 palliative care sites,
including 25 SAG hospital systems.
Activity 1: Clinical Services and Operations
BRHC will place particular emphasis this year on expanding wellness programs for HIV-infected people not
yet eligible for ART, and their family members. The goal will be to ensure early referral and enrollment into
comprehensive care programs to maintain CD4 >200, and to reduce loss to initiation. 'Wellness programs
will provide a basic care package, consisting at a minimum of: repeat CD4 testing per national guidelines,
cotrim prophylaxis, screening and treatment for opportunistic infections (OIs), ongoing counseling and
psychosocial support, nutritional assessment and supplementation, pain assessment, and prevention
messages as part of routine care. Wellness programs will also provide necessary referrals to other health
services such as reproductive health, family planning, immunization, and routine-offer HIV testing. BRHC
support to facilities will focus heavily on integration of TB and HIV services.
Activity 2: Human Capacity Development
BRHC provides a combination of in-house and outsourced training courses aimed at ensuring quality
delivery of treatment services. Alignment with SAG training plans and service providers ensures training is
provided with the appropriate intensity to all cadres of staff. All BRHC-implemented or sponsored training
courses use DOH-approved curricula. Training will emphasize provision of cotrim prophylaxis, pain
assessment/mgmt and nutritional assessment and counseling. BRHC will engage additional qualified
clinical mentors and preceptors to ensure supportive supervision within the work setting. BRHC will continue
to provide salary support to SAG for clinical and lay staff on a temporary basis to fill critical vacancies.
Activity 3: Referrals and Linkages across the Health System and Community
BRHC assists each site it supports to strengthen or develop active defaulter tracing programs for HIV-
infected patients by providing technical assistance, personnel and transportation solutions as required.
Defaulter tracing models are built on best practices and adapted to the individual needs of a particular
health system. In most areas where BRHC works, BRHC's site includes an entire health system, which
allows for the creation and testing of scaleable approaches to patient tracing across large, rural
geographical areas.
BRHC takes a family-centered approach to providing comprehensive care and treatment services and will
intensify efforts in this area to build HIV and AIDS-competent communities. In FY 2009, BRHC will expand
partnerships with non-governmental organizations (NGOs) and community-based organizations (CBOs) to
ensure uninterrupted service delivery and community-level support for PLHIV and their families. Training,
institutional strengthening, monitoring and evaluation (M&E) and other technical assistance and HR support
will be provided to NGOs/CBOs to enable them to meet the demand for community-based services for care
and support, especially those organizations specializing in HBC. Community-based services will extend and
complement facility-based services by: addressing issues of water, sanitation and hygiene; providing
linkages to wrap around programs (particularly food and nutrition programs), provide consistent prevention
messages; spiritual support; and assistance in accessing social grants. BRHC will play a critical role in
providing coordination between SAG facilities and communities, creating sustainable coordination
mechanisms and mutually beneficial partnerships. The goal is to furthermore ensure coordination and
referral mechanisms are in place such that patients are able to navigate the health and social welfare
systems successfully, and that facilities are able to track and locate patients at any time throughout this
process. Linkages with family planning, maternal and child health, gender-based violence, Directly
Observed Treatment, Short-course (DOTS) and nutrition programs will be strengthened.
BroadReach Health Care (BRHC) activities include doctor consultations, lab testing, adherence support,
patient counseling, remote decision support, quality assurance monitoring, training for both patients and
health professionals, support groups and data management. Basic Care and Support activities are in
support of individuals participating in an antiretroviral therapy (ART) program, largely representing the
population of those HIV-infected, but not yet eligible for ART. The major emphasis is on human resources
with minor emphasis on quality assurance and training. These emphasis areas are realized through clinical
and non-clinical services, human capacity development, quality assurance, referrals and linkages and South
Activity Narrative: African Government (SAG) support including meeting equipment, infrastructure and human resource needs.
Primary target populations include people living with HIV and AIDS (PLHIV) and their families/households,
program managers, public and private doctors, nurses, laboratory workers, pharmacists, other health care
workers, the business community/private sector, CBOs, FBOs, and NGOs.
PEPFAR funds support BRHC initiatives which provide HIV and AIDS clinical management, care and
support services to HIV-infected, uninsured individuals in public sector government facilities and areas
where the SAG ART roll-out has not yet reached or where there is high demand. The BRHC PEPFAR
program began in May 2005 and now operates in 15 communities across five provinces. Today, BRHC is
supporting approximately 3,500 individuals directly with care and treatment and 15,000 indirectly. The
BRHC mission is to tap into private sector health professionals to provide comprehensive care and
treatment, fostering capacity building initiatives and service delivery within the public health system, and
partnering with and supporting community-based programs with sustainable impact on long-term patient
care. BRHC leverages the community-based PLHIV support programs to identify and assist with treatment
literacy, adherence support and ongoing community mobilization, prevention education activities, and
positive living initiatives. In addition, BRHC works to build capacity in public health facilities, focusing on
human capacity development including clinical training, clinical mentorships, patient training and operational
assistance training. BRHC is expanding its provision of additional staff and infrastructure support to SAG
partnership with FBOs, CBOs, and as a partner in innovative public-private partnerships (PPPs).
The primary goal of this program area is to ensure that new patients are started on ART when clinically
qualified and enrolled patients continue to receive outstanding care and support.
BRHC patients will be treated in accordance with SAG ARV National Guidelines and provided regular
doctor visits, laboratory tests, HIV and AIDS education, counseling, TB screening, and cotrimoxazole
prophylaxis. Using a family-centered approach, BRHC will recruit eligible family members of HIV-infected
patients - including greater numbers of men and children - in order to improve the health of
families/households and facilitate family doctor visits and drug pick ups. Care includes the preventive
package, symptom and pain management, a care support program (during the time from when a patient
finds out his or her HIV-infected status until eligible for ART), are care during and after the initiation and
possibly failure of ART. Patient nutrition and wellness needs will be met by the provision of multivitamin
supplements, and doctor, patient and facilitator training in nutrition.
ACTIVITY 2: Human Capacity Development
1) BRHC will continue to provide training to its network of providers including doctors, nurses, pharmacists
and other healthcare professionals through a variety of initiatives including remote decision support,
telemedicine, web-based training, didactic training, and clinical mentoring from experienced HIV and AIDS
clinicians. Comprehensive HIV and AIDS training for health professionals includes ART Management, TB,
adherence support, management of complications and side-effects, prevention and pediatric HIV
management.
2) BRHC will continue to focus on community training on topics including HIV and AIDS, ART, adherence
support, living positively and prevention with positives, universal precautions and accessing psychosocial
support in communities. BRHC will continue to train support group facilitators on topics including HIV and
AIDS, ART, adherence, disclosure, and linking patients with psychosocial services in the community.
ACTIVITY 3: Support to SAG
BRHC will support capacity development for care and support services at partner SAG facilities. According
to SAG articulated needs, these services will include commodity procurement, healthcare financing, human
resource recruitment and salary support (for doctors, nurses, pharmacy staff etc.), BRHC doctors providing
temporary services at SAG facilities, training of SAG staff in HIV care and treatment and/or ART program
management, and physical infrastructure building/refurbishment and equipment procurement. BRHC will
work with SAG staff to improve operational efficiency in SAG facilities through needs assessments including
identification of key bottlenecks and then generate and implement solutions. Additionally, BRHC will support
SAG National Department of Health (NDOH) efforts, by assisting with development of down referral models.
Finally, BRHC will build on its existing public-private (PPP) model (SAG - BRHC - Daimler Chrysler) in East
London and develop new PPPs to further involve small to medium enterprises in supporting employees and
dependents in the communities where they operate, alleviating some of the burden on government services.
ACTIVITY 4: Referrals and Linkages
Development of linkages and referral systems will be provided through strengthened referral networks
between the public and private sectors (including referring stable patients back to the SAG ARV program),
assistance to local clinics to facilitate SAG down referral process. Finally, BRHC will continue to expand its
community-based linkages with CBOs in order to refer patients in need of non-USG funded food parcels
and other wraparound services intended to support patients.
ACTIVITY 5: Quality Assurance/Quality Improvement (QA/QI):
Recognizing the critical role of monitoring and evaluation in ensuring a successful program, BRHC QA/QI
activities include regular internal data and systems audits, collection of patient level surveillance data,
Activity Narrative: exception reports, doctor-specific feedback report, and doctor decision-making support. The BRHC
adherence program monitors and evaluates patient adherence through monitoring of drug pick up
information, clinical reports, self-reported adherence, and pill counts.
All BRHC activities articulated in the FY 2007 COP will be scaled up significantly in FY 2008 through its
partnerships with 15 SAG hospital systems (which include hospitals and affiliated CHCs and PHCs).
With FY 2008 funding, BRHC's palliative care activities will be expanded and enhanced as follows:
-BRHC will continue to support QA/QI at each of its public sector partner hospitals through QA
assessments, systems re-engineering, and the development of reporting systems that provide program
management feedback that is used to improve program performance and more closely monitor patient care.
-Strengthen down referral activities between public sector hospital partners and their affiliated clinics
(PHCs) by re-engineering referral processes, improved data management and patient tracking, and training.
-Training for health professionals at all public sector sites (hospitals and PHCs)
-HIV and AIDS Literacy training for patients as part of community mobilization
-Expanded care and treatment activities through the BRHC PPP to additional Daimler Chrysler supply chain
companies/employees and their families and communities.
-Staff augmentation: BRHC will provide additional salary support to fill key positions within SAG partner
hospital sites. BRHC will also work with the site to motivate for the creation of permanent posts where
needed and ensure that BRHC/PEPFAR supported staff are incorporated into subsequent site budgets to
ensure a sustainable staffing solution
BRHC Basic Healthcare and Support activities directly contribute to the 2-7-10 objectives of supporting 10
million people with basic healthcare and support by expanding these services in South Africa.
Continuing Activity: 13693
13693 3007.08 U.S. Agency for Broadreach 6576 416.08 $1,000,000
7511 3007.07 U.S. Agency for Broadreach 4449 416.07 $800,000
3007 3007.06 U.S. Agency for Broadreach 2663 416.06 $751,000
Estimated amount of funding that is planned for Human Capacity Development $323,876
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $100,401
Table 3.3.08:
In FY 2009, BroadReach Health Care (BRHC) will expand capacity building activities all conducted at the
request of and in partnership with the South African Government (SAG). The FY 2008 narrative primarily
describes activities under BRHC's general practitioner (GP) program with private providers which offers
services to HIV-infected persons through three different treatment models. The GP program will be
maintained, but the majority of funding for this program area will be for the intensification of BRHC's
program to build capacity in SAG facilities. All proposed activities will be aligned with the National Strategic
Plan (NSP), national ARV guidelines and other national guidelines governing the care and treatment of HIV-
infected people.
Activity 1: Clinical Services
The majority of BRHC support for accreditation has been aimed at district and regional hospitals. In FY
2008 and increasingly in FY 2009, BRHC support for accreditation will shift from hospitals to community
health centers (CHCs) and primary health clinics (PHCs) where in line with district/provincial priorities for
ART roll-out. Other support for accreditation includes human resources, training, equipment, refurbishment
or creation/expansion of space. BRHC will continue to prioritize down referral as a solution to bottlenecks
and overcrowding at hospital initiating sites. BRHC takes a holistic approach to down referral, viewing an
initiating site and all PHCs as part of one interdependent health system supported by a single information
system.
BRHC will employ both facility and community-level approaches to improving the integration of services and
referral systems within facilities. The goal is to ensure that at whatever point a patient accesses the health
care system (outpatient departments, in patient wards, mobile counseling and testing (CT), antenatal care
(ANC), TB clinic, community health workers, home-based care) that a comprehensive package of
prevention, care and treatment services are made available to that patient and family and household
members. These services will include cotrimoxazole prophylaxis, targeted prevention messages, nutritional
counseling, micronutrient supplementation, and routine offer and provider initiated CT. Linkages with family
planning, maternal and child health, gender-based violence, directly-observed treatment, short course
(DOTS) and nutrition programs will be strengthened.
BRHC support to facilities will focus heavily on integration of TB and HIV services, where routine offer of CT
of HIV patients for TB, and of TB patients for HIV is provided in accordance with national guidelines.
Importance will be placed on infection control measures in health facilities and in the home and community.
BRHC will build on existing DOTS infrastructure, programs and personnel to assist with smooth integration
of TB and HIV services.
BRHC's program will include strategic support for strengthening of supply chain for lab and pharmacy as
appropriate, and may involve partnership with other PEPFAR partners with this expertise. BRHC engages
with the National Health Laboratory System (NHLS) at both facility and district levels to improve systems for
collection and transportation of lab tests. Assistance to pharmacy is provided in the form of HR and
streamlining of dispensing and drug delivery processes, particularly in down referral settings. All ARVs used
at BRHC-supported SAG facilities are procured through SAG.
Activity 2: Human Capacity Development (HCD)
HCD activities will focus on creative problem solving to expand access to comprehensive and integrated
treatment services at lower level facilities. Approaches will include training, operations and mentoring
support to shift tasks such as treatment initiation and ARV prescription renewals from doctors to nurses.
BRHC will review existing best practices before designing new approaches, and use monitoring and
evaluation (M&E) of HCD interventions to inform strategies for scale-up.
delivery of services in the SAG facilities it supports. Training workplans are designed in cooperation with
district/provincial authorities and are harmonized to address gaps and increase training volume and
coverage. All BRHC implemented/sponsored training courses use nationally certified or DOH-approved
curricula. BRHC will engage additional qualified clinical mentors and preceptors to ensure supportive
supervision within the work setting.
BRHC provides salary support to SAG staff on a temporary basis to fill critical vacancies. This support will
be coupled with budgeting and planning technical assistance (TA) to assist SAG to take over full support of
these staff in future budget cycles. BRHC will explore innovative strategies for ensuring retention of health
workers, maintaining a healthy and productive workforce, and optimizing workstreams.
Activity 3: Referrals and Linkages
BRHC assists each site to strengthen or develop active defaulter tracing programs by providing TA,
personnel and transportation solutions as required. Defaulter tracing models are built on best practices and
adapted to the individual needs of a particular health system. In most areas where BRHC works, BRHC's
site includes an entire health system, which allows for the creation and testing of scaleable approaches to
patient tracing across large geographical areas. BRHC takes a family-centered approach to providing
comprehensive care and treatment services and will intensify efforts in this area to build HIV and AIDS-
competent communities. BRHC will expand partnerships with non-governmental organizations (NGOs) and
community-based organizations in the catchment areas of BRHC sites to ensure uninterrupted service
delivery and community-level support for people living with HIV (PLHIV) and their families. Training,
institutional strengthening, M&E and other TA will be provided to NGOs/community-based organizations
(CBOs) to enable them to meet the demand for community-based services. BRHC will help coordination
between SAG facilities and communities.
Activity 4: Information systems/M&E/Quality Assurance & Quality Improvement (QA/QI)
In anticipation of SAG decisions-mandating software, BRHC aims to provide temporary solutions that
improve the ability of sites to meet SAG reporting requirements. Information systems build on existing paper
Activity Narrative: -based and register systems, providing added value by improving data quality and information use. BRHC
will expand systematic QA/QI approaches across all sites to promote consistent quality of care for all HIV-
infected and affected people who seek services in the public sector, and to provide ongoing monitoring and
support of training that has been provided. BRHC will focus on the use of patient treatment outcomes,
especially viral load suppression, patient retention, and patient adherence, to monitor the progress and
quality of programs.
-------------------------
BroadReach Healthcare's (BRHC) antiretroviral (ARV) services activities include training for health
professionals, management support, laboratory support, quality assurance, and community outreach.
BRHC's emphasis areas are human capacity development, local organization capacity building, and
strategic information. Primary target populations include children, adolescents, adults, pregnant women,
and people living with HIV (PLHIV).
across 5 provinces. Activities will expand to a sixth province in FY 2008. BRHC is supporting approximately
5000 individuals directly with care and treatment and 15,000 indirectly. BRHC taps private sector health
professionals to provide comprehensive care and treatment, fostering capacity-building initiatives within the
public health system, and supporting community-based programs. BRHC leverages PLHIV support
programs to identify and assist with treatment literacy, adherence support and ongoing community
mobilization, prevention education activities, and positive living initiatives. BRHC also works to build
capacity in public health facilities, focusing efforts on human capacity development (HCD) activities,
including clinical didactic training, clinical mentorships, patient training and operational assistance training.
BRHC is expanding its provision of staff and infrastructure support to SAG facilities. Finally, BRHC is
expanding its involvement in the design of scaleable down referral models in partnership with faith-based
organizations (FBOs), community-based organizations (CBOs), and public-private partnerships (PPPs).
To ensure that new patients are started on ART when clinically qualified and enrolled patients continue to
receive quality care and support, BRHC will carry out the following activities:
effective treatment are provided in a coordinated manner. This includes addressing issues of human
resources, provision of technical expertise, training, information, education and communication (IEC),
community mobilization, laboratory and testing, drug logistics, equipment and supplies, physical space,
M&E, and other cross-cutting support functions such as budgeting, finance, policy, and planning support.
Patients see doctors regularly, and will receive laboratory tests, HIV and AIDS education, adherence
support, counseling, cotrimoxazole prophylaxis and linkage to other support and wellness (including
prevention) services. Patient nutrition and wellness needs will be assisted by local FBOs and NGOs (e.g.
food parcels). BRHC supports patients through the private sector until those patients can access treatment
through public services. BRHC continues to expand its support to strengthening services in the public
sector.
BRHC will provide comprehensive HIV and AIDS training to its network of providers including doctors,
nurses, pharmacists and other healthcare professionals through a variety of initiatives including remote
decision support, telemedicine, web-based training, didactic training, and clinical mentoring from
experienced clinicians. Comprehensive HIV and AIDS training for health professionals include ART
management, tuberculosis (TB), adherence, management of complications and side-effects, prevention,
and pediatric HIV management. BRHC human capacity development activities, such as training and clinical
mentoring, will also take place within SAG facilities. BRHC will continue to train patients and support group
facilitators on topics including HIV and AIDS, ART, adherence, living positively, and accessing psychosocial
support in communities. The BRHC adherence program supports patients by providing features such as
treatment buddies, support groups, cell phone message reminders, a patient call center and adherence
counseling.
BRHC will conduct an initial needs assessment at each new SAG partner facility. The assessments will
identify problems that impact overall capacity and efficiency. Solutions for each institution include
recruitment and salary support for doctors, nurses, and pharmacy staff. BRHC will also work with the site to
motivate for the creation of permanent posts where needed and ensure that BRHC/PEPFAR supported staff
are incorporated into subsequent site budgets to ensure a sustainable staffing solution. BRHC general
practitioners provide part-time services at SAG facilities, and train SAG staff in HIV care and treatment and
related management. Other support may include infrastructure, such as refurbishment, equipment and
supplies procurement. Finally, BRHC will build on its existing public-private partnership (PPP) model with
SAG and Daimler Chrysler in East London and develop new PPPs to further involve private companies in
supporting small business employees and dependents in communities where they operate.
Activity Narrative: Support systems for treatment will be provided by strengthening referral networks between the public and
private sectors, including referring stable patients back to the SAG ARV program, and support to local
clinics to facilitate SAG up and down referral. Finally, BRHC will continue to expand its linkages with CBOs
in order to refer patients in need of food and other community services.
ACTIVITY 5: Quality Assurance/Quality Improvement (QA/QI)
Recognizing the critical role of M&E in a successful treatment program, BRHC QA/QI activities include
regular internal data and systems audits, collection of patient-level surveillance data, exception reports,
doctor-specific feedback report, and doctor decision-making support. The BRHC adherence program
monitors patient adherence through monitoring of drug pick-up information, clinical reports, self-reported
adherence, and pill counts. BRHC will also work with SAG facilities to improve data management and
medical records systems.
ACTIVITY 6: Pediatric care and treatment
BRHC will expand pediatric enrollment using a family-centered approach. BRHC will encourage testing of
families/households, using patients already enrolled in the BRHC program as the index case and point of
entry into the household. By recruiting eligible family members, BRHC will enroll greater numbers, including
children, into the program. Finally, the family-centered approach will allow BRHC to link an entire household
to a single doctor in order to facilitate doctor visits and drug pick ups.
partnerships with 15 SAG hospital systems (which include hospitals and affiliated community health centers
(CHC) and primary health care clinics (PHCs).
All of the above activities will serve to greatly enhance sites' ability to enroll significantly greater numbers of
patients onto ARV treatment.
These activities directly contribute to the PEPFAR 2-7-10 goals by increasing the number of people
receiving ARVs, improving access to HIV services, and increasing the capacity of local organizations.
Continuing Activity: 13697
13697 3006.08 U.S. Agency for Broadreach 6576 416.08 $14,326,000
7510 3006.07 U.S. Agency for Broadreach 4449 416.07 $9,200,000
3006 3006.06 U.S. Agency for Broadreach 2663 416.06 $3,600,000
Estimated amount of funding that is planned for Human Capacity Development $1,270,998
Table 3.3.09:
FY 2008 COP activities will be expanded to include:
-Infants and children by strengthening linkages with existing services;
-Increase routine offer and provider-initiated testing to identify HIV-infected children;
-Expanding wellness programs for HIV-infected infants and children not yet eligible for ART;
-Employing a pediatric AIDS care and treatment specialist who will ensure integration of pediatric initiatives
across all BroadReach Healthcare (BRHC) PEPFAR-funded activities; and
-Strengthening of care and treatment programs for children and their families in Khayelitsha, the largest
township in Cape Town.
BRHC's pediatric care and treatment activities include training and salary support for health professionals,
management support, quality assurance, operations support, strategic communications, and community
outreach to increase the number of children on anti-retroviral therapy (ART) on BRHC-supported anti-
retroviral (ARV) programs. The activities described in this program area are linked closely with activities
described under adult treatment, pediatric and adult care and support, TB/HIV, PMTCT, ARV drugs, and
counseling and testing (CT). BRHC has been a recipient of PEPFAR funds to provide ARV services in
South Africa since 2005.
As of June 2008, the BRHC program operates in five provinces and has almost 20,000 people currently
receiving treatment services. Of this total, 7.8% are pediatric patients (excludes Edendale Hospital where
pediatric patients are reported by EGPAF). Under PEPFAR funding BRHC has two treatment programs
designed to support expanded treatment capacity for the South African Government (SAG). The first
program began in May 2005 and consists of three different models providing treatment to eligible patients
through networks of private GPs. Two of the models represent partnerships between the public sector and
private GPs. This program was designed to ease the burden on the public sector to provide treatment
services by strategically leveraging capacity in the private sector in underserved areas. The second
program, which began in November 2006, is a program of technical assistance to SAG hospitals to assist
with expansion and scale-up of the availability of treatment services in the public sector. The funds
requested in FY 2009 are primarily for activities under the second program working with public sector sites.
All proposed activities will be aligned with the NSP, national ARV guidelines and other national guidelines
governing the care and treatment of HIV-infected and affected people.
In late 2006, BRHC began capacity building work with SAG sites and was initially assigned to 4 hospital
systems in KwaZulu-Natal (KZN). As of June 2008, BRHC was reporting data from a total of 110 sites,
including 11 hospitals, 62 private GP practices and 37 SAG Primary Health Center/Community Health
Center (PHCs/CHCs) across districts in Eastern Cape (EC), KZN, Mpumalanga (MP), Gauteng province
(GP) and North West (NW). At the request of District Departments of Health, BRHC has committed to
continued expansion and plans to be supporting 19 complete hospital systems by September 09. With FY
2009 funds, BRHC expects to be active at 250 palliative care sites, including 25 SAG hospital systems.
Note: Pediatric patients will benefit from all of the activities described in program area "Adult Care and
Support", and the activities described here In the pediatric care and support program area BRHC is
highlighting activities which are specifically targeted to pediatric patients:
ACTIVITY 1: Target infants and children by strengthening linkages with existing services
referral systems within facilities, and between facilities and communities. The goal is to ensure that at
whatever point a pediatric patient accesses the health care system (Outpatient Department (OPD), in-
patient wards, mobile CT, ante-natal clinic (ANC),TB clinic, community health worker, Home-based Care
(HBC), well-child care, outreach program) that a comprehensive package of prevention, care and treatment
services are made available to that child and his/her family and household members. These services will
include cotrimoxazole prophylaxis from age 6 weeks for HIV-exposed infants, targeted prevention
messages, nutritional counseling, micronutrient supplementation, and routine offer and provider initiated CT.
The goal is to furthermore ensure coordination and referral mechanisms are in place such that pediatric
patients and their caregivers are able to navigate the health and social welfare systems successfully, and
that facilities are able to track and locate patients at any time throughout this process. Linkages with
malaria, family planning, Maternal and Child Health (MCH), gender-based violence, Directly Observed
Treatment/Therapy Short Course (DOTS) and nutrition programs will be strengthened. BRHC takes a family
-centered approach to providing comprehensive care and treatment services and will intensify efforts in this
area to build HIV and AIDS-competent communities. During FY 2009, BRHC will expand partnerships with
NGOs and community-based organizations in the catchment areas of BRHC sites to ensure uninterrupted
service delivery and community-level support for pediatric patients and their families. Training, institutional
strengthening, M&E and other technical assistance and human resource support will be provided to
NGOs/CBOs to enable them to meet the demand for community-based services for CT, prevention, home-
based care, access to social grants and support for OVC. Part of this support will be towards ensuring that
the proper community-based support systems are in place and strengthened to increase HIV awareness
and to create demand for testing, by providing resources for ongoing education on treatment literacy,
providing adherence support, and providing support to the families of HIV-infected pediatric patients. BRHC
will play a critical role in providing coordination between SAG facilities and communities, creating
sustainable coordination mechanisms and mutually beneficial partnerships. Most importantly, pediatric
patients and their families will benefit from programs that aim to provide longer, healthier lives.
ACTIVITY 2: Increase routine offer and provider-initiated testing to identify HIV-infected children
BRHC will support SAG sites to target infants and children for HIV testing at all service entry points,
especially ANC, maternity and in-patient pediatric wards. Protocols for the follow up of HIV-exposed infants
Activity Narrative: will adhere to national guidelines. BRHC support to facilities will focus heavily on integration of TB and HIV
services, where routine offer of CT of HIV patients for TB and of TB patients for HIV is provided in
accordance with national guidelines. Using family-centered approaches to comprehensive care and
treatment services, BRHC will ensure the screening and treatment of children of people who test positive for
HIV or TB. BRHC will build on existing DOTS infrastructure and community health workers to identify
children for HIV care and support as part of routine interactions with the households of TB patients.
ACTIVITY 3: Clinical services and operations
BRHC will place particular emphasis this year on expanding wellness programs for HIV-infected infants and
children not yet eligible for ART. The goal will be to ensure early referral and enrollment into comprehensive
care programs for children who are HIV-exposed or HIV-infected. Wellness programs will provide a
preventive care package, consisting at a minimum of: PCR testing for infants, cotrimoxazole prophylaxis,
screening and treatment for opportunistic infections (OIs) (especially TB) ongoing counseling and
psychosocial support, nutritional assessment and supplementation, pain assessment, provision of infant
feeding support, and prevention messages as part of routine care. Wellness programs will also provide
necessary referrals to other health services such as well child care, nutritional supplementation and
immunization services as part of IMCI services. BRHC support to facilities will focus heavily on integration of
TB and HIV services, and use the opportunity of ill adults attending health facilities to also reach their
infants and children with screening and referrals for HIV and TB. BRHC will increase access to PCR testing
by purchasing equipment where requested by district and provincial DOHs, or by strengthening
transportation and referral systems. It will also build laboratory capacity for early infant diagnosis by
providing technical assistance and human resources to improve quality assurance and testing turnaround
times
ACTIVITY 4: Human capacity development
In FY 2009, BRHC will employ a pediatric AIDS care and treatment specialist who will ensure integration of
pediatric initiatives across all BRHC PEPFAR-funded activities. The specialist will take the lead in
supporting sites to pilot innovative approaches to increasing testing of children, improve quality of care for
children, and will ensure consistent application of family-centered approaches to the care and treatment of
children. BRHC will engage additional qualified clinical mentors and preceptors to ensure supportive
supervision within the work setting at BRHC-supported health facilities.
BRHC will enhance training content on care and treatment of pediatric patients in existing BRHC training
offerings. BRHC provides a combination of in-house and outsourced training courses aimed at ensuring
quality delivery of treatment services in the SAG facilities it supports. All BRHC implemented or sponsored
training courses use nationally certified or DOH-approved curricula. Most courses are modular and cover a
range of relevant topics including CT, TB, ARV therapy, and management of OIs. Additionally, BRHC will
partner with programs such as the South-2-South Partnership for Pediatric HIV Care and Treatment to
leverage existing training courses and expertise. If requested by SAG and Regional Training Centers,
BRHC will assist to create new courses specifically for the care and treatment of pediatric patients. Pediatric
course content, either through existing modular or newly developed training courses, will be provided to all
professional and lay staff who have routine contact with children, regardless of ward or department. Training
will emphasize the importance of testing and early infant diagnosis for children entering the health system
through any service point: in-patient wards, OPD, ANC, MCH services, TB clinic, and community-based
services, as well as in providing a package of preventive care services specific to the needs of pediatric
patients. BRHC will continue to provide salary support to SAG for clinical and lay staff on a temporary basis
to fill critical vacancies. This support will be coupled with budgeting and planning technical assistance to
assist SAG sites to take over full support of these staff in future budget cycles thereby ensuring program
sustainability and continued growth. Through this mechanism BRHC will ensure adequate human resources
are available for the care and treatment of pediatric patients at BRHC-supported SAG sites.
ACTIVITY 5: Outreach to Children in Khayelitsha
BRHC has been asked by the WC Department of Social Development to assist with strengthening of care
and treatment programs for children and their families in Khayelitsha, the largest township in Cape Town.
This activity involves strengthening the existing Sizis'ukhanyo (NGO) resource center to serve as a
coordination and referral hub for children requiring a range of health, social and educational services. BRHC
will train resource center staff to provide community education programs on HIV and AIDS, monitor
referrals, and provide training to community members and parents/caregivers. Technical assistance from
BRHC will be used to expand and solidify linkages between the departments of health, education and social
development in the community, ensuring that children and their families can access the comprehensive HIV
and support services that they need. Referrals and linkages with other NGOs and CBOs providing services
for children in Khayelitsha will also be strengthened. The activity may also include providing health and
wellness for services for HIV-infected and affected children in the resource centre itself. Details of this
activity are still under development.
Activity 6: Information systems/M&E/Quality Improvement and Quality Assurance
BRHC will continue to support the use of interim software solutions for management of patient data at
BRHC-supported SAG sites with the goal of empowering site level staff to use routinely collected statistics
for planning and decision making. In anticipation of national, provincial or district-level decisions mandating
software for electronic patient record systems, BRHC aims to provide temporary solutions that improve the
ability of sites to meet SAG reporting requirements. Information systems build on existing paper-based and
register systems, providing added value by improving data quality and information use. Special attention will
be paid to the challenges posed by monitoring and tracking of pediatric patients, from identification of HIV-
exposed babies before birth, to PCR testing, to the commencement of pediatric treatment if necessary.
Information systems will be designed to closely track mother-infant pairs as they move through the health
system from pregnancy to well-child care, ensuring timely and comprehensive prevention, care and
treatment services are provided to both. In FY 2009 BRHC will expand systematic quality assurance and
quality improvement (QA/QI) approaches across all public sector sites. The purpose of this activity is to
promote consistent quality of care for all HIV-infected and affected pediatric patients who seek services in
the public sector, and to provide ongoing monitoring and support of training that has been provided. BRHC
Activity Narrative: will focus on the use of patient outcomes to monitor the progress and quality of programs. Pediatric patients
will be monitored according to the following age bands: 0-2, 2-4 and 5-15 years of age.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $3,576
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $3,822
Table 3.3.10:
BroadReach Healthcare's (BRHC) pediatric antiretroviral (ARV) services activities include training and
salary support for health professionals, management support, quality assurance, operations support,
strategic communications, and community outreach to increase the number of children on antiretroviral
therapy (ART) on BRHC-supported ARV programs. The activities described in this program area are linked
closely with activities described under adult treatment, pediatric and adult care and support, TB/HIV,
prevention of mother-to-child transmission (PMTCT), ARV drugs, and counseling and testing (CT). BRHC
has been a recipient of PEPFAR funds to provide ARV services in South Africa since 2005.
peds are reported by EGPAF). Under PEPFAR funding BRHC has two treatment programs designed to
support expanded treatment capacity for the South African government (SAG). The first program began in
May 2005 and consists of three different models providing treatment to eligible patients through networks of
private general practitioners (GPs). Two of the models represent partnerships between the public sector
and private GPs. This program was designed to ease the burden on the public sector to provide treatment
program, which began in November 2006, is a program of technical assistance to South African
Government (SAG) hospitals to assist with expansion and scale-up of the availability of treatment services
in the public sector. The funds requested in FY 2009 are primarily for activities under the second program
working with public sector sites. All proposed activities will be aligned with the National Strategic Plan,
national ARV guidelines and other national guidelines governing the care and treatment of HIV-infected and
affected people. BRHC's overall goal under this program area is to promote creative, sustainable and
comprehensive pediatric treatment programs that improve the quality of life of people living with HIV
(PLHIV) and increase resilience in the public health care system in South Africa.
systems KwaZulu-Natal (KZN). As of June 2008, BRHC was reporting data from a total of 110 sites,
including 11 hospitals, 62 private GP practices and 37 SAG clinics across districts in Eastern Cape
province, KZN, Mpumalanga province, Gauteng province, and North West province. At the request of
District Departments of Health, BRHC has committed to continued expansion and plans to be supporting 19
complete hospital systems by September 2009. With FY 2009 funds, BRHC expects to be active at 180
treatment sites, including 25 SAG hospital systems.
SAG's HIV and AIDS efforts across the country. To do this, BRHC breaks down the problem into demand-
side and supply-side. Demand-side addresses the patients and communities to ensure that solutions are in
place to mobilize, generate demand for testing, provide education including treatment literacy, provide
ongoing adherence and psychosocial support to PLHIV and the affected/unaffected community members.
BRHC generally does this by training and capacitating community organizations such as PLHIV support
groups, faith-based organizations, non-governmental organizations (NGOs), and SAG facilities to carry out
these activities. The supply-side addresses the provider of services such as hospitals, clinics, health-care
workers, labs, pharmacies, etc. and focuses on solutions such as training, service delivery integration and
re-engineering, operations improvement, equipment and infrastructure upgrade, etc.
Note: Pediatric patients will benefit from all of the activities described in program area 'Adult Treatment.' In
the pediatric treatment program area BRHC is highlighting activities which are specifically targeted to
pediatric patients:
BRHC will employ both facility- and community-level approaches to improving the integration of services
and referral systems within facilities, and between facilities and communities. The goal is to ensure that at
whatever point a pediatric patient accesses the health care system (out-patient departments (OPDs), in-
patient wards, mobile CT, antenatal care (ANC), TB clinics, community health worker, home-based care,
well-child care) that a comprehensive package of prevention, care and treatment services are made
available to that child and his/her family and household members. These services will include cotrimoxazole
prophylaxis from age 6 weeks for HIV-exposed infants, targeted prevention messages, nutritional
counseling, micronutrient supplementation, and routine offer and provider-initiated CT. The goal is to
furthermore ensure coordination and referral mechanisms are in place such that pediatric patients and their
caregivers are able to navigate the health and social welfare systems successfully, and that facilities are
able to track and locate patients at any time throughout this process. Linkages with family planning,
maternal and child health (MCH), gender-based violence, directly-observed treatment, short-course (DOTS)
and nutrition programs will be strengthened.
intensify efforts in this area to build HIV and AIDS-competent communities. During FY 2009, BRHC will
expand partnerships with NGOs and community-based organizations in the catchment areas of BRHC sites
to ensure uninterrupted service delivery and community-level support for pediatric patients and their
families. Training, institutional strengthening, monitoring and evaluation (M&E) and other technical
assistance and human resource support will be provided to NGOs/community-based organizations (CBOs)
to enable them to meet the demand for community-based services for CT, prevention, home-based care,
access to social grants and support for OVC. BRHC will play a critical role in providing coordination
between SAG facilities and communities, creating sustainable coordination mechanisms and mutually
beneficial partnerships. Most importantly, pediatric patients and their families will benefit from programs that
aim to provide longer, healthier lives.
Activity Narrative: ACTIVITY 2: Increase routine offer and provider-initiated testing to identify HIV-infected children
will adhere to national guidelines. BRHC support to facilities will focus heavily on integration of TB and HIV
services, where routine offer of CT of HIV patients for TB, and of TB patients for HIV is provided in
children for HIV testing as part of routine interactions with the households of TB patients.
BRHC will build laboratory capacity for early infant diagnosis by providing technical assistance and human
resources to improve quality assurance and testing turn around times. As enrollment of pediatric patients
scales up, BRHC will work with SAG sites to project ARV and commodities requirements to ensure an
uninterrupted supply of pediatric formulations. All ARVs and medical commodities used at BRHC-supported
SAG facilities are procured through SAG.
With FY 2009 funding, BRHC will employ a pediatric AIDS care and treatment specialist who will ensure
integration of pediatric initiatives across all BRHC PEPFAR-funded activities. The specialist will take the
lead in supporting sites to pilot innovative approaches to increasing testing of children, improve quality of
care for children, and will ensure consistent application of family-centered approaches to the care and
treatment of children. BRHC will engage additional qualified clinical mentors and preceptors to ensure
supportive supervision within the work setting at BRHC-supported health facilities.
BRHC will enhance training content on care and treatment of children in existing BRHC training offerings.
delivery of treatment services in the SAG facilities it supports. All BRHC implemented or sponsored training
courses use nationally certified or DOH-approved curricula. Most courses are modular and cover a range of
relevant topics including CT, TB, ARV therapy, and management of opportunistic infections. Additionally,
BRHC will partner with programs such as the South-2-South Partnership for Pediatric HIV Care and
Treatment to leverage existing training courses and expertise. If requested by SAG and Regional Training
Centers, BRHC will assist to create new courses specifically for the care and treatment of pediatric patients.
Pediatric course content, either through existing modular or newly developed training courses, will be
provided to all professional and lay staff who have routine contact with children, regardless of ward or
department. Training will emphasize the importance of testing and early infant diagnosis for children
entering the health system through any service point - in-patient wards, OPD, ANC, MCH services, TB
clinic, and community-based services.
BRHC will continue to provide salary support to SAG for clinical and lay staff on a temporary basis to fill
critical vacancies. This support will be coupled with budgeting and planning technical assistance to assist
SAG sites to take over full support of these staff in future budget cycles thereby ensuring program
BRHC has been asked by the Western Cape Department of Social Development to assist with
strengthening of care and treatment programs for children and their families in Khayelitsha, the largest
township in Cape Town. This activity involves strengthening the existing Sizis'ukhanyo (NGO) resource
center to serve as a coordination and referral hub for children requiring a range of health, social and
educational services. BRHC will train resource center staff to provide community education programs on
HIV and AIDS, monitor referrals, and provide training to community members and parents/caregivers.
Technical assistance from BRHC will be used to expand and solidify linkages between the departments of
health, education and social development in the community, ensuring that children and their families can
access the comprehensive HIV and support services that they need. Referrals and linkages with other
NGOs and CBOs providing services for children in Khayelitsha will also be strengthened. The activity may
also include providing health and wellness for services for HIV-infected and affected children in the resource
centre itself. Details of this activity are still under development.
ACTIVITY 6: Information systems/M&E/Quality Improvement and Quality Assurance
register systems, providing added value by improving data quality and information use. Special attention
will be paid to the challenges posed by monitoring and tracking of pediatric patients, from identification of
HIV-exposed babies before birth, to polymerase chain reaction (PCR) testing, to the commencement of
pediatric treatment if necessary. Information systems will be designed to closely track mother-infant pairs as
they move through the health system from pregnancy to well-child care, ensuring timely and comprehensive
prevention, care and treatment services are provided to both and loss to initiation is minimal.
With FY 2009 funding, BRHC will expand systematic quality assurance and quality improvement (QA/QI)
approaches across all public sector sites. The purpose of this activity is to promote consistent quality of care
for all HIV-infected and affected pediatric patients who seek services in the public sector, and to provide
Activity Narrative: ongoing monitoring and support of training that has been provided. BRHC will focus on the use of patient
treatment outcomes - especially viral load suppression, patient retention, and patient adherence- to monitor
the progress and quality of programs. Pediatric patients will be monitored according to the following age
bands: 0-2, 2-4 and 5-15 years of age.
Estimated amount of funding that is planned for Human Capacity Development $82,864
Table 3.3.11:
The National Department of Health (NDOH) has asked BroadReach Health Care (BRHC) to expand support
to 19 complete hospital systems. BRHC will support 250 palliative care sites, including 25 South African
government (SAG) hospital systems in FY 2009. Although BRHC has only reported TB data from four sites
in 2008, all sites provide TB services or refer TB suspects for services. All proposed activities will be aligned
with the updated SAG guidelines and updated policies and guidelines will be implemented.
ACTIVITY 1:
BRHC will continue to build capacity, but the number of SAG facilities will be increased. Training for
healthcare workers on isoniazid preventive therapy (IPT), intensified case finding (ICF), DOT and patient
support, TB infection control, prevention, diagnosis and management of MDR/XDR-TB, operational
integration of HIV and TB services, diagnostic algorithms and procedures to diagnose smear negative, extra
pulmonary and pediatric TB will be provided. All training will be SAG-accredited. Additionally, BRHC will
train home-based care workers to ensure that they receive accredited training, and for those who qualify, a
refresher training course.
BRHC will scale up its interventions to cover more communities and topics. BRHC will continue to partner
with SAG facilities, community- and faith-based organizations, PLHIV support groups, and NGOs to provide
training of trainer courses and patient/community training programs, to develop staff and volunteers within
these organizations and communities who can (i) raise awareness about TB/HIV prevention and control; (ii)
serve to provide education, infection control, treatment literacy training in SAG facilities and in the
community to those who are TB/HIV infected and affected; and (iii) provide ongoing adherence support
including DOTS. BRHC will continue to produce SAG approved patient videos, speaking books, flipcharts,
posters, treatment diaries, etc.
ACTIVITY 2:
BRHC will cover more areas and address more issues at the national, provincial and district levels. BRHC
has assisted with developing strategic plans for rolling out comprehensive HIV/AIDS programming,
including TB. BRHC will continue to do this and focus on assisting the SAG to (i) develop and implement
SAG approved models such as health-care worker participation in prevention and adherence; (ii) linkages at
all levels of SAG including laboratories; (iii) down-referral approaches; and (iv) human resource planning,
training materials and approaches.
ACTIVITY 3:
BRHC will continue to integrate and upgrade services at TB and HIV facilities, including joint planning,
supervision, staffing, medical records, protocols and procedures, fast-track processes for suspected clients,
monitoring of outcomes and referral systems, and equipment/infrastructure upgrade. BRHC will support
SAG hospitals, community and primary health clinics to ensure continuity of care for patients up and down
the referral chain by strengthening or establishing referral systems. BRHC will ensure that ICF, IPT and TB
infection control procedures are implemented correctly across sites through clinical mentorship and quality
assurance activities. Activities to ensure IPT is provided according to national guidelines will be
simultaneously addressed in ARV and TB clinics, and in patient settings.
In alignment with SAG district and provincial priorities, BRHC will support TB/HIV interventions at primary
and community health clinics, and at secondary level public health facilities. BRHC technical assistance will
be focused intensively at two hospitals: Dunstan Farrell (KwaZulu-Natal) and Umlamli (Eastern Cape).
Support will include risk assessments for TB transmission using the SAG TB Infection Control Guidelines
and assessment tools. Following assessments, BRHC will assist sites to implement infection control
procedures through changes to patient flow, fast tracking of TB suspects, cough etiquette and improved
ventilation. Infection control procedures will be tailored to the facility.
BRHC will strengthen the lab lifecycle including appropriate and safe sputum/specimen collection, timely
specimen transport, improved reporting of results from labs to clinics, upgrade lab equipment and
infrastructure, and ensure that all staff are trained in accordance with SAG policies. BRHC will assist
laboratories at sites to adhere to QA procedures for sputum smear microscopy. BRHC will work with the
National Health Laboratory Service to decentralize sputum smear microscopy services as requested by
DOH, and where deemed necessary to improve accessibility to TB diagnostic services.
ACTIVITY 4: QUALITY ASSURANCE
BRHC will expand M&E programs with emphasis on new reporting systems for the new PEPFAR TB/HIV
indicators, monitoring integration of services, implementation of and coordination of reporting systems within
SAG at all levels, and staff augmentation to support these efforts.
------------------
BroadReach Healthcare's (BRHC) activities include doctor consultations, lab testing, adherence support,
health professionals, support groups and data management.
assists ART rollout in the public sector. BRHC taps private sector health professionals to provide
comprehensive care and treatment, fostering capacity-building initiatives within the public health system,
and supporting community-based programs. BRHC leverages PLHIV support programs to identify and
assist with treatment literacy, adherence support and ongoing community mobilization, prevention education
activities, and positive living initiatives. BRHC also works to build capacity in public health facilities, focusing
efforts on human capacity development (HCD) activities, including clinical didactic training, clinical
mentorships, patient training and operational assistance training. BRHC is expanding its provision of staff
Activity Narrative: and infrastructure support to SAG facilities. Finally, BRHC is expanding its involvement in the design of
scaleable down referral models in partnership with faith-based organizations (FBOs), community-based
organizations (CBOs), and public-private partnerships (PPPs).
BRHC will continue to work with the national and provincial Departments of Health and specifically with the
HAST (HIV, AIDS STI, and TB) managers to prioritize interventions designed to address weaknesses
(identified by the departments of health) in the (directly observed therapy short-course) DOTS and TB/HIV
programs. BRHC will focus on improving policy adherence and patient follow-up. Individuals will be hired for
each site as tracers to track patients and ensure that referrals are completed. BRHC is setting aside funding
to develop (with other relevant partners or agreement counterparts) standardized tools to ensure that
policies and guidelines recommended by NDOH are followed, including guidelines for infection control.
BRHC will continue to integrate TB/HIV interventions with existing agreement programs as BRHC works
seamlessly and side by side with government employees at government facilities.
ACTIVITY 1: Human Capacity Development (HCD)
This program aims to provide TB care and treatment for HIV-infected patients by strengthening the TB skills
of health professionals through didactic training and clinical mentorships focusing on TB, TB/HIV coinfection
and systems integration. Health professionals will also receive decision support and training from the BRHC
clinical expert panel and disease management system for difficult cases. At the local level, HCD efforts will
target the communities in which the program operates by providing training and information, education and
communication (IEC) to patients and support group facilitators on TB, as well as HIV/AIDS, ART,
adherence, living positively, and accessing clinical psychosocial support and linkages to other sectors and
initiatives in their communities.
ACTIVITY 2: Support to SAG
This program will support the SAG TB program to increase the capacity of facilities in the testing and
identification of TB patients. This will be accomplished through general healthcare financing which could
include commodity procurement such as screening equipment to salary support of TB-focused clinical staff.
Salary support would be given in line with government facility rates along with transition plans for the
government facility to absorb the staff into their budget within a finite period. Alternatively staff would be
financed on a contract basis while plans were implemented in government facilities to accommodate staffing
needs. Further assistance could be given in assisting with health professional recruitment and developing
retention strategies, as well as supporting BRHC network doctors who assist with TB/HIV care and
treatment within government health facilities in their communities in order to increase treatment capacity.
Training of these doctors assists with sustainability as it provides ongoing stable support to government
facilities and allows government infrastructure to cope with fluctuating need through the provision of
sessionals. Finally, BRHC will support SAG TB/HIV efforts through infrastructure upgrade by building and/or
refurbishing hospital/clinic/lab space and purchasing equipment as needed, in order to support government
clinic activities such as screening, diagnosis and closely supervised treatment. The approach would be to
address the individual needs of each facility within areas where BroadReach provides assistance in the
form of ARV treatment or CT services across the provinces.
BRHC activities in support of TB treatment will be guided by consultations at national, provincial and district
level re: government identified shortcomings in TB programs. These interventions may include human
resource support, equipment, facility-specific policy development and business systems according to SAG
articulated needs. BRHC program support priorities will reflect SAG-identified priorities. Moreover, BRHC
HIV and TB/HIV integrated activities will build on and support pre-existing initiatives at sites, and integrate
with the facility, and district, provincial and national TB and TB/HIV programs. TB/HIV services will also be
integrated with all other related care and support services offered at facility level.
ACTIVITY 3: Referral Networks
Additional support to SAG will be provided in the form of systems strengthening around TB/HIV activities.
This will include improvement of referral linkages between the private sector general practitioners (GPs) and
public sector facilities that treat BRHC patients for TB infection in the BRHC Comprehensive Care model. In
addition, BRHC may work with government sites to facilitate linkages between TB and HIV clinics, as well
as creating capacity and linkages within communities to support BRHC patients with TB/HIV coinfection
within the context of a BRHC supported public-private partnership with Daimler Chrysler (PPP). These
linkages will be established by implementing referral processes between caregivers by holding workshops,
creating referral material (referral forms that inform the receiving provider where the patient originated and
the findings of the original provider), and informing various groups of activities in the area. Processes will
specify whether HIV patients with TB are referred to HIV clinics or TB clinics or vice versa. The expected
outcome is that patients are treated holistically and not in isolation by various providers. Since these
diseases are closely linked it is important that the treating physician treats the patient for TB and HIV so that
s/he is able to manage treatment regimes. BRHC will institute processes to ensure smooth referrals and
coordinated patient management for co-infected patients. These processes may include employing TB/HIV
case managers, integrating HIV and TB databases to facilitate patient tracking, support DOTS programs,
utilize home-based carers to monitor and support patients. Patients with TB should have access to HIV
testing and should they require ARV therapy, they would need to be treated or referred to an ARV facility.
ACTIVITY 4: Quality Assurance/Quality Improvement (QA/QI)
TB/HIV activities will benefit from the same level of oversight and quality control as all other aspects of the
BRHC treatment program including regular internal data and systems audits, collection of patient level
surveillance data, exception reports, doctor-specific feedback report, and doctor decision making support,
and community-based modified DOTS programs. TB/HIV quality assurance is further enhanced by the
tracking of co-infected patients through screening, diagnosis and treatment through the use of improved
clinical forms and referral forms. A clinical oversight committee provides any guidance to GPs regarding
complicated cases presenting with TB/HIV coinfection. Data collection and reporting on TB, and TB/HIV
coinfection will be integrated into ARV Program management reports to ensure constant monitoring of
patients and to facilitate program improvement.
Activity Narrative: All BRHC activities articulated in the FY 2007 COP will be scaled up significantly through partnerships with
15 SAG hospital systems (which include hospitals and affiliated CHCs and PHCs). With FY 08 funding,
activities will be expanded/enhanced (i.e. no new activities) as follows:
-BRHC supports QA/QI at each of its public sector partner hospitals through QA assessments, systems re-
engineering, and the development of reporting systems that provide program management feedback to
improve program performance.
-As part of systems re-engineering BRHC will focus on improving integration between HIV/AIDS treatment
programs and TB programs for testing, treatment coordination and referrals.
-Strengthen down referral activities between public sector hospital partners and their affiliated clinics by re-
engineering referral processes, improved data management and patient tracking, and training.
-Training for health professionals at all public sector sites (hospitals and PHCs) covers TB/HIV co-
-HIV/AIDS literacy training for patients as part of community mobilization.
ensure a sustainable staffing solution.
Continuing Activity: 13694
13694 7939.08 U.S. Agency for Broadreach 6576 416.08 $1,455,000
7939 7939.07 U.S. Agency for Broadreach 4449 416.07 $450,000
Estimated amount of funding that is planned for Human Capacity Development $124,785
Table 3.3.12:
BACKGROUND AND SUMMARY:
In FY 2009 BroadReach Healthcare (BRHC) will significantly expand counseling and testing (CT)
accessibility by supporting CT across an increased number of sites. In addition to activities of FY 2008,
specific focus will be placed on ensuring quality of testing, targeting of specific groups and testing facilities,
referrals and prevention education. BRHC will work with government facilities to expand and enhance CT
services within hospital systems and will aim to mobilize communities by driving large scale CT campaigns,
in addition to implementing or expanding home-based testing initiatives. BRHC will partner with community
groups and CT partners in order to obtain the necessary reach. To meet these objectives, BRHC, in
conjunction with key personnel of partner sites, will design and develop programs, processes and operating
procedures, source and develop education materials, design and implement data collection and monitoring
tools, align resourcing needs and assist with implementation.
ACTIVITY 1: Quality Assurance/Quality Improvement
BRHC will promote the use of rapid tests as a diagnostic tool in both clinical and community settings.
Partner sites will be assisted in creating, formalizing and standardizing standard operating procedures and
quality assurance programs to ensure quality around testing. This program will include proficiency testing
for those conducting rapid tests and on-site monitoring. BRHC will assist sites in taking ownership of the
program and will provide support in extending quality assurance programs from medical facilities to home-
based CT. BRHC will focus training efforts on the management of CT services aligned to the quality
program.
ACTIVITY 2: Targeted Groups and Testing Facilities
BRHC will work with government sites to ensure that HIV CT is routinely provided at the hospital level and
extended to linked community health centres (CHCs) and primary health centres (PHCs) where counselors
are trained to provide CT. Per a government request, BRHC will also be pioneering a program to train
traditional healers to perform rapid tests. Specific focus will be placed on tuberculosis (TB) , sexually
transmitted infection (STI), family planning and out-patient clinics, as well as pediatrics. BRHC will work with
sites to implement policies whereby providers initiate and offer HIV testing to all patients and ensure CT
services (including pre-test information and post-test counseling) are available on site. BRHC will promote
utilization of counselors as opposed to clinical staff in performing counseling duties to avoid diverting clinical
staff from their medical duties. In addition, BRHC will target specific audiences that engage in high risk
behavior such as sex workers through dedicated campaigns. Increased CT initiatives (campaigns and
increased facility CT services) will be planned and co-ordinated with district and hospital management to
ensure facilities are able to cope with demand for care and treatment services. Family members will be
targeted through the home-based program focusing on family members of patients receiving HIV care and
treatment. Counselors will receive advanced CT training focusing on family and child counseling.
Grassroots (including door-to-door and engagement of local leaders) campaigns will be used to mobilise
community members en masse for testing.
ACTIVITY 3: Referrals and Linkages
Underpinning all BRHC work is the concept of developing scalable solutions which can help to bolster THE
South African Government's (SAGs) HIV/AIDS efforts across the country. To do this, BRHC breaks down
the problem into demand-side and supply-side. Demand-side addresses the patients and communities to
ensure that solutions are in place to mobilize, generate demand for testing, provide education including
treatment literacy, provide ongoing adherence and psychosocial support to PLHIV and the
affected/unaffected community members. BRHC generally does this by training and capacitating community
organizations such as people living with HIV and AIDS (PLWHA) support groups, faith-based organizations
(FBOs), non-governmental organizations (NGOs) and SAG facilities to carry out these activities. The supply
-side addresses the providers of services such as hospitals, clinics, healthcare workers, labs, pharmacies,
etc. and focuses on solutions such as training, service delivery integration and re-engineering, operations
improvement, equipment and infrastructure upgrade, etc.
BRHC will work with partner sites to ensure all TB patients and (and those suspected of having TB) are
routinely tested for HIV, and all newly diagnosed HIV-infected people are referred for TB testing. BRHC will
specifically focus on referral of patients from testing to care and treatment. Processes and systems are put
in place to prevent lost to initiation with registers and monitoring mechanisms to ensure patients are
monitored within the system. HIV negative clients are registered for ongoing prevention education.
ACTIVITY 4: Prevention
BRHC recognizes that CT is an important HIV prevention opportunity. Prevention messaging is therefore a
key component of post-test counseling, providing in-depth individualized counseling tailored to the client's
needs (positive or negative). Prevention messaging is incorporated into mobilization and VCT campaigns.
BRHC will promote disclosure of HIV status to sexual partners and family members as a routine part of CT
services and will work with sites to implement processes that encourage partner referrals and partner
notification. BRHC has also developed a series of patient education videos that are to be shown in various
settings and takes a family approach to encouraging testing (including partner testing), disclosure, the
importance of TB screening, positive living and wellness, how to manage HIV in children, antiretroviral
therapy and importance of adherence. The videos also demonstrate the appropriate use of male and
female condoms (BRHC's experience to date is that shockingly large numbers of adults have never seen
these demonstrated or handled them).
Activity Narrative: ---------------------------
The primary goal of BroadReach Healthcare's (BRHC) counseling and testing (CT) is to ensure that those
testing positive for HIV are started on antiretroviral treatment (ART) when clinically qualified and enrolled
patients continue to receive outstanding care and support. CT is the entry point for this goal. BRHC also
supports activities that include test-kit procurement, meeting infrastructure and human resource demands,
increasing testing uptake, prevention, patient counseling, referral systems, and training. Primary target
populations include children, adolescents, adults, pregnant women, and people living with HIV (PLHIV).
services to HIV-infected individuals in areas where the South African Government (SAG) rollout has not yet
been implemented and assists ART rollout in the public sector. The BRHC PEPFAR program began in May
2005 and now operates across five provinces. BRHC is supporting approximately 5,000 people directly with
care and treatment and 15,000 indirectly. BRHC taps private sector health professionals to provide
mentorships, patient training, and operational assistance training. BRHC is expanding its provision of staff
and infrastructure support to SAG facilities. Finally, BRHC is expanding its involvement in the design of
The primary goal of the program is to ensure that those testing positive for HIV are started on ART when
clinically qualified and enrolled patients continue to receive outstanding care and support. CT is the entry
point for this goal.
ACTIVITY 1: Voluntary Counseling and Testing
BRHC will provide access to rapid voluntary counseling and testing (CT) at enrollment sessions and, where
available, CD4 testing services for patients who test positive to determine eligibility for treatment. In
accordance with SAG guidelines, BRHC patients will be properly counseled (pre- and post-test), tested, and
referred as appropriate to a BRHC network doctor or to an accredited SAG facility.
ACTIVITY 2: Support to South African Government
BRHC will expand access and availability of CT by (1) procuring testing materials (rapid test kits when
unavailable through the government system); (2) improving operational efficiency through needs
assessment, identification of operational bottlenecks, implementing solutions to address bottlenecks; (3)
assisting with refurbishing physical space at government clinics/hospitals; and (4) advising SAG partner
clinics on increasing CT uptake and improving the percentage of results received. BRHC will further support
SAG efforts in meeting the increased demand created by testing. This will range from providing salary
support for counselors to improved processes and systems for enrolling and following up greater numbers
of new patients.
ACTIVITY 3: Outreach
Using a family-centered approach to care and treatment, BRHC will encourage the testing of families and
households, utilizing patients already enrolled in the BRHC program as a point of entry. BRHC will also
promote community-based programs such as support groups, CBOs, and churches as entry points for CT
services.
All HIV-infected patients identified through BRHC-supported CT efforts, will be linked (via BRHC network
doctors, home-based care (HBC) and support groups) to other services such as TB care, nutrition and
wellness, and psychosocial support.
ACTIVITY 5: Human Capacity Development
BRHC may enhance the quality of CT services at selected sites (assigned by the relevant district
authorities) through training and mentoring for counselors, health professional staff, outreach workers and
support group facilitators. In addition to training, BRHC will assist CT programs at sites by providing salary
support to counselors as sites expand access to CT services.
BRHC's CT activities directly contribute to the 2-7-10 objectives by identifying infected individuals who are
unaware of their HIV status and who may be eligible for treatment. Greater numbers of people tested
means meeting the treatment and care and support objectives. Moreover, prevention messages given to
both infected and uninfected individuals during post-test counseling will contribute to the goal of averting 7
million infections.
All BRHC activities articulated in the FY07 COP will be scaled up significantly in FY 2008 through its
partnerships with 15 SAG hospital systems, which include hospitals and affiliated community and primary
Activity Narrative: health centers.
The FY 2007 activities will be expanded and enhanced in FY 2008 as follows:
BRHC will support quality assurance at each of its public sector partner hospitals through quality assurance
This includes monitoring, tracking and reporting on CT activities at partner sites.
As part of systems re-engineering BRHC will focus on improving CT referrals at sites to boost the number of
patients tested, and the numbers that receive their results and ultimately enroll in treatment. A special effort
will be made to test family members of patients in an effort to boost family-centered care initiatives at sites
through partnerships with CBOs and home-based care organizations.
Continuing Activity: 13695
13695 3136.08 U.S. Agency for Broadreach 6576 416.08 $870,000
7513 3136.07 U.S. Agency for Broadreach 4449 416.07 $220,000
3136 3136.06 U.S. Agency for Broadreach 2663 416.06 $62,000
Estimated amount of funding that is planned for Human Capacity Development $44,614
Table 3.3.14:
BroadReach Health Care (BRHC) implements several treatment models in South Africa using PEPFAR
funds. BRHC uses PEPFAR funding to procure antiretrovirals (ARVs) for two treatment models involving
private sector general practitioners. BRHC uses the majority of its PEPFAR funding to support expanding
capacity of South African Government (SAG) health facilities to provide comprehensive care and treatment
services. BRHC does not procure ARVs using PEPFAR funding for SAG sites. All ARVs at these sites are
provided through the government of South Africa.
-------------------------------------------
BroadReach Healthcare's (BRHC) antiretroviral (ARV) drug activities include drug procurement and
distribution, training for health professionals on drugs, supporting pharmacy staff salaries, training patients,
quality assurance (QA), and data management. BRHC's emphasis areas are human capacity development,
local organization capacity building, and strategic information. Primary target populations include children,
adolescents, adults, pregnant women, and people living with HIV (PLHIV).
services to HIV-infected individuals in areas where the South African Government's (SAG) rollout has not
yet been implemented and assists ART rollout in the public sector. The BRHC PEPFAR program began in
May 2005 and now operates across five provinces. An additional province will be added in FY 2008. BRHC
is supporting approximately 5,000 individuals directly with care and treatment and 15,000 indirectly. BRHC
taps private sector health professionals to provide comprehensive care and treatment, fostering capacity
building initiatives within the public health system, and supporting community-based programs. BRHC
leverages PLHIV support programs to identify and assist with treatment literacy, adherence support and
ongoing community mobilization, prevention education activities, and positive living initiatives. BRHC also
works to build capacity in public health facilities, focusing efforts on human capacity development (HCD)
activities, including clinical didactic training, clinical mentorships, patient training and operational assistance
training. BRHC is expanding its provision of staff and infrastructure support to SAG facilities. Finally, BRHC
is expanding its involvement in the design of scaleable down referral models in partnership with faith-based
The primary goal of this program area is to ensure that new patients are started on antiretroviral treatment
(ART) when clinically qualified, and enrolled patients continue to receive high-quality care and support.
Monitoring of CD4 counts, viral loads, and resistance testing are part of the monitoring system. For
continued program sustainability, BRHC continues to work on the transference of costs to government, and
already in the North West province, the provincial government provides all drugs.
ACTIVITY 1: Drug Procurement and Distribution
BRHC will continue commodity procurement of ARVs through its supply chain vendors including its courier-
based pharmacy partners. BRHC will oversee the delivery of drugs to the accredited community-based
providers. In some instances, the community-based providers will be paid a capitated rate per patient and
those providers will be procuring drugs according to PEPFAR standards and national guidelines. BRHC will
negotiate best available pricing for USG and SAG approved ARV drugs. Community-based providers are
trained in drug forecasting, procurement and supply chain management.
BRHC partners with a private mail order pharmacy provider, Pharmacy Direct (PD), in its procurement and
distribution efforts for the BRHC general practitioners (GP) network. Pharmacy Direct liaises directly with
the BRHC GP network to manage patient prescriptions, dosing, medicine delivery and pick-up of returned
medicines. In partnership with Pharmacy Direct, BRHC manages patient adherence through monitoring of
medicine collection and regular data reports.
BRHC will continue to provide comprehensive HIV and AIDS training to its network of providers including
doctors, nurses, pharmacists and other healthcare professionals through a variety of initiatives including
remote decision support, telemedicine, web-based training, didactic training, and clinical mentoring from
experienced HIV and AIDS clinicians. Topics include drug supply chain logistics, operational improvements
for drug management, tracking for expiration dates, comprehensive ART management, adherence,
management of complications and side-effects, prevention and pediatric HIV management. BRHC-
supported human capacity development activities, such as training and clinical mentoring, will also take
place within SAG facilities.
BRHC will support capacity development for drug procurement and pharmaceutical management at partner
SAG facilities. BRHC has conducted a needs assessment that examined the operational processes for drug
procurement, forecasting, stock management, and dispensing, and has used this assessment to streamline
its supply chain management.
ACTIVITY 4: Quality Assurance/Quality Improvement
BRHC maintains a close relationship with its drug procurement and distribution client. The client provides
regular feedback and reports to BRHC regarding delivery problems, missed medicine pick-ups, and collects
Activity Narrative: all unused medicines. Drug distribution, pick-up, and returns data is collected and maintained in the BRHC
program database. This data feeds into numerous reports including doctor-specific feedback reports and
patient exception reports.
This activity facilitates the ARV service delivery component of the project, which contributes directly to the
PEPFAR 2-7-10 goal of two million people receiving treatment. BRHC will contribute to PEPFAR's vision
outlined in the Five-Year Strategy for South Africa by expanding access to ART services for adults and
children, building capacity for ART service delivery, and increasing the demand for and acceptance of ARV
treatment.
Continuing Activity: 13696
13696 3133.08 U.S. Agency for Broadreach 6576 416.08 $737,200
7512 3133.07 U.S. Agency for Broadreach 4449 416.07 $2,950,000
3133 3133.06 U.S. Agency for Broadreach 2663 416.06 $1,687,000
Table 3.3.15:
