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: 2007 2008 2009
SUMMARY:
The Southern African Clothing and Textile Workers Union (SACTWU) has received PEPFAR funding in
previous years through a sub-agreement with the Solidarity Center. In FY 2008, SACTWU started receiving
direct PEPFAR funding. SACTWU has a well-structured training program, initiated in 1999, that has evolved
within the dynamics of the industry and includes basic facts on HIV, AIDS, abstinence, being faithful and
condom use. The major emphasis area of the activity is training. Target populations include factory workers
and people affected by HIV, HIV-infected adults, especially women, and the business community.
BACKGROUND:
SACTWU is South Africa's largest trade union organizing textile and clothing workers. It also organizes
footwear, leather and retail workers and has a membership of approximately 110,000 members nationally.
Sixty-six percent of SACTWU's membership is female with the majority aged between 20 and 60 (i.e., the
greatest population infected and affected by HIV and AIDS).
The SACTWU AIDS Project, known as SACTWU Worker Health Program, is a national program that
provides prevention and care services in five provinces: KwaZulu-Natal, Western Cape, Gauteng, Eastern
Cape and Free State. This Project was initiated in 1999 and developed as a national comprehensive
program, with an initial focus on prevention. It has matured over the years to the point where it now has a
well-structured comprehensive training program, provides workplace theatre, in-house voluntary counseling
and testing (VCT) services, access to a social worker in KwaZulu-Natal, income generating workshops, a
primary package of care through the VCT services, home-based care through its regional nurses, and a
home-based care network in KwaZulu-Natal and the Western Cape. The nurses provide some level of
support in the home through home visits, but this activity is mainly implemented by the home-based care
network that provides ongoing home-level support.
The prevention program is a three-level training program that starts with a foundation phase on the basic
facts of HIV and AIDS, abstinence, being faithful and consistent and correct condom use (ABC). These
facts are reinforced and strengthened with the intermediate and advanced modules of training. The
intermediate module deals with legal aspects and workplace policy development. In the advanced module,
delegates are trained to become trainers, lay counselors and home-based carers. SACTWU also has an
HIV and AIDS awareness workplace program where trainers take the training to floor level in 30-minute
sessions in the factories. The major emphasis of the workplace program is on prevention. A particular focus
of the SACTWU's program is to create greater gender equity in HIV and AIDS programs and address male
norms and behaviors.
Previously, although work was done in this specific area of prevention, all activities were addressed in the
area "prevention through behavioural change beyond abstinence and/or being faithful". This has been
modified to allow for activities in "prevention through abstinence and/or being faithful" to occur and be
reported on separately.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Training
One of the key objectives of SACTWU's training program is to educate shop stewards as master
trainers/peer educators. This enables them in delivery of messages and information that directly address
the issue of the prevention of HIV, to workers at the workplace. Emphasis is placed on behavioral change
and the following topics are addressed: the effectiveness of abstinence in the prevention of HIV and
sexually transmitted infections (STIs) and family planning; risk reduction through mutual fidelity and the
importance of protecting one's family by staying negative; risk reduction through the reduction of multiple
partners; and the need for parents to educate their children in the advantages of delaying sexual activity.
Shop steward training is typically last from two to five days. At least one course per week will be offered with
expected average attendance of about 20 participants per course. This training is conducted by SACTWU's
internal trainers. Due to current gender inequalities, a key objective for FY 2009 is to develop an outreach
training program aimed at training female adolescents at schools as peer educators in the areas of
prevention, including abstinence and being faithful (AB), gender-based abuse and violence, and HIV risk
reduction through the avoidance of alcohol and drug abuse.
ACTIVITY 2: Workplace Theatre
A fulltime drama group based in KwaZulu-Natal provides workplace theater at factories during tea and lunch
breaks. Different scripts have been developed to address HIV-related topics including AB; STIs; correct
condom usage; TB; and antiretroviral treatment. Recently, a sixth script has been developed to address
prevention among adolescents with particular focus on abstinence, the advantages of delayed sexual
activity and/or being faithful. The drama club will do outreach work at one or more high schools per month
within the communities that SACTWU members live and work. It is anticipated that targets will be increased
in this program area due to this outreach work.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $18,500
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Activities that started in FY 2008 will continue in FY 2009.
-Condom dispensers will be inserted in 150 factories associated with SACTWU. It is planned that 375,000
male condoms and 6,000 female condoms will be distributed.
- During the month of April each year, an annual blitz is held in the industry where factories are visited by
internal shop steward master trainers, and workers are educated on specific prevention messages. It is
anticipated that 50,000 workers will be reached.
- The South African Clothing and Textile Workers' Union (SACTWU) Worker Health Program trainers will
also provide workplace training throughout the year. This is made up of a 30 minute training module
conducted at factories. Approximately 30 factories will be visited throughout the year where 5,000 workers
will be educated on the above stated issues relating to prevention.
- The drama group will conduct workplace drama, with a particular script delivering abstinence and being
faithful prevention messages. The group will perform this script at an estimated 30 factories, relaying the
message to an estimated 5,000 workers. SACTWU has two months of shutdown in the industry over
December and January; therefore the projected annual targets are divided over 10 months.
The following modifications apply:
Recently, a new script has been developed for the drama club addressing tuberculosis (TB), which will be
performed at factories educating workers on this topic. It is also intended for the drama club to do outreach
work at at least one high school per month within the communities that SACTWU members live and work. It
is anticipated that targets will be increased in this program area due to this outreach work.
Further outreach work is planned at schools based within communities in which SACTWU members live
and work. Twenty five female adolescents will be trained as peer educators in the following prevention
areas: abstinence, being faithful, gender-based abuse and violence, and risk reduction through the
avoidance of alcohol and drug abuse. All current peer educator and workplace training material was
updated and revised in July 2008. In the new training material, including the script targeting adolescents, a
greater emphasis has been placed on risk reduction through the avoidance of alcohol and drug abuse. This
is directly due to the high prevalence rate of substance abuse amongst SACTWU's members and their
families.
All nurses and lay counsellors will be trained to ensure that drug and alcohol education is included within
the voluntary testing and counseling (VCT) services provided at SACTWU's VCT sites. Currently, education
on abstinence and/or being faithful is also included in the training provided by lay counsellors based at
SACTWU's VCT sites.
---------------------
The Southern African Clothing and Textile Workers Union (SACTWU) project has received PEPFAR
funding in previous years through a sub-agreement with the Solidarity Center, but in FY 2007, SACTWU
received direct PEPFAR funding. SACTWU has a well-structured training program, initiated in 1999, that
has evolved within the dynamics of the industry and includes basic facts on HIV, AIDS, abstinence, being
faithful and condom use. The major emphasis area of the activity is training. Target populations include
factory workers and people affected by HIV, HIV-infected adults, especially women, and the business
community.
The Southern African Clothing and Textile Workers Union is South Africa's largest trade union organizing
textile and clothing workers. It also organizes footwear, leather and retail workers. Hence, SACTWU
members form part of the economically active population that has been identified as being the hardest hit by
the HIV and AIDS epidemic. Further, around 66% of SACTWU's membership is female, mostly between 20
and 60. The prevention program is a three-level training program that starts with a foundation phase on the
basic facts of HIV and AIDS, abstinence, being faithful and consistent and correct condom use (ABC). In FY
2008 the training will focus specifically on the issues of multiple concurrent partnerships, and
intergenerational sex. These facts are reinforced and strengthened with the intermediate and advanced
modules of training. The intermediate module deals with legal aspects and workplace policy development.
In the advanced module, delegates are trained to become trainers, lay counselors and home-based carers.
SACTWU also has an HIV and AIDS awareness workplace program where trainers take the training to floor
level in 30-minute sessions in the factories. The major emphasis of the workplace program is on prevention.
A particular focus of the SACTWU AIDS Program is to create greater gender equity in HIV and AIDS
programs and address male norms and behaviors.
SACTWU has a membership of approximately 110,000 members nationally. The SACTWU AIDS Project is
a national program that provides prevention and care services in five provinces: KwaZulu-Natal, Western
Cape, Gauteng, Eastern Cape and Free State. The SACTWU AIDS Project was initiated in 1998 and
developed a national comprehensive program, with an initial focus on prevention. It has matured over the
years to the point where it now has a well-structured comprehensive training program, provides "in house"
voluntary testing and counseling (VCT) services, access to a social worker in KwaZulu-Natal, runs income
generating workshops, provides a primary package of care through the VCT service, and provides home-
based care through its regional nurses and a home-based care network in KwaZulu-Natal. The nurses
provide some level of support in the home through home visits, but this activity is mainly implemented by
the home-based care network of 19 home-based carers who provide ongoing home-level support.
Activity Narrative: ACTIVITY 1: Training
The training program serves as an education program and addresses stigma and discrimination associated
with HIV status for all workers, shop-stewards, managers and healthcare staff within the industry nationally.
It also serves as an instigator for the demand for the care and treatment services offered through the
SACTWU AIDS Project, including counseling and testing, and antiretroviral treatment. With PEPFAR
funding SACTWU employs two trainers and a training coordinator fulltime to deliver all prevention programs
in-house and achieve set targets. This activity will aim to educate shop-stewards and workers within the
industry in the five provinces where the program is active and to address issues of HIV prevention, stigma
and discrimination by empowering the delegates and repeatedly reinforcing the facts on HIV. The basic
module emphasizes the ABC message of the South African government and aims to prevent new
infections. SACTWU also has an intermediate module that deals with the worker's rights and HIV as well as
development of workplace policies. Empowering individuals on their rights directly addresses the issue of
stigma and discrimination. Workplace training is done throughout the year, but with additional focus in April
and December. This training will be expanded in FY 2008 to cover additional sites and services added to
the program, including a focus on the issues of children (pediatric HIV care and treatment), and TB.
ACTIVITY 2: Condom Distribution:
The SACTWU AIDS program will distribute male and female condoms. One of the reasons why the
epidemic is more prevalent among women is the lack of power of women in the relationship, which impacts
on negotiating condom use. By making available the female condom SACTWU allows women additional
protection if the male partner refuses to wear a condom. The prevention training is complemented by
activities like the condom man campaign as well as using drama to reinforce the prevention message--this
helps to get HIV "out of the closet" and make it an interactive and informal discussion. The training focuses
on the correct and consistent use of condoms, as per Department of Health training guidelines.
PEPFAR funding will be used for human resources costs related to the prevention program. These activities
support the overall PEPFAR objectives of 7 million infections averted.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13818
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13818 7933.08 HHS/Centers for South African 6624 4632.08 $125,000
Disease Control & Clothing & Textile
Prevention Workers' Union
7933 7933.07 HHS/Centers for South African 4632 4632.07 New APS 2006 $90,000
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.03:
In order to provide comprehensive and quality services to the Southern African Clothing and Textile
Workers Union (SACTWU) members and their families suffering from HIV/TB, SACTWU has recently
negotiated and signed a memorandum of understanding (MOU) to build capacity and support at St Luke's
Hospice in the Western Cape. SACTWU is currently in negotiation with a similar facility in KwaZulu-Natal.
With SACTWU's support, St Luke's has been able to reopen a ten-bed ward that has been closed due to a
lack of funding. Although SACTWU members will be provided with preferential access to these services,
the use hereof will be extended to any HIV/TB-infected individual requiring care.
In order to provide a quality home-based care program, unemployed former SACTWU members will be
trained on the national accredited home-based care program. This will consist of a full-time six-week home-
based care and mentorship course which will then be complimented with DOTS training. Ex SACTWU
members are trained on the national training program. It is a 59-day course inclusive of practical and
theory. Theory work covers: home-based care (HBC) ethics; physical, social, psychological & spiritual
needs of the client; creating a caring, safe environment; communication; sexually transmitted infections,
HIV/AIDS/TB infections and control; nutrition; basic anatomy and physiology and common disease
management. 180 hours is spent in the classroom on practical work, such as hygiene promotion, pressure
care, basic observations, catheter care, nutritional care after which the carers are placed at care centres
and receive four weeks on site practical experience. With FY 2009 funding, it is planned that these
services will expand to all areas in the geographic scope of the project.
A home visit will be made and a psychosocial assessment will be conducted for all clients being initiated
onto ART. A report is provided at the multidisciplinary team meeting on this assessment. Integrated
Management of Childhood Illnesses (IMCI) components will be added to the current home assessment
forms as well as to the home-based care visitation forms.
As the bargaining council clinics offer services to SACTWU members and their dependants, a family
centered approach will be adopted at all sites and an early referral and retention in care service will be
promoted. Wellness programs have been initiated at all sites for individuals that are HIV but not eligible for
antiretroviral therapy (ART). Services include the support and encouragement of status acceptance and
disclosure; psychosocial support; partner counseling and testing; prevention for positives; treatment literacy
and adherence counseling and family support groups and counseling. A six-month cohort and defaulter
system has been introduced to enable prompt follow up and tracing of individuals that do not return to the
service outlet.
All care givers will be provided with ongoing psychosocial support in the way of group debriefing sessions
provided by an external provider.
Skills development workshops will be implemented in all five provinces in which SACTWU services are
provided. SACTWU has an existing care component for the program in KwaZulu-Natal which includes
building capacity for HIV-infected workers and their families. The following skills development workshops
are conducted which are geared as income generating activities for participants. These workshops currently
include but are limited to the following: beadwork; food gardens; quilting; and floral arranging. It is planned
to roll out the skills development workshops to all five provinces in which SACTWU operates. SACTWU
plans to hold workshops once per month in all five provinces, with each session lasting up to three hours.
------------------------
factory workers and people affected by HIV, HIV-infected women and business/ community/ private sector.
the HIV and AIDS epidemic. Further, around 66% of SACTWU's membership is female. The prevention
program is a three-level training program that starts with a foundation phase on the basic facts of HIV and
AIDS, abstinence, being faithful and consistent and correct condom use (ABC). The FY 2008 the training
will focus specifically on the issues of multiple concurrent partnerships, and intergenerational sex. These
sessions in the factories.
testing and counseling (CT) services, access to a social worker in KwaZulu-Natal, runs income generating
workshops, provides a primary package of care through the CT service, and provides home-based care
Activity Narrative: through its regional nurses and a home-based care network in KwaZulu-Natal. The nurses provide some
level of support in the home through home visits, but this activity is mainly implemented by the home-based
care network of 19 home-based carers who provide ongoing home-level support.
SACTWU has not received PEPFAR funding for palliative care before. However, though the activities are
new, they support the current prevention, counseling and testing (CT) and ARV services components.
SACTWU has an existing care component for the program in KwaZulu-Natal. These include counseling and
therapeutic services on social problems to workers and their dependants within the industry to enhance
their social functioning; to provide psychosocial support to HIV-infected workers and their families, including
support groups; building capacity by running skills development workshops (e.g., food gardens, beadwork
skills, cooking, cushion-making skills, and candle making skills). These activities are geared as income
generating activities for participants.
In addition the FY 2008 funding provides for the palliative care of the ARV services program, including:
screening for pain and symptoms; screening for TB, STI and OI including the management of opportunistic
infections; cotrimoxazole prophylaxis; support groups for people on antiretroviral treatment, support groups
for those who are HIV-infected but not yet on treatment, integrated preventions services, including
prevention with positives and nutrition assessment, counseling and support.
The training programs involve skills transfer for income generation to the targeted participants. These
participants include HIV-infected members of SACTWU and their families. The training frequency is
expected to be once per month, lasting between 2 and 3 hours for each session.
For health workers, SACTWU has an in-house home-based care training program. There are 3 levels of
training: Phase 1 - 2 day theory, 2 day Practical; Phase 2 - Mentorship Program; and Phase 3 - Field
Assessment. The mentorship program is conducted at a step-down facility. The field assessments are
conducted by the regional nurse who assesses the home-based carers on their skills at the home of a
client. Once the assessments are complete the home-based carers are required to conduct 3 home visits on
their own. Once the home-based carers have successfully completed the 3 home visits they are given a
certificate of competency and are then deployed to provide service
With FY 2008 funding, these services will expand to the Western Cape, and possibly to other areas in the
geographic scope of the project.
The SACTWU activities support the PEPFAR 2-7-10 goals of reaching 10 million people with care.
Continuing Activity: 13821
13821 13821.08 HHS/Centers for South African 6624 4632.08 $300,000
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $25,000
Estimated amount of funding that is planned for Economic Strengthening $20,000
Estimated amount of funding that is planned for Water $2,000
Table 3.3.08:
In March 2008, a mobile clinic was purchased by way of a sub-grant from The Solidarity Centre. Although
this will initially be used as a mobile voluntary counseling and testing (VCT) clinic, servicing factories within
the Amajuba and Uthikhela districts, it is anticipated that in FY 2009, workers that have been initiated on
treatment at public sector clinics and are stable, will be "down referred" and managed by this clinic. This
clinic is manned by a professional nurse, an enrolled nurse and a lay counselor/driver.
Similarly, HIV counseling and testing (CT) has been rolled out at seven bargaining council clinics in the
Western Cape. Within the clinics, lay counselors offer counseling and education on prevention to clients in
the waiting rooms.
Currently in the Western Cape, patients testing HIV-positive are being referred to public sector clinics.
However, it is anticipated that a Wellness Program will be piloted at Salt River Clinic, one of the seven
bargaining council clinics. CD4s, viral loads and other baseline tests will be conducted as will sexually
transmitted infection (STI) and TB screening and testing. The Western Cape Department of Health
(WCDOH) has committed to cover the costs of all lab tests up until the end of Quarter 1 FY 2008. It is
currently being negotiated that this agreement be extended for a greater period of time. Negotiations are
currently underway to utilize these clinics as "down referral" sites for all SACTWU members and their
dependants that have been initiated onto treatment at Department of Health (DOH) facilities and considered
to be clinically stable.
To ensure continuous improvement and quality of care, antiretroviral therapy (ART) clinical staff are
provided with didactic training and onsite mentorship. The didactic training is provided by another PEPFAR
partner, The Foundation for Professional Development and the medical faculty of the University of KwaZulu-
Natal. All lay counselors are trained in defaulter tracing and treatment adherence and provide such
interventions where necessary.
Micronutrient supplements are provided where indicated e.g. when clinical assessment indicates
inadequate dietary intake to meet basic vitamin and mineral supplements. Food supplements are also
provided to severely and moderately malnourished people living with HIV (PLHIV). At the skills
development workshops, PLHIV are also taught skills to develop food gardens and provided with seeds.
The social worker makes a home visit prior to any HIV client being initiated onto antiretroviral treatment. A
psychosocial assessment is completed and a report is presented at the pre-initiation multi-disciplinary team
meeting. Included in this assessment is a report on the client's availability and access to clean water as well
as their ability to store clean water within their homes. Lay counselors provide hygiene education and
promote hand washing with soap when conducting educational talks in the bargaining clinic waiting rooms.
All HIV clients are initiated onto cotrimoxazole prophylaxis prior to being initiated onto anti retroviral therapy.
Screening and treatment for the prevention of cervical cancer in HIV-infected women will be routinely
conducted.
----------------------------
The Southern African Clothing and Textile Workers Union (SACTWU) has a comprehensive HIV program
that has received PEPFAR funding in the past through a sub-agreement with the Solidarity Center. In FY
2007, SACTWU received direct PEPFAR funding for prevention, care and treatment activities, with the
prevention and care program focused in five provinces: KwaZulu-Natal, Western Cape, Gauteng, Eastern
Cape and Free State. The treatment program is currently limited to KwaZulu-Natal, but will add activities in
Free State and Western Cape in FY 2008. The emphasis areas are gender, human capacity development,
local organization capacity building, and workplace programs. The target population of the overall program
is factory workers.
The Southern African Clothing and Textile Workers Union is South Africa's largest trade union supporting
textile and clothing workers. It also supports footwear, leather and retail workers. Hence, SACTWU
members form part of the employed population. SACTWU has a membership of approximately 110,000
members nationally, of which 66 percent is female.
The SACTWU AIDS Project is a national program that provides services in five provinces. The SACTWU
AIDS Project was initiated in 1998 and developed a national comprehensive program. It has matured over
the years to the point where it now has a well-structured comprehensive training program, provides in-
house voluntary and counseling services, provides access to a social worker in KwaZulu-Natal, runs income
-generating workshops, provides a primary package of care through the voluntary and counseling testing
service, and provides home-based care through its regional nurses and a home-based care network in
KwaZulu-Natal.
SACTWU initiated a pilot antiretroviral therapy program in the KwaZulu-Natal province as a public-private
partnership (PPP) with the Department of Health in FY 2007. SACTWU utilizes South African government
protocols. SACTWU has designed confidentiality protocols as well as client care flowcharts, and is working
closely with the King Edward VIII Hospital in Durban to ensure a formal confidential referral system via a
public-private partnership.
SACTWU will contract medical practitioners to provide treatment services as per the South African
guidelines and eligibility criteria. Lay counselors or field workers will be employed (one per site) as well as
Activity Narrative: one contracted social worker per site to serve as part of the multidisciplinary team. The long-term goal will
be to develop a partnership with the public sector to replicate the model developed with the King Edward
Hospital where the clients are prepared for initiation of treatment (which includes laboratory tests, and
adherence counseling sessions), then referred to King Edward VIII Hospital for the initiation of treatment,
and then down referred back to SACTWU once stable. The South African government will provide the
antiretroviral drugs for the program. Patients will be identified for the program through the counseling and
testing program, in one established site and two new rural sites in KwaZulu-Natal. In addition, patients will
be referred from the existing SACTWU home-based care program, factories and the Bargaining Council
Clinic in KwaZulu-Natal. In partnership with the Dream Centre in Durban, patients will have access to step-
down care.
The aim in FY 2008 is to train shop-stewards and volunteers as home-based carers. This training will be
done in collaboration with a Belgian-based trade union (ABVV), which supports the clothing, textile and
leather sectors in Belgium. This is a long-standing cooperation relationship.
In FY 2008 this pilot will be expanded to two additional sites in KwaZulu-Natal. In addition to the two new
sites in KwaZulu-Natal, SACTWU will also add a site in the Free State (a mobile clinic), and one in the
Western Cape.
The services provided, beyond the standard counseling and testing, palliative care, and ART (as piloted in
KwaZulu-Natal), will be expanded to include a pediatric ART component. This will be done by strengthening
the family-centered approach to ensure that workers in the factories have the opportunity to bring their
children for HIV care and treatment. In addition the new site in Western Cape will focus specifically on
ensuring HIV care and treatment for TB patients (due to the high prevalence of TB in that area).
The SACTWU activities support the PEPFAR 2-7-10 goals.
Continuing Activity: 13820
13820 7934.08 HHS/Centers for South African 6624 4632.08 $450,000
7934 7934.07 HHS/Centers for South African 4632 4632.07 New APS 2006 $510,000
Estimated amount of funding that is planned for Human Capacity Development $5,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Table 3.3.09:
funding in previous years through a sub-agreement with the Solidarity Center. In FY 2008, SACTWU started
receiving direct PEPFAR funding. SACTWU has a well-structured training program, initiated in 1999, that
well-structured comprehensive training program, provides workplace theater, in house voluntary counseling
and testing (VCT) services, access to a social worker in KwaZulu-Natal, income-generating workshops, a
primary package of care through the VCT services, and home-based care through its regional nurses and a
Another PEPFAR partner, TB Care Association, has committed to provide 50 home-based caregivers with
DOTS training for TB/HIV, which is in accordance with the South African Tuberculosis Strategic Plan for
South Africa, 2007-2011. This training will be in addition to home-based care training.
SACTWU's VCT/home-based care manager will be trained as a master trainer on the PALSA Plus training
program offered the Western Cape Department of Health. This training program covers all key TB activities
such as routine screening of all VCT and people living with HIV (PLHIV); counseling for all TB suspect
clients; TB infection control; HIV/TB co-infection management; isoniazid prophylaxis and effective recording
and reporting. The master trainer will provide PALSA Plus training to 30 professional nurses employed at
SACTWU service outlets in the five provinces in which SACTWU is based. All "master" training materials
will be provided by the Western Cape Department of Health.
In order to provide a quality home-based care program and to ensure true quality of care, unemployed, ex-
SACTWU members will be trained on the national accredited home-based care program. This will consist of
a full-time six-week home-based care and mentorship course, which will then be complemented with DOTS
training. In accordance with the national guidelines, service outlet staff will be trained and provided with
continuous education, home-based caregivers will be trained in accordance with the DOTS strategy and
National Department of Health's TB policies and guidelines.
ACTIVITY 2: Workplace Theater
breaks. Different scripts have been developed addressing aspects of HIV, with one script focused on TB
topics. It is anticipated that the TB script will be delivered at a minimum of two factories per month.
ACTIVITY 3: Screening and Testing
Routine TB screening is conducted on all clients provided with VCT and all self-referred TB suspects are
routinely offered HIV counseling and testing. Sputum testing is conducted where indicated and all TB clients
are referred to Department of Health (DOH) facilities for treatment. Referrals are conducted by way of initial
telephonic contact made by the referring clinician to the DOH facility. Where possible, an appointment is
made. The client is then given a referral letter and instructed to deliver this letter to the clinician at the
referred DOH facility. Again, wherever possible, the patient is given the name and details of the actual
clinician to whom they have been referred.
VCT is currently conducted at factories in all five provinces. From July 2008 TB screening will also be
routinely offered to workers, thereby extending the reach and access to TB screening. DOH TB suspect
registers are currently completed and statistics reported on in the Western Cape and KwaZulu-Natal.
Discussions are currently being held with the provincial Departments of Health in Gauteng, Eastern Cape,
and Free State to sign MOU/service level agreements to enable SACTWU to expand current services,
ensure effective referral and cross referral linkages between TB and HIV service outlets, and to initiate
effective reporting systems in these provinces.
ACTIVITY 4: Palliative Care
Home-based caregivers will be trained to undertake early identification and referral of TB suspect clients
and provide a defaulter tracing system for TB programs. In order to provide comprehensive and quality
services to SACTWU members and their families suffering from TB/HIV, SACTWU has recently negotiated
Activity Narrative: and signed an MOU to build capacity and support at St Luke's Hospice in the Western Cape. SACTWU is
currently in negotiation with a similar facility in KwaZulu-Natal. With SACTWU's support, St Luke's has been
able to reopen a 10-bed ward that has been closed due to a lack of funding. Although SACTWU members
will be provided with preferential access to these services, the use hereof will be extended to any HIV/TB
individual requiring care. St Luke's is a TB step-down facility.
All HIV clients in which TB has been ruled out will be routinely provided with isoniazid prophylaxis therapy.
Negotiations are also underway with the Departments of Health in the Western Cape and KwaZulu-Natal to
cover the costs of Isoniazid treatment.
ACTIVITY 5: Infection Control
SACTWU's interventions are in line with the National TB Infection Control Guidelines which promote the
reduction of TB transmission through prompt recognition, initiation of treatment, and referral of suspect TB
clients. In line with these guidelines, risk assessments will be conducted at all service outlets followed up
with a written TB infection prevention and control plan. In accordance with the guidelines, service outlet staff
will be trained and provided with continuous education, home based caregivers will be trained in
accordance with the DOTS strategy and National Department of Health's TB policies and guidelines.
Estimated amount of funding that is planned for Human Capacity Development $45,000
Table 3.3.12:
In April 2008 a counseling and testing (CT) and home-based care (HBC) manager was employed to
oversee the CT and HBC programs. CT has been extended to include workplace testing in KwaZulu-Natal
by way of a mobile clinic servicing the Amajuba and Uthikhela districts in KwaZulu-Natal. In addition to this,
CT has been rolled out to include seven bargaining clinics based in the Western Cape. Ten ex shop
stewards and South Africa Clothing and Textile Workers' Unioin (SACTWU) members were employed as
lay counselors and underwent an intensive 10 day training course. Two of these counselors are now based
at James Bolton Clinic in Durban, one works from the mobile clinic, seven are based at the seven
Bargaining Council clinics based in and around the Western Cape and one counselor assists the VCT
Manager in doing VCT at factories within the Western Cape. A lay counselor will be employed at each of
the remaining sites viz: Gauteng, Eastern Cape and Central and it is anticipated that with additional
capacity, the number of clients tested at the workplace will increase. Within the clinics, lay counselors offer
counseling and education on prevention to clients in the waiting rooms.
Currently in the Western Cape, patients testing positive for HIV are being referred to public sector clinics.
However, it is anticipated that a wellness program will be piloted at Salt River Clinic, one of the seven clinics
bargaining council clinics. CD4 counts, viral loads and other baseline tests will be conducted as will sexually
transmitted infection (STI) and tuberculosis (TB) screening and testing. The Western Cape Department of
Health (DOH) has committed to cover the costs of all lab tests up until the end of Quarter one of FY 2008. It
is currently being negotiated that this agreement be extended for a greater period of time.
In March 2008, a mobile clinic was purchased by way of a sub-grant from the Solidarity Center. This will
initially be used as a mobile voluntary counseling and testing (VCT) clinic, servicing factories within the
Amajuba and Uthikhela districts. STI and TB screening and testing services will also be provided. It is
anticipated in FY 2009 that workers that have been initiated on treatment at public sector clinics and are
stable, will be "down referred" and managed by this clinic. This clinic is manned by a professional nurse,
enrolled nurse and a lay counselor/driver.
During FY 2009, SACTWU has committed to provide lay counseling and adherence training to 30 ex-
SACTWU members that have retired or that have been retrenched due to the closure of factories within the
clothing and textile industry. Two modules will be conducted once a week over a period of 10 weeks.
Clinical staff will also be provided with "provider initiated counseling and testing" training and phlebotomy
training. New staff will be provided with onsite training on the policies and procedures and use of rapid test,
injection safety and waste management. Standard operating procedures are provided to all CT service
outlets and updated regularly to ensure the provision of a quality service. As the Bargaining Council clinics
are family centric, couple counseling and testing is strongly encouraged within these service outlets.
Additional training will be provided to all lay counselors in this regard and will readdress disclosure
counseling. All staff has been trained on prevention-with-positives and will provide counseling and conduct
interventions thereon with emphasis placed on discordant couples.
The Western Cape Department of Health (DOH) has requested SACTWU to assist them in the development
of a CT flip chart that will be utilized at all DOH CT outlets within the province.
This activity will provide access to comprehensive voluntary counseling and testing (CT) services in five
provinces with initial emphasis in KwaZulu Natal. The Southern African Clothing and Textile Workers Union
(SACTWU) program will provide training, support and supervision to CT counselors. SACTWU has five
existing CT sites and intends to establish two additional sites in KwaZulu-Natal and one site in Western
Cape, the two provinces with the largest union membership. Target populations include factory workers,
nurses and other healthcare workers. CT services will be on site at the factory health facility.
textile and clothing workers. It also organizes footwear, leather and retail workers. SACTWU members form
part of the economically active population that has been identified as hardest hit by the epidemic and, due
to work constraints, cannot access offsite CT services. Onsite services allows access to all employees
including the nearly 66% of SACTWU's membership which is female.
a national program that provides services in five provinces, KwaZulu-Natal, Western Cape, Gauteng,
Eastern Cape and Free State. The SACTWU AIDS Project was initiated in 1998 and developed into a
national comprehensive program. Prior to FY 2007 SACTWU received PEPFAR funding as a sub-grant
from the Solidarity Center. The voluntary counseling and testing (CT) program was initiated in June 2002
and is ongoing nationally, and received PEPFAR funding in FY 2006 through the sub-agreement. In FY
2007, SACTWU became a prime partner and received direct funding to scale up services in KwaZulu-Natal.
ACTIVITY 1: Capacity Building for Counseling and Testing (CT) Services
This activity will provide access to workplace CT services for SACTWU members and their dependents who
are members of the communities in the five provinces, starting in KwaZulu-Natal. SACTWU has three
general settings for service delivery: (1) the clinic setting, (2) the regional office setting, and (3) stand-alone
sites within factory-based settings. This project, however, emphasizes is on the factory-based health facility
Activity Narrative: setting. The program also includes training, support and supervision of CT counselors using the National
Department of Health (NDOH) training model. PEPFAR funds will be used for human resources to employ
nurses and counselors who will provide CT services, infrastructure (minor refurbishment), procurement of
test kits, quality assurance using NDOH guidelines and supportive supervision and capacity development of
the counselors. The nurses will provide a rapid test while lay counselors will perform pre- and post-test
counseling. The site will be a down-referral site for ART and provide dispensing for antiretroviral treatment
(ART) and care/support services. Initiation of ART will be done in nearby hospital accredited ART sites.
SACTWU will train lay counselors to provide CT services. The target group for this activity is shop-stewards,
industry healthcare practitioners, and volunteers. The training includes pre- and post-training assessments.
ACTIVITY 2: Commodity Procurement
SACTWU will purchase rapid test kits and other expendable materials from a competitive pharmaceutical
supplier. Purchasing staff will make sure that the tests used are recommended by the NDOH. Quality
assurance testing will be done in compliance with national guidelines.
In FY 2008 SACTWU will expand the CT program to two new sites in KwaZulu-Natal. The national
campaign among clothing and textile workers will be increased significantly with the additional funding.
Community and Family members are also eligible for CT at the SACTWU sites.
The SACTWU activities contribute to the PEPFAR 2-7-10 goals.
Continuing Activity: 13819
13819 7932.08 HHS/Centers for South African 6624 4632.08 $1,000,000
7932 7932.07 HHS/Centers for South African 4632 4632.07 New APS 2006 $400,000
Estimated amount of funding that is planned for Human Capacity Development $15,000
Table 3.3.14:
