The Integrated HIV and AIDS Prevention and Care Project (IHAPC) seeks to support and deliver HIV/AIDS-related palliative care services (care and support), TB HIV, HIV Counseling and Testing (HCT) and Integrated Access to Care and Treatment programme (I-Act) through indigenous community based organizations (CBOs) in Mpumalanga, Limpopo, Free State and Gauteng Provinces. The Project Goal is improved and sustained access to care, support, and treatment for PLHA, ultimately resulting in a decrease in HIV- and AIDS related morbidity and mortality in key districts as agreed with the Department of Health. Objectives and activities will include: Improved management of 24 CBOs that will also receive sub-grants through training and mentoring of management and administrative staff Improved access to quality HCT services through capacity development of CBO staff and HRH Integrated TB services into HIV/AIDS management through scaling up of TB screening among PLHIV and referring suspects for clinical diagnosis And Strengthened referral systems between health facilities and CBOs to ensure continuum of care and support of PLHIV through Home Based Care and support groups such as the I ACT programme and provision of services such as Nutrition Assessment Care and Support (NACS) and PwP programmes.M&ER remains a key focal point in all the above objectives for better understanding of indicators and better management of impact within organizations. To this end, M&E officers have been recruited to mentor and support CBOs in developing strong monitoring and evaluation systems. Vehicles: TOYOTA HILUX, 2,7-YYW 452 GP Vehicle CDC $40,806.59 11-Feb-10.

CARE will facilitate improved and sustained clients care and support from the health facility to the home and communityin the following geographical areas:Province and district (Population per district) HIV prevalenceMpumalanga -Ehlanzeni district ( 1,526.236) 37.7%Free State -Thabo Mofutsanyane district (725.700) 31.3%Limpopo -Mopani District (1,068.569) 25%Gauteng -City of Johannesburg (11, 191 700) 30.4%The project targets HIV positive individuals for linkage and retention into care and support programme. To realise this, efforts are being made to improve both access to and quality of pre-ART care and support. It enhances HBC services by regular in-service training of Community Care Workers (CCW) in new policies and guidelines in addition to the accredited 69 days HBC training. Strategies for expansion of services include community mobilisation and re-defining the role and responsibilities of the CCW within the ongoing PHC re-engineering as key liaisons between communities and facilities. People Living With HIV (PLHIV) are given knowledge and skills to handle issues around HIV/AIDS and to advocate for their own health through the Integrated Access to Care and Treatment (I-ACT) programme which also links them to other social networks for further support and care both in facilities and communities. Continued provision of food supplements to mitigate the vicious cycle of poverty, malnutrition and disease progression.Newly diagnosed HIV positive patients through HCT and HIV TB suspects will be referred to health facilities for HIV clinical staging, entering clients in pre-ART register and for TB diagnostic work-up. This will help to maintain PLHIV on database and to deal with HIV/TB co-infections simultaneously. .The project intends to utilise software, Soweto Care Systems, to streamline data collection and collation processes. This will further improve and strengthen the programme.Should funding allow, workshops for all Care and Support partners will be hosted for learning and sharing lessons learnt in collaboration with DoH and SANAC.

CARE will support the scale up of community TB screening for all people diagnosed HIV positiveThe project integrates TB screening in all HCT programmes. This approach aims to combat HIV/TB co-infections, TB being the commonest and deadliest opportunistic infection in HIV positive individuals. All people diagnosed sero-positive at community level are symptom screened for TB using simple procedures such as presence of chronic cough, unwarranted weight loss etc. TB suspects identified in the community are referred for facility-based diagnostic work-up. All HIV positive clients who test TB negative are encouraged to be on IPT for the duration indicated by the health professional. Treatment Support is given by CCW to those who are on TB treatment through medication supervision. A total of 109 CCW have been trained in clinical TB/HIV, the collation of data and patient tracking and support. And an extra 100 are currently been trained.The project will be aligned to the National Strategic Plan for HIV/AIDS and TB, 2012-2016 (NSP) and the Provincial Operations Plans (POP) in focus provinces. The project has and will continue to conduct sub-districts HCT campaigns in three provinces that will also cover TB screening and other non communicable deceases, in support of the PHC re-engineering.The project will also continue to screen family members of TB positive patients during the HCT campaigns.The project will continue to organize community dialogues to educate communities on matters relating to TB prevention, diagnosis and treatment. This intervention will also target high risk population areas such as informal settlements and farming communities in accordance with the current NSP.

Although the project focus is on adult care and support, the project provides appropriate counselling and referral support to pregnant mothers and children orphaned or made vulnerable by HIV and AIDS. CARE will therefore endeavour to promote increased linkages to relevant child survival and development programmes including vitamin A supplementation; immunization; counselling and support on optimal, safe infant and young child feeding practices, especially in the context of HIV and AIDS; oral rehydration therapy for diarrhoea; antibiotic treatment for pneumonia; and insecticide treated mosquito nets in malaria endemic areas.

Mothers who are pregnant will be directed to PMTCT programmes in their local facilities and followed up as part of support from community based organisations.

CARE will work to expand access to Quality HCT Services.The area of operation is in three provinces of Mpumalanga (Ehlanzeni district), Free State (Thabo Mofutsanyane district), Limpopo (Mopani District) and Gauteng (City of Johannesburg) The project will ensure that CBOs have increased capacity to carry out HCT to enable communities to access high quality testing services. The project will train CCW/Lay Counsellors in HCT in terms of the norms and standards set by the NDoH, which currently allow CCW to administer the HIV test under the supervision of a professional nurse.Currently all CBOs under the project are being prepared for accreditation as non medical HCT centres that will be linked to local health facilities. This will expand access to quality community based HIV testing services to individual, couples (especially providing further referrals to sero-discordant couples), seasonal farm workers and migrants. TB screening is currently integrated with pre-test counselling.The project will facilitate major HCT campaigns per province in collaboration with sub-grantees and primary health care facilities linked to them. Emphasis will be made on Couple HCT campaigns which may take the form of door-to-door campaign targeting Households. Community dialogues are also under way to further mobilise and create health seeking behaviour particularly for HIV/AIDS related services.The above strategies will greatly contribute to the overall NDoH target and foster earlier enrolment into care and support services as per Strategic Objective # 3 of the National Strategic Plan (2012-16).Clients reached 9000(Target) 10912 (Reached in 2011)Individuals HIV tested 15000(Target) 16770 (Reached in 2011)

The project also intends to evaluate the effectiveness of referral systems between communities and facilities and will make recommendations to strengthen referral systems further and reduce loss-to-follow-up.