The goal of Right to Cares (RtC) Systems Strengthening TA model is a) Improve HIV-related patient outcomes by strengthening health and patient management systems at facility, sub-district and district level through capacity building and support; b) Build capacity of facility, sub-district and district management systems in coordination with provinces to strengthen health systems in support of HIV/TB-related services; and c) Provide support for development and implementation of successful SAG policies for HIV related interventions. RtC supports 42 sub-districts in 10 districts in 5 provinces (GP, MP, FS, NC, WC) with MOUs in place. Target populations include district health management teams (DMT), facility managers, health care workers and PLWHAs. RtC emphasises staff transition opportunities wherever possible, facilitating the release of staff from contracts with RtC to take up positions in DoH in clinical and management structures. RtC uses DHIS data complemented by data from TherapyEdge (TE), NHLS, Tier.net, ETR.net, and external surveillance/survey data, to monitor progress towards results. Targets are aligned with national targets, and district-specific targets will be negotiated with DMTs.

Right to Care (RtC) provides direct facility-based care to patients in >60 DoH and NGO facilities, as well as providing TA, in 10 districts across 5 provinces (CoJ in GP; Gert Sibande and Ehlanzeni in MP; Thabo Mofutsanyane in FS; Overberg and Central Karoo in WC; and Frances Baard, Namakwa, Siyanda and JT Gaetsewe in NC).

In terms of Leadership & Governance, Clinical Quality and Innovation, RtC provides TA to the HAST program management by providing key expert input at all levels. Examples are District Joint Review meetings where different sectors integrate their HIV plans, and District Health Management Team meetings where District Health Plans are formulated and monitored. RtC assists with the development of the NACS rollout plan, and supports HCT campaigns, encouraging a focus on key populations, e.g. young women, MSM, migrant/farm labourers, inner city and prisoners. RtC supports the 3 prongs of PHC Re-Engineering. RtC assists with developing and disseminating clinical SOPs aligned to NDoH guidelines. RtC also supports the establishment of District Quality Improvement Teams, which has culminated in several QI projects. RtCs flagship in SRH, the Cervical Cancer (CC) program, now serves 25 clinics with Paps, STI care, colposcopies, LEEPS, and nurse-driven (cost-effective) VIAs and cryotherapy. The CC unit assists in guideline development and was instrumental in the inclusion of cervical and HPV considerations in the NSP.

HR Development is integrated throughout RtC, utilising the expertise of national specialists, provincial managers, trainers, clinical mentors and coordinators, thus forming (sub-)district Mentorship Teams. RtC provides a range of DoH-aligned training activities to HCWs from DoH and partners, including didactic courses; mentoring and onsite training; supportive site visits; clinical conferences and seminars; and (in GP and MP) some pre-service training. This enhances HCWs capacity to deliver quality patient care through better implementation of national guidelines. RtC also assists DoH and Regional Training Centres with development/review of training curricula and materials.

Care-related skills development covers HCT, FP, STI, Counselling Skills, Adherence, and HIV Management. The CC training program covers Paps, LEEPS, colposcopy, VIA and cryotherapy. RtC and DoH conduct joint supervisory monthly visits and regular QA/QI initiatives to address quality gaps, particularly to increase facilities capacity to conduct PICT and improve linkages from HCT into Care and/or MMC; promotion of couple counselling; retention in Care including pathology monitoring and timely ART initiation; prevention and treatment of OIs including TB, CM and KS; provision of CPT and IPT; and referral networks to PLHIV support groups with support of CBOs, and nutritional services.

RtC uses HMIS TherapyEdge (TE) to reduce LTFU rates through automated SMSes, patient transfers with electronic records, and clinical oversight through electronic alerts, and to measure retention along the care continuum, including linkage and early retention in care for newly diagnosed individuals and retention over 24 months. In terms of SI, RtC covers record-keeping and registry management in site visits and training to improve site data quality, and supports DoH with improving DHIS data quality. RtC assists provinces and districts with monitoring progress of key quarterly indicators.

Right to Care (RtC) provides direct services at >60 DoH/NGO facilities, as well as providing TA, in 10 districts across 5 provinces (CoJ in GP; G Sibande and Ehlanzeni in MP; T Mofutsanyane in FS; Overberg and Karoo in WC; and F Baard, Namakwa, Siyanda and JT Gaetsewe in NC).

The aim is to assist DoH to reach NSP targets to halve TB mortality in HIV-infected population and to halve TB incidence by 2016.

In Leadership & Governance, Clinical Quality and Innovation, RtC provides TA to the HAST program by providing key expert input at all levels, e.g. District Joint Review meetings where different sectors integrate their HIV plans, and District Health Management Team meetings where District Health Plans are formulated and monitored. RtC actively participates in TB Guideline committees and assists with developing/disseminating clinical SOPs aligned to DoH guidelines. RtC contributes to TB campaigns and supports District QI Teams, which has culminated in several QI projects.

RtC actively participated in developing the GeneXpert (GXP) strategic plan to improve TB diagnostics in advanced sputum negative TB suspects, ETB specimens, and paed TB, and now provides implementation support, training, and evaluation of the program. RtC participates in the GF R10 application which provides funds for initial phases of GXP implementation. RtC supports operational research on MDR/XDR TB and on identification of further opportunities e.g. ELISA-based testing for urinary TB-LAM antigen. RtC improves rx access for mono-resistant, MDR and XDR patients by supporting drug-resistance treatment sites, community-based MDR rx, and contact tracing and prophylaxis.

HR Development in RtC uses the expertise of its specialists, managers, trainers, clinical mentors, and coordinators, thus forming district Mentorship Teams. RtC provides DoH-aligned training activities, incl didactic courses; mentoring and onsite training; supportive site visits; clinical conferences and seminars; and (in GP and MP) pre-service training. RtC also assists DoH and Regional Training Centres with development/review of training curricula and materials.

TB-related skills development covers TB Diagnosis and Treatment, Paed TB, Infection Control, and TB Counselling. RtC and DoH conduct joint QA/QI initiatives and supervisory monthly visits, particularly to increase facilities capacity to integrate HIV and TB services incl increased PICT uptake and universal TB symptom screening; expanded implementation of IPT and CPT guidelines; intensified case finding with improved TB notification and TB treatment initiation; better TB completion and cure rates; improved ART initiation and adherence rates; and linkages and referral networks to DOTS, nutritional assessments, and non-clinical services. Paed TB services is a particular focus area. RtC works towards revitalisation of Infection Control Committees and compliance with quarterly IC assessments.

In terms of SI, RtC covers record-keeping and registry management in site visits and training to improve site data quality, and will support DoH with improving ETR.net data quality. RtC assists provinces and districts with monitoring progress of key indicators.

Right to Care (RtC) privides direct site-based care to paeds in >60 DoH/NGO facilities, as well as providing TA, in 10 districts in 5 provinces (CoJ in GP; G Sibande and Ehlanzeni in MP; T Mofutsanyane in FS; Overberg and Karoo in WC; and F Baard, Namakwa, Siyanda and JT Gaetsewe in NC).

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RtC has established 2 referral/training sites for management of complicated cases, with plans for a third. Adolescent clinic days are held at 3 sites, offering adolescent-specific adherence counselling; treatment simplification (daily fixed-dose combinations); supervision of treatment dosing; psychological support including adolescent support groups; and age-appropriate disclosure of HIV status.

In Leadership & Governance, Clinical Quality and Innovation, RtC provides TA to the HAST program by providing key expert input at all levels, i.e. District Joint Review meetings where different sectors integrate their HIV plans and District Health Management Team meetings where District Health Plans are formulated and monitored. RtC assists with developing the NACS rollout plan, and supports the PHC Re-Engineering. RtC provides input to the National Paediatric Treatment Guidelines and HIV Clinicians Society guidelines for diagnosis and treatment of paediatric resistance, particularly 3 class failure. RtC assists with developing and disseminating clinical SOPs aligned to NDoH guidelines, and supports District Quality Improvement Teams.

HR Development is integrated throughout RtC, utilising the expertise of national specialists, provincial managers, trainers, clinical mentors and coordinators, thus forming (sub-)district Mentorship Teams. RtC provides a range of DoH-aligned training activities to HCWs, including didactic courses; mentoring and onsite training; supportive site visits; clinical conferences and seminars; and (in GP and MP) some pre-service training. RtC also assists DoH and Regional Training Centres with development/review of training curricula and materials.

Skills development covers Paeds NIMART, Paeds HIV Management and Virological Resistance, and Paeds Adherence Counselling. RtC conducts annual provincial paediatric conferences. The RtC Paeds E-Discussion Group disseminates info to >1800 HIV clinicians nation-wide and the 24/7 Paediatric ART helpline provides HCWs with access to consultation support.

RtC and DoH conduct joint QA/QI initiatives and supervisory monthly visits, particularly to increase facilities capacity to integrate paediatric/adolescent ART into NIMART; integration of IMCI & PALSA PLUS; close linkages to PMTCT services for early infant diagnosis, treatment referral and infant CPT; paediatric retention in care including pathology monitoring and timely ART initiation; OI management including provision of CPT and IPT; nutritional evaluation and malnutrition care; and referral networks to social and OVC services.

RtC uses HMIS TherapyEdge (TE) to reduce LTFU rates through automated SMSes, patient transfers with electronic records, and clinical oversight through electronic alerts, and to measure retention along the care continuum, including linkage and early retention in care for newly diagnosed paeds and retention over 24 months. RtC covers record-keeping and registry management in site visits and training to improve site data quality, and supports DoH with improving DHIS data quality. RtC assists provinces and districts with monitoring progress of key indicators.

RtC assists with developing/reviewing guidelines on PMTCT, TB (incl MDR), MMC, Adult and Paed ART, Cervical Cancer etc.

RtC assists with coordinating GeneXpert activities by various partners, primarily looking at GXP MTB/Rif as diagnostic tool for MDR TB, ETB, Paed TB, and HIV+ TB suspects.

RtC supports 3-Tier Strategy DITs/PITs in all areas, plus national TWG. RtCs current 9 Master Trainers assist with Tier.net rollout (130 sites so far) incl back-capturing/data cleaning; flow of dispatch files; training data staff; reviewing and verifying data on Tier.net and paper registers; and proper use of clinical stationery. Recruitment is underway for 22 Data Quality Mentors. Whilst awaiting DoH tier 3 system, RtC maintains HMIS TherapyEdge (TE) at selected sites, which has automatic download of blood results from NHLS into TE to improve lab data usage, as well as resistance testing.

Right to Care (RtC) provides direct services in >60 DoH and NGO facilities, as well as PMTCT TA in 10 districts across 5 provinces (CoJ in GP; Gert Sibande and Ehlanzeni in MP; Thabo Mofutsanyane in FS; Overberg and Central Karoo in WC; and Frances Baard, Namakwa, Siyanda and JT Gaetsewe in NC).

The target is to assist DoH to reduce MTCT to <2% at 6 weeks and <5% at 18 months, striving towards the goal of zero new children with HIV.

In terms of Leadership & Governance, Clinical Quality and Innovation, RtC provides TA to the HAST program management by providing key expert input at all levels. Examples are District Joint Review meetings where different sectors integrate their HIV plans, and District Health Management Team meetings where District Health Plans are formulated and monitored. RtC contributes to the development of PMTCT Action Frameworks integrated with MNCWH, and facilitates the establishment of district steering committees and formulation of District Action Frameworks. RtC works with DoH to integrate PMTCT, MCWH and FP services at sites (more details on Cervical Cancer program under HBHC). RtC assists with developing and disseminating clinical SOPs aligned to NDoH guidelines. RtC also supports the establishment of District PMTCT / MNCWH Quality Improvement Teams, which has culminated in QI projects in several sites thus far. RtC contributes to the development of implementing plans for the Nutrition, Assessment, Counselling and Support (NACS) approach, including Infant and Young Child Feeding services, and RtC is involved with the piloting of the Mother and Baby Friendly Hospital Initiative (MBFI).

Human Resources Development is integrated throughout RtC, utilising the expertise of all national specialists, provincial managers, trainers, clinical mentors, and district coordinators, thus forming (sub-)district Mentorship Teams. RtC provides a range of DoH-aligned training activities to HCWs from DoH and partners, including didactic courses; mentoring and onsite training; supportive site visits; clinical conferences and seminars; and (in GP and MP) some pre-service training. This enhances HCWs knowledge and skills and their capacity to deliver quality patient care through better implementation of national guidelines. RtC also assists DoH and Regional Training Centres with development / review of training curricula and materials.

PMTCT-related skills development covers Infant Diagnosis, PMTCT, BANC, IMCI, EPI, FP and IUCD insertion. RtC and DoH conduct joint supervisory monthly visits to address quality gaps, particularly to improve PICT uptake at ANC incl 32week retest, access to CD4 testing, AZT and HAART initiation rates, ARV adherence, and infant prophylaxis and testing uptake. All RtC coordinators are being trained in lactation management and will roll out this training to HCWs at sites. RtC is involved in the initiative of starting a Milk Bank in MP.

In terms of SI, RtC covers record-keeping and registry management in site visits and training to improve site data quality, and supports DoH with improving DHIS data quality. RtC assists provinces and districts with monitoring progress of the central (dashboard and cascade) quarterly indicators.

Right to Care (RtC) provides direct services to patients at >60 DoH and NGO facilities, as well as providing TA, in 10 districts across 5 provinces (CoJ in GP; G Sibande and Ehlanzeni in MP; T Mofutsanyane in FS; Overberg and Karoo in WC; and F Baard, Namakwa, Siyanda and JT Gaetsewe in NC).

The aim is to assist DoH to reach NSP targets of 80% of eligible persons started on ART, a 94% retention-on-ART rate at 12 months and 80% rate of blood tests done at 12 months, by 2016.

In terms of Leadership & Governance, Clinical Quality and Innovation, RtC provides TA to the HAST program by providing key expert input at all levels, e.g. District Joint Review meetings where different sectors integrate their HIV plans and District Health Management Team meetings where District Health Plans are formulated and monitored. RtC assists with the ongoing expansion of NIMART and with developing and disseminating clinical SOPs aligned to NDoH guidelines. RtC supports the establishment of District Quality Improvement Teams which has culminated in several QI projects. RtC contributes to the Central Procurement Authority, MCC, SANAC Pharmacovigilance, and EDL guideline committees and was instrumental in inclusion of third-line agents and fixed-dose combinations in the ARV tender. RtC sits on the GP Drug Utilization Review Committee and PTC and assists with revision of provincial medicines formulary and reporting of ADRs.

HR Development is integrated throughout RtC, utilising the expertise of all national specialists, provincial managers, trainers, clinical mentors, and coordinators, thus forming (sub-)district Mentorship Teams. RtC provides a range of DoH-aligned training activities to HCWs, incl didactic courses; mentoring and onsite training; supportive site visits; clinical conferences and seminars; and (in GP and MP) pre-service training. RtC also assists DoH and Regional Training Centres with development / review of training curricula and materials, and liaises with the Pharmacy Council on registration of sites and tutors for the pharmacist-assistant learnership program.

ART-related skills development covers NIMART, HIV Management, Adherence Counselling, and pharmacist-assistant learnerships. RtC and DoH conduct joint QA/QI initiatives and supervisory monthly visits, particularly to increase facilities capacity to provide cotrimoxazole prophylaxis; prevention and optimized management of OIs including TB, CM and KS; drug-resistance screening and referrals; pathology monitoring and timely ART initiation; and linkages and referral networks to non-clinical services.

RtC uses HMIS TherapyEdge (TE) to reduce LTFU rates through automated SMSes, patient transfers with electronic records, and clinical oversight through electronic alerts, and to measure retention and treatment success, including retention on ART up to 60 months, laboratory testing rates, and viral load suppression. The automated download of NHLS blood results into TE ensures better usage of lab data. At several TE sites RtC has ensured access to HIV drug resistance testing and surveillance, as well as access to third line treatment for HIV DR. RtC covers record-keeping and registry management in site visits and training to improve site data quality, and supports DoH with improving DHIS data quality. RtC assists provinces and districts with monitoring progress of key quarterly indicators.

Right to Care (RtC) implements Paediatric ART since 2002 and renders direct services at >60 DoH/NGO clinics plus TA in 10 districts in 5 provinces (CoJ in GP; G Sibande and Ehlanzeni in MP; T Mofutsanyane in FS; Overberg and Karoo in WC; and F Baard, Namakwa, Siyanda and JT Gaetsewe in NC).

RtC has 2 training sites with plans for a 3rd. Adolescent days are held at 3 sites, offering adolescent adherence counselling; treatment simplification (daily fixed-doses); supervision of treatment dosing; psychological support incl adolescent support groups; and age-appropriate disclosure of HIV status.

In Leadership/Governance, Clinical Quality and Innovation, RtC provides TA to HAST program by providing key expert input, e.g. District Joint Review meetings where different sectors integrate their HIV plans and District Health Management Team meetings where District Health Plans are formulated and monitored. RtC assists with developing the NACS rollout plan; supports PHC Re-Engineering; assists with developing/disseminating clinical SOPs aligned to DoH guidelines; supports District QI Teams; and provides input to DoH Paed ART guidelines and HIV Clinicians Society guidelines for dx and rx of paed resistance, particularly 3 class failure. RtC participates in EDL guideline committee and was instrumental in inclusion of third-line agents and fixed-dose combinations in the ARV tender. RtC sits on GP Drug Utilization Review Committee and PTC and assists with revision of medicines formulary and reporting of ADRs.

HR Development in RtC utilises the expertise of its specialists, managers, trainers, clinical mentors and coordinators, thus forming district Mentorship Teams. RtC provides DoH-aligned training activities incl didactic courses; mentoring and onsite training; supportive site visits; clinical conferences and seminars; and pre-service training. RtC assists DoH and Regional Training Centres with development/review of training curricula and materials.

Skills development covers Paed NIMART, Paed HIV Mgt and Virological Resistance and Paed Adherence Counselling. RtC conducts annual prov paeds conferences. The RtC Paeds E-Discussion Group disseminates info to >1800 HIV clinicians and the 24/7 Paed ART helpline provides HCWs with consultation support.

RtC and DoH conduct joint QA/QI initiatives and supervisory monthly visits, particularly to increase facilities capacity to integrate paed/adolescent ART into NIMART; integration of IMCI & PALSA PLUS; close linkages to PMTCT for early infant diagnosis, treatment referral and infant CPT; paed retention in care incl lab monitoring and timely ART initiation; OI mgt incl provision of CPT and IPT; nutritional evaluation and malnutrition care; and referral networks to social and OVC services.

RtC uses HMIS TherapyEdge (TE) to reduce LTFU rates through automated SMSes, patient transfers with electr records, and clinical oversight through electr alerts, and to measure retention on ART up to 60 months, lab testing rates, and VL suppression. Automated download of NHLS blood results into TE ensures better use of lab data. At several TE sites RtC has ensured access to HIV drug resistance testing and surveillance and 3rd line ART for HIV DR. RtC covers record-keeping and registry mgt in site visits and training to improve site data quality and supports DoH with improving DHIS data quality. RtC assists provinces and districts with monitoring progress of key indicators.