INTEGRATED ACTIVITY FLAG: This Track 1-funded activity is part of a comprehensive program that receives both Track 1 and in-country funding. Catholic Relief Services' (CRS) Track 1-funded submission also relates to activities in ARV Services (#7485). The Catholic Relief Services' in-country submission includes activities described in ARV Drugs (#7489) and ARV Services (#7487), Counseling and Testing (#7488), TB/HIV (#7953) and Basic Health Care and Support (#7490).

SUMMARY: Activities are implemented to support procurement of antiretroviral (ARV) drugs under the comprehensive ART program carried out by Catholic Relief Services (CRS) in 25 sites. Coverage extends to eight provinces in South Africa (excluding the Western Cape). The target population includes people affected by HIV and AIDS as well as higher risk populations such as migrant workers and refugees.

BACKGROUND: AIDSRelief (the Consortium led by Catholic Relief Services) received Track 1 funding in FY 2004 to rapidly scale up antiretroviral therapy (ART) in nine countries, including South Africa. Since FY 2005 in-country funding has supplemented Track 1 funding, and this will continue in FY 2007. The activity is implemented through two major in-country partners, Southern African Catholic Bishops' Conference (SACBC) and the Institute for Youth Development South Africa (IYD-SA).

ACTIVITIES AND EXPECTED RESULTS: With funding provided in FY 2007, AIDSRelief will continue implementing the activities in support of South African Government (SAG) national ART rollout. In the interest of maximizing available funds the focus will be placed on strengthening the existing sites' provision of services rather than on assessing and activating new sites. Utilizing technical assistance from AIDSRelief staff members and South African experts, ongoing support and guidance will be provided to sites in the form of appropriate refresher medical training courses, patient tracking and reporting, monitoring and evaluation mechanisms and other necessary support.

ARV drugs are provided to all qualifying HIV patients who present at the sites, irrespective of their age, gender, nationality, religious or political beliefs. Historically, about 90% of adults and 10% of children with HIV have been receiving ARV drugs through the 25 partner sites.

ARV drugs purchased will be used by the 25 sites to treat ARV patients through clinic-based and home- -based activities aimed at optimizing quality of life for HIV-infected clients and their families. For most of the 25 sites, ARV drugs are currently being purchased centrally through a Johannesburg-based pharmaceutical company, and delivered via courier to the field sites monthly on a patient-named basis. CRS is billed once a month for all site deliveries after verification of drugs delivered to each site. The opportunity of accessing preferential cost drugs is being utilized through cooperation with GlaxoSmithKline where available.

Generic medications purchased comply with the USG PEPFAR Task Force requirement of FDA approval as well as approval from the Medicines Control Council of South Africa.

All activities will continue to be implemented in close collaboration with the South African Government's (SAG) HIV and AIDS Unit and the respective provincial authorities to ensure coordination and information sharing, directly contributing to the success of the South African Government's own rollout and the goals of the President's Emergency Plan. These activities are also aimed at successful integration of AIDSRelief activities into those implemented by the South African Government, thus ensuring long-term sustainability.

All sites operate in terms of a Memorandum of Understanding (MOU) with the Provincial Department of Health in which they operate, observing the national and provincial treatment protocols. There is a concerted effort at each site to ensure sustainability by either having the SAG provide antiretroviral drugs, or by down referring stable patients in to the public primary healthcare clinics after providing training for the SAG clinic staff. St. Mary's Hospital, which accounts for more than a third of patient numbers, has already

been accredited as a SAG rollout site. Sinosizo is receiving drugs from Department of Health due to its status as a down referral clinic for Stanger Hospital. At Centocow and Bethal, all patients are already receiving drugs through the SAG rollout.

This activity will directly contribute to the goal of 2 million individuals on treatment of the PEPFAR 2-7-10 goals.

INTEGRATED ACTIVITY FLAG:

This Track 1-funded activity is part of a comprehensive program that receives both Track 1 and in-country funding. Catholic Relief Services' (CRS) Track 1-funded submission also relates to activities in ARV Drugs (#7485). The Catholic Relief Services' country-funded submission includes activities described in ARV Drugs (#7489), ARV Services (#7487), Counseling and Testing (#7488), TB/HIV (#7953) and Basic Health Care and Support (#7490). Please note that the targets below represent a combination of Track 1 and South Africa funding.

SUMMARY:

Activities are implemented to support provision of quality ARV services under the comprehensive ART program carried out by Catholic Relief Services (CRS). Geographical coverage extends to eight provinces in South Africa (excluding the Western Cape). The target population includes people affected by HIV and AIDS as well as higher risk populations such as migrant workers and refugees.

BACKGROUND:

AIDSRelief (the Consortium led by Catholic Relief Services) received Track 1 funding since FY 2004 to rapidly scale up antiretroviral therapy (ART) in 9 countries, including South Africa. Since FY 2005 in-country funding was received to supplement central funding. The activity is implemented through two major in-country partners, Southern African Catholic Bishops' Conference (SACBC) and Institute for Youth Development South Africa (IYD-SA).

ACTIVITIES AND EXPECTED RESULTS:

With funding provided in FY 2007 AIDSRelief will continue implementing the activities in support of the South African Government (SAG) national ARV rollout. In the interest of maximizing available funds the focus will be on strengthening the existing sites providing services rather than on assessing and activating new sites. Utilizing technical assistance from AIDSRelief staff members and South African experts, ongoing support and guidance will be provided to sites in form of appropriate refresher medical training courses, patient tracking and reporting, monitoring and evaluation mechanisms and other necessary support.

ARV services will be provided through the 25 sites to ARV patients through clinic-based and home -based activities to optimize quality of life for HIV-infected clients and their families. All the relevant healthcare providers and administrative support staff at the sites will be trained to implement the ART program, using government-approved training curricula. Staff who have already received initial training will undergo refresher courses (either in-house or external), coupled with exchange of training courses and materials between sites with active support from the local training provider, Kimera training center. Treatment adherence training is provided to all patients who are enrolled on the ART program. In most sites home-based care networks will follow-up and support patients. Each site ensures that HIV-infected patients are screened for tuberculosis (TB) prior to placing them on antiretroviral treatment, and are referred to TB treatment if they tested positive. Screening and testing for TB is conducted in a number of different ways, and these testing methods are specific to each site. While screening is conducted by a medical professional at each of the sites, in most cases patients are referred to the nearby SAG medical facility for TB testing and are only enrolled in antiretroviral treatment once they have completed two months of TB treatment, or have been found not to have active TB.

PEPFAR funding will also be used to support laboratory services, which are outsourced to a private provider, Toga Laboratories. A courier service collects blood that is drawn at each site, and delivers these samples to the laboratories. Results are e-mailed or faxed back to the site within 48 hours of the laboratory receiving the blood samples.

The program is designed to improve each site's capacity to implement the national ART program in the long-term, and to strengthen clinical, administrative, financial and strategic information systems. Through linkage with another PEPFAR-funded partner, John Snow Inc. (JSI), CRS is receiving technical assistance and systems support to implement a

patient information system that will be based on innovative smartcard technology. Sites will be assisted in developing appropriate policies and protocols and in setting up sound financial and strategic information systems. Each site will also develop a unique community mobilization plan for the ART program and implement it in collaboration with relevant community organizations and leaders. Many of the sites are already involved in HIV and AIDS community mobilization activities and these will be linked to ART services. These lessons learned will be of value to other partners working in the non-governmental organization (NGO) sector.

All activities will continue to be implemented in close collaboration with the Department of Health HIV and AIDS Unit and the respective provincial authorities to ensure coordination and information sharing, and this will directly contribute to the success of the SAG's own rollout and the goals of PEPFAR. These activities are also aimed at successful integration of AIDSRelief activities with those implemented by the South African Government, thus ensuring long-term sustainability.

All sites operate under the terms of a Memorandum of Understanding (MOU) with the provincial Department of Health in which they operate, observing the national and provincial treatment protocols. There is a concerted effort at each site to ensure sustainability by having the SAG provide antiretroviral drugs, or by down referring stable patients into the SAG's primary healthcare clinics after providing training for the SAG clinic staff. St. Mary's Hospital, which accounts for more than a third of patient numbers, has already been accredited as a SAG rollout site. Sinosizo receives drugs from the National Department of Health due to its status as a down referral clinic for Stanger Hospital, and at a further two sites, Centocow and Bethal, all patients already receive drugs via the SAG rollout. Monthly statistics are shared with the relevant provincial health departments.

There is a concerted effort to include men and children in the program, and all sites have specific plans to increase enrolment, including couple counseling and using a family-based approach. Most sites have clinic-based gardens to assist with nutrition programs, and several sites provide nutrition supplements, as per South African treatment guidelines. All sites provide ART access to non-South Africans, including refugees.

The CRS treatment program supports the PEPFAR goal of treating 2 million people with antiretroviral drugs.