SUMMARY:

HIVCare will use FY 2008 funds to work with the Free State Department of Health (FSDOH) to provide

antiretroviral treatment and care in private health facilities to patients who do not have medical insurance,

either through referrals from the public sector, or self-referrals. The Free State has mainly a rural

population, with only two major metropolitan areas (Bloemfontein and Welkom). In addition, the government

rollout of HIV care and treatment has been geographically limited, with only one treatment initiating site in

each of the five districts. The major emphasis area for this program will be the development of networks,

linkages and referral systems, with minor emphasis given to quality assurance & supportive supervision,

food and nutrition support as well as commodity procurement. The target population includes men and

women; families (including infants and children) of those infected and affected factory workers and other

employed persons, and government employees - specifically teachers, nurses and other health workers

(without medical insurance). The most significant target group is those persons in the economically active

age group of the population that cannot access services in the public health system due to the high demand

for services. Additional attention is to be given to the screening and treatment of TB among the patients

attending the program. The linkage with the youth centre will ensure that the program will have a larger

proportion of younger persons being attended to specifically adolescents aged 10-14 and 15-24. This focus

on the youth should further encourage some involvement with the street youth and it is anticipated that the

program will be marketed among those NGOs working with the street youth as a testing & treatment site.

BACKGROUND:

Since 2005, the main thrust of the activity was to match the FSDOH with partners from the private sector (in

this case Netcare, the largest private sector health provider in South Africa, through their primary health

centers) in order to build private sector capacity and absorb some of the burden from state facilities. Many

FSDOH centers have waiting lists of people waiting to go on ARV treatment. Patients from these waiting

lists who meet the eligibility criteria for this program are referred from those public sector clinics to one of

the primary health centers throughout the Free State Province for treatment. The FSDOH is a collaborating

partner in this public-private partnership.

The Medicross Medical Centre in Bloemfontein, a well-equipped private primary health center, provides the

main resource base and in conjunction with three other sites in Bloemfontein and another two in Welkom,

will provide an effective means of distributing antiretroviral treatment (ART) to patients who are either

referred from state facilities or who access the sites by word of mouth. In addition patients will be able to

access a private doctor from the Netcare network in a number of rural towns across the Free State

Province. These network doctors that will be enrolling patients onto the program are based in the following

communities: Botshabelo; Kroonstad; Harrismith; Phuthithaba; Frankfort; Winberg; Warden and

Viljoenskroon.

ACTIVITIES AND EXPECTED RESULTS:

The HIVCare treatment sites will provide comprehensive palliative care to those patients mostly referred by

state clinics in immediate need of ART. The program is able to focus its attention on actual ART patients as

a result of its linkages with the Department of Health facilities in the area.

ACTIVITY 1: Clinical Care

The clinic staff comprises a full-time HIV trained doctor, nurses (with training in HIV, TB and pain

management) and counselors. Clinical activities include the usual onsite activities of any HIV clinic: ART

education and readiness assessment, drugs and pathology testing as required for proper follow-up,

adherence education and follow-up, prophylaxis of opportunistic infections, treatment of minor out-of-

hospital opportunistic infections, management of disease and or drug-related associated symptoms such as

pain and diagnosis and treatment of TB through DOT. Nutritional supplementation is provided until

nutritional status has recovered to within normal range (BMI >16). The same activities, including family

planning, are to be provided at the Youth Clinic. Prevention with positives interventions will be emphasized.

ACTIVITY 2: Psychosocial Support

Psychosocial support is provided for those patients who are in need of it through a support group which

meets weekly. Where the clinic is far from the patient's home, the patient will be referred to a support group

with a more accessible venue. For patients who are bedridden, HIVCare has strong links with the local Red

Cross home-based care organization. Patients in this instance are visited in the home with deliveries of

medication and supplements as required. Counselors regularly contact patients in need of psychosocial

support where referred by the doctor or nurses and in addition provide an important support service to the

families of patients. Consultations with a trained psychologist are also available where appropriate to patient

wellbeing. Spiritual care is not directly provided at the clinic. Those patients requiring spiritual services are

usually referred to a religious support group near their home. A priest frequently attends the support group

sessions and HIVCare has further links with both the Protestant Church and the Catholic Relief Services (a

PEPFAR partner).

ACTIVITY 3: Social Care

HIVCare clinics place emphasis on social care in the context of the family. The testing of partners is actively

promoted as is disclosure to a spouse/partner. Child testing days over weekends are regularly organized for

the children of patients. Patients are educated on their rights and on the access to social grants. A social

worker is available on call.

Patients attend the clinic monthly to collect their medication. Those that do not attend on schedule are

phoned by counselors or visited at home by a Red Cross home-based carer.

ACTIVITY 4: Integrated Prevention Services

Apart from the family members of patients, the adult clinic does not promote extensive CT sessions. This

role is fulfilled through the Youth Centre, which serves to screen and provide HIV education for

Activity Narrative: children/adolescents. The Youth Clinic is situated in close proximity to provide clinical support and

treatment. This public-private partnership has been ongoing for a number of years and includes the greater

Netcare Group in the Free State.

By providing HIV care services to a significant population of people without private insurance and school

age children, HIVCare is contributing to the PEPFAR goals of providing care for 10 million others who are

infected with HIV. These activities also support care and treatment objectives outlined in the USG Five-Year

Strategy for South Africa by expanding public-private partnerships and expanding care to an underserved

population.

SUMMARY:

HIVCare will use FY 2008 funds to work with the Free State Department of Health (FSDOH) to provide

antiretroviral treatment and care in private health facilities to patients who do not have medical insurance,

either through referrals from the public sector, or self-referrals. The Free State has mainly a rural

population, with only two major metropolitan areas (Bloemfontein and Welkom). In addition, the government

rollout of HIV care and treatment has been geographically limited, with only one site in each of the five

districts.

Since 2005 and the start of the program, patients have been referred from the State facilities to the HIVCare

centers mostly already staged for HIV and assessed for TB. Following an analysis of lost to follow-up cases,

HIVCare determined that splitting HIV and TB treatment and monitoring resulted in delays with access and

adversely impacts on compliance. In coordination conjunction with the TB department of the FSDOH, TB

assessment and treatment is to be integrated into HIVCare activities. Following technical input from the

FSDOH, the centers chosen for TB treatment sites are suitable and certain recommendations have been

made. These recommendations include separate facilities for patients and staff, air circulation and

extraction processes in the clinic and a separate area for sputum collection. Various policies relating to

infection control have been provided by the FSDOH for HIVCare implementation and these policies have

been adopted within the centers' operational procedures.

The clinic is in possession of all of the necessary forms and registers, supplied by the FSDOH, to comply

and integrate its TB service with theirs. Staff in the HIVCare centers are experienced public health nurses

and refresher training is to be provided in TB management by the local FSDOH offices.

Staff are routinely monitored on an annual basis for TB infection including the requisite chest x-ray.

The major emphasis area for this program will be the provision of comprehensive care and support to

persons infected with HIV as well as the improvement of referral systems, with minor emphasis given to

quality assurance & supportive supervision, food and nutrition support as well as commodity procurement.

The target population includes men and women; families (including infants and children) of those infected

and affected factory workers and other employed persons, and government employees - specifically

teachers, nurses and other health workers (without medical insurance). A further specific population that will

be targeted will be secondary school children. The most significant target group is those persons in the

economically active age group of the population that cannot access services in the public health system due

to the high demand for services. Additional attention is to be given to the screening and treatment of TB

among the patients attending the program. The linkage with the youth center will ensure that HIVCare has a

larger proportion of younger persons being attended to, specifically adolescents aged 10-14 and 15-24. This

focus on the youth should further encourage some involvement with the street youth and it is anticipated

that the program will be marketed among those NGOs working with the street youth as

BACKGROUND:

Since 2005, the main thrust of the activity was to match the FSDOH with partners from the private sector (in

this case Netcare, the largest private sector health provider in South Africa, through their primary health

centers) in order to build private sector capacity and absorb some of the burden from state facilities. Many

FSDOH centers have waiting lists of people waiting to go on ARV treatment. The Free State Province has a

large prevalence of TB because of the number of deep mining activities in the area. MDR and XDR-TB have

been identified in the province. As a result, a large proportion of newly identified patients are co-infected

with TB. In the past all patients were referred back to government facilities to initiate TB treatment prior to

beginning on ART with the HIVCare program. Aside from the general delay that this caused, some

confusion among patients occurred. In addition, the inconvenience of further travel expenses and waiting

periods to access the TB treatment resulted in many patients simply abandoning treatment and not

returning to the clinic.

The Medicross Medical Centre in Bloemfontein, a well-equipped private primary health center, provides the

main resource base and in conjunction with three other sites in Bloemfontein and another one in Welkom,

will provide an effective means of providing TB treatment to patients who are either referred from state

facilities or who access the sites by word of mouth.

ACTIVITIES AND EXPECTED RESULTS:

Following consultation with the FSDOH, the activities of the clinic operations have been expanded to

include TB screening, related laboratory sampling and clinical treatment of TB using DOTS. Patients from

these waiting lists who meet the eligibility criteria for this program are referred from those public sector

clinics to one of the three HIVCare primary health centers in Bloemfontein and one in Welkom for TB

treatment. The FSDOH is a collaborating partner in this public-private partnership.

All pathology samples will be tested by the National Health Laboratory Service and all statistics relating to

TB treatment will be forwarded to the TB department for inclusion in national figures.

Patients referred to the program receive PEPFAR-funded consultations and exams from HIVCare center

physicians, who will also order relevant tests and refer patients to expert specialists when necessary. Based

on the partnership with the FSDOH and the services requested that HIVCare provide, HIVCare centers do

not provide free treatment for complex opportunistic infections, although some prophylaxis is provided (e.g.

cotrimoxazole) and HIVCare staff will treat minor infections and HIV conditions that do not require

investigative procedures or hospitalization.

Patients are still able to access public health facilities for more serious opportunistic

infections/hospitalizations. Likewise, treatment for tuberculosis (TB) can be obtained from the centers. In

those instances where patients are referred back to government facilities, a referral letter is provided from

the treatment center to the public clinic with a request for information about the patient's TB regimen. Due to

the close working relationship and partnership between HIVCare and the FSDOH facilities, this referral

process is seamless. Very sick patients that are unable to access the centers will able to receive their

medication via the HIVCare linkage with the Red Cross home-based carers.

Activity Narrative:

HIVCare's activities to integrate TB and HIV care contribute to the PEPFAR 2-7-10 goals.

SUMMARY:

HIVCare will use FY 2008 funds to work with the Free State Department of Health (FSDOH) to provide

antiretroviral treatment in private health facilities to patients who do not have medical insurance (either

through referrals from the public sector, or self-referral). The Free State has mainly a rural population, with

only two major metropolitan areas (Bloemfontein and Welkom). In addition, the government rollout of HIV

care and treatment has been geographically limited with only one treatment site in each of the five districts.

The Medicross Medical Centre, a well-equipped private primary health center, provides the main resource

base in conjunction with three other sites in Bloemfontein, another two in Welkom and nine other centers

located in rural towns within the province. The centers will provide an effective means of providing HIV care

and treatment to patients who are either referred from state facilities or who access the sites by word of

mouth. The major emphasis area for this program will be commodity procurement, with minor emphasis

given to logistics and the development of networks, linkages and referral systems, quality assurance and

supportive supervision. The target population already includes men and women; families (including infants

and children) of those infected and affected factory workers and other employed persons, and government

employees - specifically teachers, nurses and other health workers. A further specific population that will be

targeted will be secondary school children as HIVCare has determined that a definite need exists. Activities

will include active prevention campaigns, HIV counseling and testing (CT) and treatment for those

diagnosed. The most significant target group is those persons in the economically active age group of the

population that cannot access services in the public health system. Additional attention is to be given to the

screening and treatment of TB amongst the patients attending the program. The linkage with the youth

centre will ensure that the program will have a larger proportion of younger persons being attended to,

specifically adolescents aged 10-14 and 15-24. This focus on youth should further encourage involvement

with the street youth and it is anticipated that the program will be marketed among those NGOs working

with the street youth as a testing and treatment site.

BACKGROUND:

The HIVCare project began in June 2005 with PEPFAR funding. The main aim of the program was to match

the FSDOH with partners from the private sector (in this case Netcare, the largest private sector health

provider in South Africa, through their primary health centers) in order to build private sector capacity and

absorb some of the burden from state facilities. Many FSDOH centers have waiting lists of people for ARV

treatment and given that CT is the mainstay of the National Strategic Plan, these waiting lists are likely to

continue to grow. Prevalence amongst children in the 9 to 15 year age group in the Free State province is

among the highest in the country. The HIVCare site is the only child-friendly site in the area. Patients from

these waiting lists, who meet the eligibility criteria for treatment, are referred from those public sector clinics

to one of the HIVCare primary health centers. The FSDOH is a collaborating partner in this public-private

partnership.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Provision of Medical Services

The HIVCare treatment sites will provide all medical services related to the delivery of HIV care and

treatment. In addition they will provide counseling and testing services. Management and coordination

activities will be provided by HIVCare. Active marketing of CT service will only be done within local

secondary schools as part of an HIV awareness and prevention strategy although it is expected that word of

mouth and the central location of the sites will provide the desired accessibility for the public and will

furthermore ensure that the required patient numbers are achieved. Consideration will be given to the

principle of opt out testing embodied in the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011.

This principle will be applied with due regard to the sensitivities involved with dealing with the youth. In

addition to clinic referrals, Free State government employees will be encouraged to make use of the

HIVCare services. The HIVCare centers are promoted among government employees (who do not have

medical insurance) in the Bloemfontein area as independent testing and treatment sites where

confidentiality can be ensured.

ACTIVITY 2: Counseling and Testing

Patients attending the center for testing receive comprehensive counseling and testing. Persons testing

positive, with their consent, are screened for treatment and care options including staging tests (e.g. CD4)

to determine the level of disease progression. Those that meet the clinical criteria will be referred to the

treatment program. Persons participating in CT will be provided with a call center number, which they will be

able to use to access further advice and /or information. Literature on HIV and related matters will also be

provided. All persons testing negative receive post test counseling and are encouraged to test again within

three months, receive information as to where they can access condoms and are provided with the phone

number of the 24-hour assistance line. Those persons testing positive receive the same information and are

staged. On returning for their results are asked to return after six months to check the progression of the

disease should they not need to initiate antiretroviral treatment (ART).

ACTIVITY 3: Public Private Partnership

This program area will promote the public-private partnership between HIVCare/Medicross and the FSDOH.

This partnership strengthens the system of both parties and allows for the sharing of knowledge and skills.

This public-private partnership has been ongoing for a number of years and includes the greater Netcare

Group in the Free State. In addition, HIVCare will expand its existing project to target children as part of its

continuum of care. This activity targets girls and boys of mainly secondary school age through messages of

awareness of HIV care and treatment. A teen center catering for the specific needs of this age group has

been established and PEPFAR funding will be used to continue the treatment services already started. CT

that takes place at this center will be provided in an environment that is sensitive to the special needs of this

group and in line with the South African laws and regulations pertaining to children and HIV.

By providing comprehensive CT services to patients and promoting ARV services for a significant

population (people without private insurance and school age children) HIVCare is contributing to the

Activity Narrative: PEPFAR goals of placing 2 million people on ARV treatment and providing care for 10 million others who

are infected with HIV. These activities also support care and treatment objectives outlined in the USG Five-

Year Strategy for South Africa by expanding public-private partnerships and expanding care to an

underserved population.

SUMMARY:

HIVCare will use FY 2008 PEPFAR funds to work with the Free State Department of Health (FSDOH) to

provide antiretroviral treatment in a private health facility to patients who do not have medical insurance and

who are referred from the public sector waiting lists for treatment. The Medicross Medical Centre, a well-

equipped private primary healthcare center, provides the main resource base and in conjunction with

thirteen other sites, will provide an effective means of properly distributing ART to patients who are either

referred from public sector facilities or who access the site by word of mouth. The emphasis areas for this

program will be human capacity development and local organization capacity building. The target population

includes men and women; families (including infants and children) of those infected and affected, factory

workers and other employed persons, and government employees - specifically teachers, nurses and other

health workers (who do not have medical insurance). A further specific population that will be targeted will

be secondary school children. The most significant target group is those persons that cannot access

services in the public health system.

All treatment administered is done in strict accordance with South African Government (SAG) guidelines

and with due regard to the need to transfer the patients back to SAG facilities when feasible. Additional

attention will be given to the screening and treatment of TB among the patients attending the program. The

linkage with the youth center will ensure that HIVCare reaches a larger proportion of younger persons,

specifically adolescents aged 10-14 and 15-24. This focus on the youth should further encourage

involvement with street youth and it is anticipated that the program will be marketed among NGOs working

with street youth as a testing and treatment site.

BACKGROUND:

PEPFAR funding for the HIVCare project commenced in June 2005. The main thrust of the activity was to

match the FSDOH with private-sector partners (in this case Netcare, the largest private sector health

provider in South Africa) in order to build private sector capacity and to absorb some of the burden from

public sector facilities. Many FSDOH centers have waiting lists of people for ARV treatment. Patients from

these waiting lists who meet the eligibility criteria for this program are referred from these public sector

clinics to one of the four primary health centers in Bloemfontein and one in Welkom for treatment. The

FSDOH is a collaborating partner in this public-private partnership, and they have commited incorporate

HIVCare patients into existing FSDOH treatment sites on cessation of PEPFAR funds. An intermediate

project that is underway is the credentialing by the FSDOH of the HIVCare sites so that ARV medication

can be drawn from state supplies. This will dramatically reduce the requirement for external purchases.

ACTIVITIES AND EXPECTED RESULTS:

Drugs and other commodities used in the treatment process are procured through the Netcare purchasing

system, the single largest purchaser of medical supplies outside of the South African government. The

drugs, specifically regulated in terms of South African legislation, are distributed to treatment centers via the

Netcare pharmacies in Bloemfontein and Welkom and are dispensed to patients by qualified pharmacy

staff. All medication issued to patients is done on presentation of a prescription issued by the treating

physician. All other products are purchased within the procurement system of Netcare and some products

are specially packaged for the program. Maximum use is made of volume discounts where possible

although current SA legislation makes this problematic in respect of medicines. The Netcare purchasing

department continually receives pricing updates from all major suppliers and all purchases are subject to

competition amongst said approved suppliers. All antiretroviral drugs procured are in line with national

treatment guidelines, and generic drugs purchased are FDA-approved and registered by the Medicines

Control Council. All medication and supplements are stored off site and delivered either daily or weekly as

required. Due to the availability of medicines, a month's buffer stock is available at any time while two

months stock of other products is maintained. Due to space limitations within the clinic itself, large deliveries

are impossible and smaller frequent deliveries are made. Medication is delivered to the clinic weekly.

HIVCare also includes a parcel of nutritional supplements with the medication to improve treatment efficacy.

The supplements provide a single fortified meal per day for each of the indigent patients on ART and aids in

the absorption of the medication. Patients are assessed based upon their body mass index and general

condition. The benchmark weight among patients starting ART at the center is just 55 kg (-5.2). In previous

years the nutritional supplements were obtained with private funds, but in FY 2008, these will be purchased

with PEPFAR funds in line with the Food and Nutrition guidance.

The program is subject to regular management review through the Netcare management and the medical

director. This forms a crucial aspect of continuous improvement as practiced by the company. Both clinics

are equipped with software specifically designed to monitor and manage patients. This program, coupled

with individual patient folders, follows the specifications, definitions and classifications listed in the WHO

2006 patient monitoring guidelines for HIV care and antiretroviral therapy. The list of collected data includes

demographic information, family status (partners, children and their HIV status when known), treatment

supervisor details, clinical relevant information (symptoms, opportunistic infections, staging, TB status,

family planning method or pregnancy status, weight, and height) and laboratory results. All of the

abovementioned indicators as well as prophylaxis and antiretroviral treatments, starting dates, interruptions,

reasons, side effects and severity are recorded. These data form the basis of internal management reports

used to improve systems.

The existing program is small and makes use of existing infrastructure and skills. Training focuses on skills

enhancement takes the form of mentorship and on-the-job development. Formal training is restricted to

addressing identified skills gaps.

The following procedures are followed to ensure the optimal follow-up for the patient: (a) scripts are written

by the doctor (full-time HIV trained doctor); (b) scripts are delivered to the designated pharmacy; (b) drugs

are prepared, labeled, named and packed for each patient; (c) parcels are sent back and stored at the

clinic, pending collection; and then (d) treatment is dispensed to the patient after consultation and recording

patient adherence, side-effects (if any) and weight in the patient folder. These details are captured using the

software described above.

Activity Narrative: The software allows the clinic staff to monitor any relevant information as side-effects, complications,

opportunistic infections, TB statistics, etc.. Clinic management reports are distributed to the local treating

doctor as well as to the medical director. Procedures are in place to address matters arising with staff in the

form of corrective action and training.

By providing comprehensive ARV services to patients and promoting ARV services to a large population of

underserved people living with HIV (people without private insurance) and school-going children, HIVCare is

contributing to the PEPFAR goals of placing 2 million people on ARV treatment and providing care for 10

million others who are infected with HIV. These activities also support care and treatment objectives

outlined in the USG Five-Year Strategy for South Africa by expanding public-private partnerships and

expanding care to an underserved population.

SUMMARY:

HIVCare will use FY 2008 PEPFAR funds to work with the Free State Department of Health to provide

antiretroviral treatment in a private health facility to patients who do not have medical insurance and who

are referred from the public sector waiting lists for treatment. The Medicross Medical Centre, a well

equipped private primary healthcare center, provides the main resource base and in conjunction with

thirteen other sites, will provide an effective means of properly distributing ART to patients who are either

referred from public sector facilities or who access the site by word of mouth. The emphasis areas for this

program will be human capacity development and local organization capacity building. The target population

includes men and women; families (including infants and children) of those infected and affected, factory

workers and other employed persons, and government employees - specifically teachers, nurses and other

health workers (who do not have medical insurance). A further specific population that will be targeted will

be secondary school children. The most significant target group is those persons that cannot access

services in the public health system.

All treatment administered is done in strict accordance with South African Government (SAG) guidelines

and with due regard to the need to transfer the patients back to SAG facilities when feasible. Additional

attention is to be given to the screening and treatment of TB amongst the patients attending the program.

The linkage with the youth centre will ensure that we have a larger proportion of younger persons being

attended to, specifically adolescents aged 10-14 and 15-24. This focus on the youth should further

encourage some involvement with the street youth and it is anticipated that the program will be marketed

amongst those NGOs working with the street youth as a testing and treatment site.

BACKGROUND:

PEPFAR funding for the HIVCare project commenced in June 2005. The main thrust of the activity was to

match the Free State Department of Health (FSDOH) with partners from the private sector (in this case

Netcare, the largest private sector health provider in South Africa) in order to build private sector capacity

and absorb some of the burden from public sector facilities. Many FSDOH centers have waiting lists of

people for ARV treatment. Patients from these waiting lists who meet the eligibility criteria for this program

are referred from those public sector clinics to one of the four primary health centers in Bloemfontein and

one in Welkom for treatment. The FSDOH is a collaborating partner in this public-private partnership.

ACTIVITIES AND EXPECTED RESULTS:

The HIVCare treatment sites will provide all medical services related to the delivery of HIV care and

treatment. Management and coordination activities will be provided by HIVCare. The majority of patients will

be referred from public clinics in the FSDOH network to the thirteen HIVCare centers based on the following

criteria: (1) Clinical criteria (CD4 <200 cells/mm3 or WHO stage III or IV); (2) Inability to pay (lack of private

insurance or state coverage) and (3) Overcrowding at referring clinic.

Among the non-medical criteria for enrollment (based on the SAG's Operational Plan for Comprehensive

HIV and AIDS Care, Management and Treatment for South Africa and a request from the FSDOH), is that

the patients have a stable point of contact to assure continued follow-up. HIVCare relies heavily on

telephone access to ensure that patients keep scheduled physician visits, collect their medication, and

respond to other questions.

Patients referred to the program receive PEPFAR-funded consultations and exams from HIVCare

physicians, who will also order relevant tests and refer patients to expert specialists when necessary. The

package of care also includes counseling and testing (for patients who do not know their status), adherence

counseling, and access to therapeutic nutrition support as per the national guidelines and OGAC guidance.

An initiative aimed at improving overall compliance and treatment efficacy is the distribution with the

medication of a parcel of nutritional supplements. The supplements provide a single fortified meal per day

for each of the indigent patients on ART and aids in the absorption of the medication. Patients are assessed

based upon their BMI and general condition. Benchmark weight amongst patients starting ART at the center

is just 55kg( -5.2). The patients that are on the waiting lists for ARV treatment at the public health facilities

are offered the option of attending the HIVCare treatment sites. The patients that choose the HIVCare

program present at the treatment center with a referral letter and other clinical notes (e.g. CD4 count) from

the public health center. The patients meeting the clinical criteria are enrolled onto the program. Where

patients present directly at the HIVCare treatment center and are found to be in need of TB treatment or

treatment of an opportunistic infection requiring specialized treatment, hospitalization or investigative

procedures, are referred to the local public facility for care. Similarly radiography and pathology for

investigative procedures is provided by the public health facilities. This is based on the request from the

FSDOH to provide only a limited range of services, and the HIVCare program is only meant to assist with

the unmet demand at the public sector sites, rather than create a parallel health service delivery program.

Due to this working relationship, referrals between the HIVCare sites and public sector sites are seamless.

With regard to pregnant patients, they receive PMTCT drugs and information on its use prior to the birth

event. Subsequent to this, the patient returns to the center to continue treatment and unless specifically

rejected by the mother, infant formula is made available. Prophylaxis syrup is also made available to the

infant until it is possible to perform the PCR test to determine the infant's status.

Data is shared with the DOH on two levels. Firstly data on all new patients enrolled onto ART is provided by

the pharmacy to the provincial authorities. Secondly a return is submitted to the National Department of

Health, with a copy to the Provincial DOH, giving the data of all those on the program. In addition to this, a

representative of HIVCare attends the monthly provincial task team meetings.

In addition, HIVCare will expand its existing project to target children as part of its continuum of care. This

activity targets children between the ages of six and secondary school age through HIV awareness

activities. Older children will be provided with access to HIV care and treatment, as well as psychosocial

support services (in line with relevant South African laws and regulations pertaining to healthcare for

minors). A teen center catering for the specific needs of this age group has been established and PEPFAR

funding will be applied in continuing the treatment started in FY 2007. The funds will be specifically applied

in providing ARV treatment to children and some prevention materials (including abstinence and being

faithful) at a number of schools in order to expand awareness of HIV care and treatment services offered by

Activity Narrative: the program. The teen center will provide a testing service to local orphanages with treatment where not

otherwise provided through SAG resources. Other referrals will be made by the FSDOH clinics in the area

and through HIVCare's collaboration with other organizations, including the Anglican Church and Red Cross

Society.

A number of support groups have been established aimed at involving the partners of the mainly female

patients in the treatment process. These groups meet weekly and the aim is to promote support for the

patients among their family members and also to get their partners to test and where necessary to join the

treatment group. The Welkom area will include two treatment sites which should encourage a greater

proportion of male patients into the program as a result of the number of large mines in close proximity and

their use of migrant, mainly male labor. Case managers employed by HIVCare provide psychosocial

support, treatment management and compliance promotion. This individualized management approach will

also include telephone support for patients and their families, information about the condition and its

symptoms, nutrition advice and healthy living. Case managers actively assist patients to identify and utilize

the family and community structures that may exist as well as providing information on other available

support . A defaulter program exists that utilizes local resources - Home Based Carers - to follow up not

compliant patients. The service is provided through the church and the Red Cross.

By providing comprehensive ARV services to patients and promoting ARV services for a large population of

underserved people living with HIV, and who do not have private insurance) and school age children,

HIVCare is contributing to the PEPFAR goals of placing 2 million people on ARV treatment and providing

care for 10 million others who are infected with HIV. These activities also support care and treatment

objectives outlined in the USG Five-Year Strategy for South Africa by expanding public-private partnerships

and expanding care to an underserved population.