In response to request for changes in prevention.

SUMMARY:

World Vision (WV) is expanding to include abstinence and being faithful activities by increasing the

coverage, scope, and quality of services to family members of HIV-infected individuals and older OVC.

Emphasis areas are community mobilization, training, and development of linkages and referral systems.

The target populations are people living with HIV and AIDS.

BACKGROUND:

World Vision is a non-profit organization established in 1967 working in six provinces of the country. World

Vision seeks to make a difference in the impact of HIV and AIDS and improve the situation of children in

rural schools. WV aims to build on the Radically Different Species (RADS) prevention program (change

behavior to change the future). In the Free State, RADS is a full-scale prevention program, which mainly

focuses on peer education support, and is managed by youth from the local community. RADS is

abstinence based, which aims at helping youth delay sexuality activity, deal with relationships, prevent

sexually transmitted infections (STIs), understand teenage social context, take responsibility, and maintain

independence and interaction between youth and the community. WV has established a memorandum of

understanding (MOU) with the Free State Department of Education to roll out this prevention program,

which includes life skills. The RADS are the 'cool and hip prevention program' that emphasizes the

enhancement of learners' self-worth, and their influence on others and society. The program develops

knowledge, skills, attitudes and values, addresses self-awareness, HIV and AIDS, sexuality and life skills,

and emphasizes behavior change. RADS is a character building program, as character changes behavior

and behavior changes the future.

ACTIVITY 1: Training Youth as Peer Educators

WV will train peer educators in the RADS prevention program to help change behavior and change the

future. RADS training workshops will be organized in the Free State and Eastern Cape. RADS is a

prevention program, which focuses on peer education support, managed by youth from the local

community. RADS aims at delaying sexuality activity, dealing with relationships, STIs, Teenage social

context in the time of HIV and AIDS, accountability and future perspective, independence and inter-action

between youth and the community. WV through its MOU with the Free State Department of Education will

roll out this prevention program in schools using the RADS trained peer educators.

ACTIVITY 2: Implementation

WV in collaboration with Free State Department of Education, will implement RADS at schools, reach more

learners, and establish support groups in each school. WV also intends to work with educators to develop

the peer educator program in the schools, whereby the life skills program is aligned to life orientation

programs. This is outcomes-based in the form of knowledge and understanding of self-conceptualization,

esteem, behavior change, effective communication, gender differences and sexuality, self-awareness,

critical thinking, problem solving, action planning for the future, goal setting, psycho-social emotions,

resisting peer pressure, negotiation skills to ensure abstinence, and delaying sexual activity. RADS is built

around community engagement, involving parents and caregivers in its messages, and working through the

Community Care Coalitions in identifying resources in assisting young people in life-skills.

One of the key priority areas of the NSP is Prevention, which aims to reduce the new rate of HIV infections

by 50% by 2011. WV through the RADS program, "Courage to Become Me," and the Channels of Hope

program aims to reduce sexual transmission HIV by strengthening its behavior change programs. RADS is

an innovative programmed of using language of the youth to address behavior change and also advocates

for open dialogue of HIV and sexuality between parents and children. The RADS program aims at

adolescents and young adult at higher risk, in alignment with the NSP. In training the educator to assist with

the peer education program, this highlights a multi-faceted approach of a high risk population group (i.e.,

infected teachers are 12.7% sero-prevalence in South Africa), this contributes to a greater involvement of

people affected and infected with HIV.

One of the strategic objectives of the Policy Framework on Orphans and Other Children Made Vulnerable

by HIV and AIDS calls for the mobilization and strengthening of community-based responses for the care,

support and protection of orphans and vulnerable children (OVC) and to promote and strengthen linkages

between community-based responses to OVC made vulnerable by HIV and AIDS with prevention, treatment

and care programs. RADS will integrate its program holistically into the community care coalitions.

In order to address the gender issues, RADS will facilitate an increase in dialogue among young women

and men, talking about their sexuality, values, behavior changes and norms. Age intersects with gender in

determining the allocation of dominance in any society, young people typically have less power than older

generations, and younger women or girls have less power that younger men or boys. Hence power

imbalances in gender relations have many of its roots in adolescence. RADS is determined to increase the

dialogue between boys and girls, younger women and younger men. Cultural, societal, ethical, biological

and psychological factors contribute in determining the mindset of young people, and RADS integrates

these factors in influencing sexuality and gender roles. WV will also attempt to address multiple concurrent

partnerships and cross-generational sex in its prevention program.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $48,500

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:

Data quality management is a key requirement in the roll out of the PEPFAR-funded World Vision programs

in all the Area Development Programs (ADPs). FY 2009 priority actions will involve the improvement of

service quality. World Vision will ensure that strengthened and adequate supportive supervision of

caregivers/volunteers is continuously provided with at least one visit every quarter for direct assessments,

training and enhancement of service delivery.

Human Capacity Development (HCD)

World Vision will endeavour to strengthen the capacities and abilities of families, community members, non-

governmental, community and faith-based organizations at ADP level in the six communities in which the

Networks of Hope (NoH) project operates.

World Vision, in collaboration with local health allied bodies and relevant stakeholders, will carry out

extensive training for home visitors, home-based carers, peer counselors and others to enhance their ability

to carry out nutritional assessments and counseling.

World Vision will conduct Palliative Care Training for ADPs using South African Government (SAG) -

accredited service providers. This will be based on the national minimum standards for training on Palliative

Care for Community Caregivers and Resilience in Children and Caregivers. Some of the core models

include basic hygiene, psychosocial support and community care. The training activities will take place

routinely during the Community Care Coalitions (CCC) monthly meetings and periodically on arrangements

over a period of time.

Capacitating the community members and locally-based stakeholders in this way will ensure sustainability

of the deliverables of this program as the skills transferred will remain with the individuals and institutions

based in the community ensuring continuity and future task shifting to the community members.

Alignment with the National Strategic Plan or other SAG policies or plans

The Government of South Africa (GSA)'s HIV & AIDS and STI National Strategic Plan for South Africa 2007

-2011(NSP) calls for: 1) reduction of HIV incidence by 50%; and 2) expanding access to appropriate

treatment, care and support to 80% of all HIV-infected people and their families by 2011. In order to achieve

these targets communities and the health system must be engaged to expand and improve the continuum

of prevention, care and treatment services provided to people living with HIV (PLHIV) and orphans and

vulnerable children. Through its NoH project, World Vision fully endorses and is aligned to these NSP

objectives in collaboration with the SAG at various district levels is essential for an active, effective and

sustainable response.

GENDER

In the spirit of collectivism and collaboration, the NoH would continue to work with local communities to

facilitate access to essential services, integration at local level, and build local capacity building programs.

In sustaining and system strengthening at local and provincial levels, World Vision strives to achieve on the

goal of GSA in providing a better life for its entire people.

World Vision Channels of Hope (CoH) team will conduct Community conversations in the communities/

(CCC) to address the following topics gender based violence, gender inequalities, help and support for

female child-headed households, the right of women and girls to say no to unwanted sex and gender norms

that deny women inheritance rights. World Vision will ensure that women and men will have equitable

access to care and support and other services, under the adult care and support program

----------------------------

SUMMARY:

World Vision (WV) is expanding OVC care activities by increasing the coverage, scope, and quality of

services to family members of HIV-infected individuals and older OVC. Emphasis areas are community

mobilization, training, and development of linkages and referral systems. The target populations are people

living with HIV and AIDS.

BACKGROUND:

World Vision is a non-profit organization established in 1967 working in 14 Area Development Programs

(ADPs) in six provinces of the country, reaching over 42,000 children with holistic development support.

World Vision has already identified and is providing community-led support to 4,439 OVC in these ADPs.

With PEPFAR funding this number will be increased to 17,500 children through the OVC project. For this

project, the target will be to address the needs of primary caregivers of OVC and older OVC which are not

covered by OVC funding. By working with community partnerships through their Community Care Coalitions

(CCC) model, World Vision enhances their ability to prevent, mitigate and alleviate the impact of HIV and

AIDS. Care at the home and community level is a strategy within the South African Government National

Strategic Plan.

World Vision will continue to strengthen access to integrated services as a part of a comprehensive care

package for PLHIV and their families in Free State, Limpopo and Eastern Cape provinces, with expansion

to at least 2 ADPs in Kwazulu-Natal province. The activities reinforce and expand services provided by

Community-based Organizations (CBOs) and government care programs, such as basic hygiene, wound

care, screening for pain and symptoms, nutrition assessment and support, spiritual care and support,

psychological care and promotion of the HIV preventive care package. With FY 2008 funding, World Vision

Activity Narrative: will further institutionalize the program within government and CBOs, while also expanding its reach. World

Vision will emphasize capacity building and local skills transfer, and assist HBC programs to develop

strategies to alleviate the care burden on girls. These strategies will specifically address gender sensitive

counseling, community outreach and couple counseling furthermore World Vision will ensure quality of

community-based services, and identify/apply lessons learned.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Home-based care program

The majority (over 70%) of care workers (home visitors - HVs) in OVC programs are women (while two

thirds of the adult beneficiaries of the current home care programs are also women. In many cases, care

workers may also be recognized as traditional healers. World Vision will work to increase the involvement of

men in care giving. As part of psychosocial support trainings, care workers will engage men by focusing on

such topics as family violence, anger management, fathering and parenting skills. A stipend provided to

care workers and volunteers through the HBC program is an important source of household income.

Regular financial training seeks to improve the capacity and economic advancement of care workers in the

program. In addition to the psychosocial support training HVs will be trained on Palliative Community

Caregiving by Hospice.

Trained HVs provide a minimum standard of care focusing on physical, psychological, spiritual and social

interventions. In addition to sharing integrated HIV-related palliative care messages with HIV-infected

individuals and their families, care workers will use a family-centered approach to client assessment. Based

on the need, clients will be referred to partner clinics and hospitals for pain management, treatment of OIs

including cotrimoxazole prophylaxis, family planning or other issues as observed. Home visitors will monitor

referrals to ensure appropriate follow-up and ongoing care and support. All clients will be counseled on

prevention with positives and family members will be referred for counseling and testing. Outreach to the

community and referrals are part of the HBC activities. An additional key activity of care workers is

monitoring of adherence to TB and HIV treatment. Elements of the preventive care package for adults and

children are also included during interaction between the care worker and the client. Special emphasis

during training will ensure HVs have a comprehensive understanding of referrals and linkages with other

services, including linkages with health and social welfare sectors for grants, legal aid, micro-finance,

spiritual support, CT, ARVs, and FP. With FY 2008 funding, World Vision will also seek to include bicycle

transport options for care workers to further improve coverage and support.

ACTIVITY 2: Psychosocial support training

In addition to home visitors, World Vision will also continue to identify and train supervisors and group

leaders to provide psychosocial support services. In districts where psychosocial support will be

established, community group leaders will be trained to reach family members of PLHIV and OVC, adults,

and their households through group counseling. At each site, qualified and trustworthy community members

to guide support group activities will be identified. These community-based group leaders will lead weekly

support sessions for the group members and conduct home visits to families of OVC. WV's Regional

Psychosocial Advisor will train supervisors as well as selected World Vision staff on a training curriculum

based on successful modules designed to address the particular needs of children and of adults. The

training will equip supervisors to assist and support others in care of the carer. At all levels, care of the carer

and care support training will focus on psychosocial interventions, including assessment, basic counseling,

group facilitation, and advocacy. Complementing health and nutrition lessons, training will ensure that all

trainees are able to recognize general physical as well as psychosocial health problems associated with

HIV and AIDS in children, and to make appropriate referrals to Child and Family Wellness clinics, Health

Centers and PHC Centers as needed.

Support group meetings led by trained group leaders using interactive and participatory techniques will be

held regularly with HVs. Working with churches/FBOs, and CBOs, World Vision will invite community

members to form psychosocial support groups. Group members will also be identified through assessment

interviews and information provided by relevant community members. During these support group sessions,

HVs and volunteers will learn to enhance coping skills to accomplish activities of daily living. Members will

carry out tasks designed to enhance relationships and build self-esteem. Positive living is reinforced as

group members develop emotional resilience. At the end of the project's first year, groups will be

encouraged to continue meeting, with ongoing guidance from World Vision's staff. The positive impacts of

psychosocial support will extend to group members' households, and family members will benefit indirectly

from the support group's second year of activities.

In all of the above activities, OVC will be counted only in the OVC program area. Palliative care to family

members of PLHIV or OVC will be provided in at least two or the five categories of palliative care services.

PLHIV will receive at least one clinical and one other category of palliative care service.

These activities will contribute to the PEPFAR goal of reaching 10 million HIV-infected and affected

individuals with care.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13907

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13907 12355.08 U.S. Agency for World Vision 6647 4103.08 World Vision $594,000

International South Africa

Development

12355 12355.07 U.S. Agency for World Vision 4498 4103.07 World Vision $200,000

International South Africa

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $145,500

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Expanded community-led response to provide care and support for OVC:

World Vision's (WV) Community Care Coalitions (CCC) model is similar to the Department of Social

Development's (DOSD) Child Care Forum structure and is based on global best practice. In line with the

goals of multi-sectoral and holistic support for children, CCCs draw their membership from an array of

stakeholders at local level to include churches and other FBOs, CBOs, local government, traditional

leaders, associations of PLHIV and OVC. The CCC is responsible for coordinating OVC activities in the

community, and for recruiting and supervising Home Visitors (HVs) who are then trained by WV to visit OVC

and PLHIV.

The identification of OVC will take place at the same time, to link support provided to individuals in the same

household.

The project will work with existing CCCs in the eight Area Development Programs (ADP); a new intake of

600 HVs will be needed to reach the additional 10,000 OVC that the project will target. HVs will be trained

on the full range of child care and support topics.

The menu of services include the following: child monitoring, HIV prevention education, psychological

support, succession planning, health care support (referrals, transport), nutrition support (in the form of

food, e-pap, chickens), education assistance (uniforms, materials, vocational training), child protection (birth

registration), economic strengthening, agricultural support and shelter support.

Additional Activity: Mobilized and strengthened community-led response to care for PLHIV and their families

Networks of Hope (NoH) will work through the same CCC structure to introduce home-based care into

project areas, by training HVs in the DoH proposed new 72-credit minimum skill set (MSS), to become

accredited Community Care Supporters (CCS). These CCSs with stipends will expand their duties to

provide a comprehensive and quality package of essential services to a total 9,915 PLHIV/chronically ill.

Using the Health and Welfare Sector Education and Training Authority (HWSETA) Accreditation Toolkit, WV

will pursue accreditation as a provider of the MSS. WV will employ its own accredited trainers. WV will

receive guidance from the DoH regarding the finalization of the approved unit standard-based skills

programs that will form the MSS, and will use this accredited program in its trainings.

The eight CCC Coordinators will be trained to accreditation in the MSS and will, in turn, train the 600

existing HVs to accreditation as CCSs in line with DoH requirements. CCSs may begin visiting PLHIV in

their homes and providing basic care and support as part of the practical component of the training, prior to

receiving full accreditation.

Human Capacity Development:

WV will continue to mainstream Channels of Hope training for faith-based organizations through a two-day

workshop. WV will work with each local FBO to develop action plans to address congregational and

community, as well as confront gender discrimination, promoting gender equity in communities. Trained

congregation and FBO members will form Hope Teams which WV will support with ongoing training and

mentorship. In turn, these Hope teams will develop and carry out action plans relating to the protection and

care of OVC working closely with CCCs.

WV through its Organizational Capacity Building (OCB) process will work with community care groups and

community care coalitions in high prevalence regions to provide care and support to orphans and other

vulnerable children, home-based and palliative care, prevention activities, care and support.

WV will strengthen the already established resource centers in each ADP. Each ADP will be trained on how

to source and utilize resources. The resource centers will be used by the CCCs and community assisting

them in the development of an adequate response to the OVC issues.

The South African government's (SAG)'s HIV & AIDS and STI National Strategic Plan for South Africa 2007-

2011 (NSP) calls for: 1) reduction of HIV incidence by 50%; and 2) expanding access to appropriate

treatment, care and support to 80% of all HIV-infected people and their families by 2011. Through its NoH

project, WV fully endorses these objectives in collaboration with the SAG at various district levels is

essential for an active, effective and sustainable response.

Gender:

Peer support groups and Youth AIDS clubs will be targeted toward adolescents through schools and

churches. Training in Youth prevention strategies will target boys and girls. OVC will identify role models to

serve as the peer support leaders. The anticipated outcome of this process is a re-emergence of AB as a

community norm and a reduction in the practice of cross-generational sex, transactional sex and multiple

casual sex partnerships, etc.

Holistic Soul Body Institute will be responsible for delivering gender-related trainings for home visitors,

adolescents and relevant community members and key stakeholders.

-------------------------

SUMMARY:

World Vision (WV), together with the Christian AIDS Bureau of South Africa (CABSA), will mobilize and

strengthen a community led response to protect and care for orphans and vulnerable children (OVC) and

their families. The program is active in the Free State, Limpopo and the Eastern Cape provinces and with

will expand to the KwaZulu-Natal province. The major emphasis area is human capacity development

Activity Narrative: (training). The target population is OVC.

BACKGROUND:

WV works in six provinces in South Africa (SA) in collaboration with CBOs, FBOs and government entities

to support over 42,000 sponsored children including 4,439 OVC registered at present. Currently, PEPFAR

supports Area Development Programs (ADPs in three and this will be expanded to four additional sites

within KwaZulu-Natal province. WV partners with CABSA to empower faith communities to develop projects

addressing HIV and AIDS. WV will use the CABSA curriculum (Channels of Hope (CoH)) to address

churches and FBOs to deal effectively with HIV and AIDS. The South African Government (SAG) Policy

Framework for OVC asserts that NGOs should assist in rolling out innovative and tested models to mobilize,

strengthen and support community led OVC efforts. With FY 2008 funding, WV will continue to assist

targeted communities to establish structures through which the community can care for and support OVC.

One element of an enabling environment for OVC support is the sustainability of community-based

organizations (CBO) such as Community Care Coalitions (CCC) which are equivalent to Child Care

Forums. WV will implement an organizational capacity building guide that includes self-assessment, training

based on the assessment and the follow-up support. WV will facilitate a process of sustainable community

involvement through this training to enable communities to develop and support their OVC. The WV

program will continue to work toward gender equity in service deliver by offering short gender courses to

NGOs and CBOs to improve their knowledge about child protection and how to address the factors that

keep girls out of school.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

WV will conduct workshops, utilizing the CABSA CoH curriculum. A two-day Leaders Workshop will be held

with interested religious leaders The workshop will help religious leaders understand the urgency of the HIV

and AIDS crisis, to address negative and discriminatory attitudes and to work towards compassionate and

effective responses in congregations and communities. These leaders return to their congregations and to

FBOs to identify interested members who will in turn attend a four day workshop, which give attention to

best practice models for prevention, care for OVC, home-based care, voluntary counseling and testing and

advocacy. As a result of the four-day workshop, WV will work with each FBO to develop action plans to

address congregational and community, as well as confront gender discrimination, promoting gender equity

in communities. Trained congregation and FBO members will form Hope Teams which WV will support with

ongoing training and mentorship. In turn, these Hope teams will develop and carry out action plans relating

to the protection and care of OVC. The Hope Teams will work closely with the CCCs. 111 Hope Teams

have already been formed, training at this level will continue in FY 2008.

ACTIVITY 2: Community Mobilization

Through CCCs, WV will mobilize community stakeholders, including FBOs, CBOs, local government,

traditional leaders, school committees, health representatives, women groups, associations of people living

with HIV (PLHIV) and OVC. A two day stakeholder workshop will be held to identify gaps, and select the

CCC structure most appropriate to the local context. WV and CCCs will recruit new Home visitors (HV) to

visit OVC in their homes. CCCs will be encouraged to link and play an active role within the District Action

Committee for Children affected by HIV and AIDS (DACCA). Together with the CCC the HV will receive

training on Child Rights and Protection, access to education, health and nutrition, HIV prevention, Life Skills,

psychosocial support (PSS) and succession planning over five days. As a result, each identified OVC will

receive support from HV ranging from direct material provision to greater livelihood security.

ACTIVITY 3: Care and Support

After the workshops for CCCs and HVs, each OVC will receive a basic minimum package of services and

support. The services will include child monitoring and protection, PSS, agricultural inputs, facilitating

access to education, health care, basic nutrition training, HIV prevention, home-based care for chronically ill

adults and children, succession planning and supervised recreation. Direct support will include school fees,

vocational training, school uniforms, books and supplies, facilitation with transport for primary health care

checkups, improved diets/livelihoods through, clothing shoes, bedding and blankets.

ACIVITY 4: Local Organizational Capacity Development

WV developed an Organizational Capacity Building (OCB) guide to build organizational capacity. The OCB

process begins with an organizational self-assessment, training based on the result of the assessment and

follow-up support. The training may include Organizational Purpose, Planning, Procedures, Group

dynamics, Monitoring, Evaluation and Reporting, Finance, Resource Mobilization and external relations.

Through this activity WV will build the capacity of local organizations to operate effectively in providing

adequate protection and care to OVC and their families. WV will partner with CABSA to establish resource

centers in each ADP; stocked with relevant HIV and AIDS materials. The resource centers will be used by

the CCCs and community assisting them in the development of an adequate response to the OVC issues

facing their community.

ACIVITY 5: Referrals and linkages

WV works in collaboration with the DOSD, the Departments of Health, Education, Agriculture, private

companies, FBOs and CBOs. These partnerships will be expanded to ensure that all OVC are provided with

a full package of care and referred for appropriate treatment and care services. In addition to establishing a

program of 'community conversations', the project will integrate a gender component and advocacy into all

activities. The aim of these activities is to build stronger, more gender-equitable relationships with better

communication between partners utilizing participatory learning to improve the health, well-being and

Activity Narrative: resilience of adolescent OVC (Boys and Girls). Emphasis is place on options to delay sexual activity.

In FY 2008 the following activities will be added:

ACTIVITY 6: Community conversations

Facilitated community conversations will focus on raising awareness of social-economic and cultural

inequalities that put women at a disadvantage and how this contributes to the spread of HIV and AIDS.

Specifically, discussions will focus on how to strengthen the negotiating powers of women and girls in

sexual relationships and on raising the awareness of men about the role they play in sexual relationships.

This gender equality dialogue will emphasize the positive aspects of changing the behaviors that increase

the risk of becoming HIV-infected and using best practices. WV will benefit from participatory research

conducted demonstrating that these open and frank but sensitive "community conversations" help cement

new positive attitudes among youth and reduce gender-biased stereotypes. The majority of care workers

(Home visitors/HV) in OVC programs are women (over 70%). WV will work to increase the involvement of

men in care-giving of OVC. As part of the CCC (Community Care Coalition) trainings, HV's will engage men

by focusing on such topics as family violence, anger management, fathering and parenting skills. Training

materials will include discussion of power relations between girls and boys, women and men, and will give

girls skills in refusal and negotiation. CoH training will also emphasize addressing gender from a standpoint

of context and attitudes. WV will focus on men and boys as agents of change in this process of awareness

building, mobilizing and spreading HIV prevention messages.

ACTIVITY 7: Peer-support groups and Youth AIDS clubs

Peer support groups and Youth AIDS clubs will be targeted toward adolescents. WV will connect with these

adolescent OVC through schools and churches. Training in Youth prevention strategies will target boys and

girls. Using a participatory process, OVC will identify role models (including positive deviants) to serve as

the peer support leaders. The adolescents will form peer-education groups and these groups will form the

critical catalysts for the community social discourse on healthy norms and avoidance of risk behavior. The

anticipated outcome of this process is a re-emergence of AB as a community norm and a reduction in the

practice of cross-generational sex, transactional sex and multiple casual sex partnerships, etc.

In all WVSA ADP PEPFAR-funded sites there are sponsored children, funded by donors from different

countries, many of whom are OVC. WV requires at least quarterly visits to each of these children by

Development Workers. Through this process WVSA identifies the education, health, spiritual and other

needs of the children and their families. WV field staff provides a proactive role in identifying the needs of

OVC and the subsequent delivery of services, justifying the allocation of WV Matching funding to the budget

allocated by PEPFAR.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13908

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13908 6561.08 U.S. Agency for World Vision 6647 4103.08 World Vision $3,939,000

International South Africa

Development

7634 6561.07 U.S. Agency for World Vision 4498 4103.07 World Vision $1,200,000

International South Africa

Development

6561 6561.06 U.S. Agency for World Vision 4103 4103.06 World Vision $550,000

International South Africa

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $340,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $80,000

Education

Water

Program Budget Code: 14 - HVCT Prevention: Counseling and Testing

Total Planned Funding for Program Budget Code: $38,459,064

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Background

South Africa (SA) has a highly generalized HIV epidemic with prevalence of 18% among sexually active adults. The South African

government (SAG) has responded to the rising HIV and AIDS burden by constructing an ambitious national strategic plan, South

Africa National Stretegic Plan for HIV & AIDS and STI, 2007-2011 (NSP). The NSP outlines four priority areas, including

prevention; treatment, care and support; research, monitoring and surveillance; and human rights and access to justice. Since

2000, the National Department of Health (NDOH) has supported widespread implementation of a national program for voluntary

counseling and testing (VCT). The predominant model of counseling and testing (CT) that was used between years 2000 and

2006 has been VCT, but a variety of models have been implemented since then to reach the different target populations in the

country.

Policy

In early 2008, NDOH updated the policy and guidelines to ensure that CT service outlets provide caring, high quality, uniform, and

equitable CT services in South Africa. The document also provides a guide for the implementation of a more comprehensive

national CT program that should improve CT uptake among the target population. In addition, the NSP promotes the use of

Routine Offer of Testing and Counseling (ROTC), and the NDOH has drafted guidelines on the implementation of ROTC.

Until recently in South Africa, the Child Care Act 74 of 1983 was the single most important law regulating children's access to

medical treatment or procedures. The new Children's Act 38 of 2005, revoked the Child Care Act 74 of 1983, and some sections

of the 2005 Act were amended in 2007. A major amendment in 2007 was the clause decreasing the age of consent to an HIV test

from 14 to 12 years. In addition, in South Africa a child 12 years or older can legally access contraceptives without parental

consent.

Partners

The United States government (USG) and PEPFAR partners continue to support the NDOH in their efforts to update policy,

guidelines, training, and mentoring in order to increase the demand for and the availability of quality CT services. In 2009, 53

PEPFAR-funded partners identified CT as a primary activity including all treatment partners who routinely receive a CT budget to

ensure smoother referrals, access to treatment, and movement into care. Some partners work independently, while others support

NDOH sites, but all comply with NDOH policies. NDOH-supported sites integrate CT services within a comprehensive health

service package. Levels of support to NDOH sites vary among partners, but common elements are provision and training of lay

counselors and professional nurses and provision of technical assistance and mentoring. The SA USG team conducted an

internal paper-based partner evaluation with all partners this year. Partners submitted an early modified COP, which probed in

areas that needed clarification in various aspects such as improved service delivery and gaps for each program area. The data

from the partner evaluation provided a broad review of the PEFPAR CT partners, which is outlined below. The South African

USG/CT team is actively responding to the need for improvements in areas such as TB screening for all CT partners and

utilization of multiple CT models per partner and site.

Models

Partners utilize a wide variety of CT models across the country, and all are in line with NDOH guidance. An increasing number of

partners are offering mobile, stand-alone, and traditional VCT services. In addition, there has been evidence of a steady increase

of partners providing ROTC, known as provider-initiated testing and counselling. A considerable number of partners have started

providing home-based CT, a new model in South Africa, but one that South African partners have embraced. In all nine provinces,

there is at least one partner proposing to implement home-based CT. Home based CT is mainly proposed in rural areas where

services are not easily accessible. Workplace CT is another important model that is being implemented by several partners in

South Africa. Finally, couple HIV counseling and testing is being implemented on a large scale in the country. The biggest

challenge in South Africa, however, is attracting clients to come as couples for CT. Partners have therefore proposed interesting

and innovative ways of attracting couples, such as opening for longer hours and partnering with churches and other

organizations where people go as couples. Partners aim to attract both married and cohabitating couples.

Geographic coverage

The 2008 COP indicated that there was a large gap in geographical distribution of services, particularly in the provinces of Free

State, Northern Cape and the North West. This year, however, partners are distributed more evenly, and all the provinces have

some coverage, with a variety of models. Each province has more than five partners providing CT services. Provinces such as

KwaZulu-Natal and the Eastern Cape, which have a higher disease burden, have more partners working in the area. Models such

as home-based and mobile CT are largely used to serve the rural populations.

Targets

The FY 2007 CT target was estimated by reviewing the antiretroviral treatment (ART) targets for each year over a five-year period

in order to reach 500,000 persons on ART by September 2009. Over the past three years, approximately 19 people were tested

for HIV per every one person placed on ART. The September 2008 and 2009 CT targets are estimated at 2,036,000 for each

year.

About 80% of public health facilities offer VCT nationwide through 4,000 public VCT service points. Though this may seem

adequate, recent data show that only 2% of persons who need to be tested undergo testing. This means that while testing

services are accessible in most parts of the country, only a few people in the target population utilize the services. One of the

target populations for CT services is men and partners have proposed methods of attracting men to test for HIV. The NSP sets

new targets for CT to ensure that all persons at risk get tested, especially those at highest risk who present at clinics for family

planning, sexually transmitted infections, antenatal, and TB services and those in high transmission areas. The NSP recommends

provision of ROTC in health facilities. It sets a target of 75% of all public health facilities using this model by 2011. The ROTC

model is used in addition to the standard VCT and other CT models.

Cost per target

The South African government provides test kits to public health facilities as well as to selected stand-alone and mobile CT

facilities. Independent CT services, however, need to purchase their own supplies. This makes it difficult to calculate average cost

per target, and in an attempt to remedy this, partners have been asked to provide an explanatory narrative in their COP entries to

explain costs related to CT services. Given all the different circumstances, the average cost per target for South Africa in the 2009

COP is $22.50 USD.

Training

All partners described their training activities in COP FY 2009. This year's PEPFAR guidance discouraged training on traditional

VCT. Instead, partners were encouraged to identify gaps and provide more training on ROTC, couple counseling, and quality

assurance. The South Africa USG team will review partner training activities in 2009 to ensure that multiple aspects of training and

evaluation are taking place.

Challenges

As more people become willing to undergo HIV testing and counseling, the need for quality assurance increases. In addition to

increased demand for CT services, the NDOH approved five test kits to be used on tender last year. This meant that each

province was assigned different combinations of test kits, which may have led to a lack of standardized procedures and thus

decreased quality of testing. The USG is currently working with the NDOH and the National Institute for Communicable Diseases

to strengthen quality management systems and particularly, quality assurance and quality improvement.

The amended Children's Act that allows children aged 12 and upwards to consent to HIV testing, has also affected CT service

providers. Many counselors are not comfortable discussing sexual issues with children and adolescents as they have not received

any training on these target populations as yet. There is an urgent need for more training on counseling children and adolescents.

Table 3.3.14: