In 2008 Anova Health Institute (Anova) responded to a request by the South African Department of Health (DOH) to implement sexual health services for men who have sex with men (MSM). With funding from USAID/PEPFAR Anova undertook a rapid assessment and initiated an MSM-focused project, Health4Men, to address prevention, treatment and care among MSM, developing a model that could be replicated in diverse South African environments.

Anova established Africas first two Centers of Excellence (COE) in MSM healthcare, located in the Western Cape and Gauteng respectively. Each COE is supported by a number of additional MSM-competent sites, providing an essential platform for ongoing operational research to understand the needs of MSM. All sites are embedded within existing public health facilities, cementing partnerships between Anova and the DOH on national, provincial, district and sub-district levels.

Based on sound research Anova has developed public messaging to address prevention and to attract MSM into treatment and care. Anova has trained and mentored health workers enabling scale-up of MSM-competent services. This training had been successfully implemented in various environments, allowing for a carefully nuanced skills-transferal program. These are supported by national annual MSM-focused symposia.

Anova will extend MSM-competent services in Gauteng and the Western Cape, and introduce such services into Limpopo, Mpumalanga and North West provinces. This process is underpinned by Anovas active leadership role within the South African National AIDS Council (SANAC) and ongoing consultation with DOH, guided by the National Strategic Plan on HIV, TB and STIs for 2012 - 2016 (NSP) highlighting MSM as a key population.

Anova Health Institute (Anova) is at the forefront of providing innovative HIV interventions for men who have sex with men (MSM) in South Africa. MSM are vulnerable to HIV, have significantly higher rates than the general population and are recognized as a key population needing special attention by the South African government in the National Strategic Plan (NSP).

Anovas MSM care and support activities will be integrated into MSM-competent healthcare, scaling up and institutionalizing MSM services within DOH sites, promoting health and service utilization by MSM through community engagement, and ongoing operational research. The establishment of 2 community-based health posts, where MSM can readily access relevant information, peer support, ARV medication in the case of treatment adherent clients and assisted referral to clinical sites will explore ways of reducing strain on clinical services.

Anova provides direct health services at 2 Centers of Excellence (COE) to approximately 17 000 MSM. This has allowed Anova to develop insight into cost-effective interventions and to refine a multi-faceted model for competent MSM healthcare in South Africa. Approximately 5000 MSM are regular clinic attendees with over 1500 being HIV positive in care and 1000 on antiretroviral treatment. Anova has contributed to international and local guidelines for the detection and management of STIs and HIV for MSM.

MSM services are established in Gauteng and Western Cape, and have been introduced to Limpopo, Mpumalanga and North West provinces with 105 sites planned. Anova actively engages with the Department of Health (DOH) and the South African National Aids Council (SANAC) to influence policies conducive to the extension of services.

Anova will establish a Regional Leadership Site (RLS) or COE in each province, each designed to act as the provincial hub for the extension of services through a coordinated process of skills transference to DOH staff at selected facilities through training and mentoring using SANAC and DOH endorsed material. Staff at each RLS/COE are trained and mentored, with a nurse mentor deployed to each such site. Additional sites are selected in consultation with DOH, based on population densities and provided with technical assistance including a supply of MSM-targeted educational materials, condoms and sachets of lubricant, and ongoing consultation.

Community engagement targeting local MSM individuals, networks, groupings and organizations promotes service utilization, HIV prevention and adherence.

Sustainability is addressed at all levels of DOH and SANAC to ensure their commitment and by embedding and integrating MSM competent services within existing DOH health services. This integration and transfer of skills to existing DOH staff ensures cost-effectiveness. Human resources expenditure is limited to the establishment of a central training team deployed to undertake training in various provinces, comprising 5 provincial nurse mentors, peer educators (three per RLS) and project managers.

The M&E plan ensures the impact of these interventions, with follow-up training provided as needed and includes baseline and end of project evaluations, and quarterly collection of process and output indicators. Singizi will conduct annual implementation assessments using District Health Information System data for outcome, impact and NSP target indicators, and feedback dashboard mechanisms will monitor health service coverage and quality.

Men who have sex with men (MSM) are vulnerable to HIV, have significantly higher rates than the general population and are recognized as a key population needing special attention by the South African government in the National Strategic Plan (NSP).

Anova will support TB/HIV integration programs, in line with the NSP in all sites providing competent HIV services for MSM. This initiative will contribute towards the reduction in the number of new TB infections, as well as deaths from TB by 50% by 2016. Anova-supported sites screen over 98% of all newly diagnosed HIV-positive people for TB.

Combination prevention approaches to reduce TB Infection and disease will be employed. Anovas focus is to prevent new infections, to effect early diagnosis and rapid enrolment into treatment, to integrate HIV and TB care within an efficient chronic care delivery system, and to improve patient adherence and defaulter tracing through community outreach teams. Anova will provide technical assistance and health systems strengthening. The major cost of the program will be borne by the DOH.

Baseline assessments followed by annual facility audits will be conducted in all supported MSM-competent services on the status of the TB/HIV program, focusing on TB/HIV integration and implementation of Isoniazid Preventative Therapy and infection control activities.

At facility level, Anova will provide technical assistance through mentorship and supportive supervision by experienced TB mentors. Key interventions will include a) Intensified TB case finding through universal screening for TB and contact-tracing, b) TB infection control through training, mentorship and establishing facility-based infection control committees; c) Scale-up of Isoniazid Preventative Therapy through training and data collection to enable effective outcomes and eliminate or reduce frequency of drug stock outs; d) Management of drug resistant TB through training, mentoring and improving time between diagnosis, follow-up and tracing and; e) Overall health systems strengthening to improve management and costing of TB programs.

At community level, Anova will work with established MSM community groups to link to facilities and conduct mass media and local campaigns, promoting a culture of cough hygiene and household infection control. Community health workers and outreach teams will assist in engaging with the household contacts of index cases, conducting household door-to-door visits and enhancing community follow up of MDR-TB cases. Anova supports the integration of screening activities across program areas for early identification of most at risk populations including children and informal settlement dwellers.

Anovas strategy, in close partnership with the DOH, will provide intensive cost-effective support for 2-3 years and then scale down to a mentoring role to ensure full managerial and financial responsibility by DOH.

The M&E plan includes baseline and end of project evaluations, and quarterly collection of process and output indicators. Singizi will conduct annual implementation assessments. Assessments for outcome, impact and NSP target indicators will use District Health Information System data, and feedback dashboard mechanisms will monitor health service coverage and quality

Anova Health Institute (Anova) is at the forefront of providing innovative HIV interventions for men who have sex with men (MSM) in South Africa. MSM are vulnerable to HIV, have significantly higher rates than the general population and are recognized as a key population needing special attention by the South African government in the National Strategic Plan (NSP).

Anovas HTXS activities will develop and evaluate innovative models for MSM-competent healthcare, scaling up and institutionalizing MSM services within DOH sites, promoting health and service utilization by MSM through community engagement, and ongoing operational research. The establishment of 2 community-based health posts, where MSM can readily access relevant information, peer support, ARV medication in the case of treatment adherent clients and assisted referral to clinical sites will explore ways of reducing strain on clinical services.

Anova provides direct health services at 2 Centers of Excellence (COE) to approximately 17 000 MSM. This has allowed Anova to develop insight into cost-effective interventions and to refine a multi-faceted model for competent MSM healthcare in South Africa. Approximately 5000 MSM are regular clinic attendees with over 1500 being HIV positive in care and 1000 on ART. Anova has contributed to international and local guidelines for the detection and management of STIs and HIV for MSM.

MSM services are established in Gauteng and Western Cape, and have been introduced to Limpopo, Mpumalanga and North West provinces with 105 sites planned. Anova actively engages with the Department of Health (DOH) and the South African National Aids Council (SANAC) to influence policies conducive to the extension of services.

Anova will establish a Regional Leadership Site (RLS) or COE in each province, each designed to act as the provincial hub for the extension of services through a coordinated process of skills transference to DOH staff at selected facilities through training and mentoring using SANAC and DOH endorsed material. Staff at each RLS/COE are trained and mentored, with a nurse mentor deployed to each such site. Additional sites are selected in consultation with DOH, based on population densities and provided with technical assistance including a supply of MSM-targeted educational materials, condoms and sachets of lubricant, and ongoing consultation.

Community engagement targeting local MSM individuals, networks, groupings and organizations informs them of the project and promotes service utilization.

Sustainability is addressed at all levels of DOH and SANAC to ensure their commitment and by embedding and integrating MSM competent services within existing DOH health services. This integration and transfer of skills to existing DOH staff ensures cost-effectiveness. Human resources expenditure is limited to the establishment of a central training team deployed to undertake training in various provinces, comprising 5 provincial nurse mentors, peer educators (three per RLS) and project managers.

The M&E plan ensures the impact of these interventions, with follow-up training provided as needed and includes baseline and end of project evaluations, and quarterly collection of process and output indicators. Singizi will conduct annual implementation assessments using District Health Information System data for outcome, impact and NSP target indicators, and feedback dashboard mechanisms will monitor health service coverage and quality.