Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4504
Country/Region: South Africa
Year: 2007
Main Partner: Elizabeth Glaser Pediatric AIDS Foundation
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: HHS/CDC
Total Funding: $5,283,351

Funding for Treatment: Adult Treatment (HTXS): $5,283,351

INTEGRATED ACTIVITY FLAG: This EGPAF Track 1 activity is part of a comprehensive program that receives both Track 1 and in-country funding. The Track 1-funded activity is related to activities described in ARV Services (#7653), ARV Drugs (#7655), TB/HIV (#7968), Basic Health Care and Support (#7654) and PMTCT services (#7969). Please note that the targets below are a combination of both Track 1 and country funding.

SUMMARY: The primary emphasis area for this activity is human resources, with minor emphases in development of networks, infrastructure, quality assurance and supportive supervision, strategic information and training. Primary populations targeted include infants, men and women, people living with HIV (PLHIV), and public and private healthcare providers. The geographic focus is KwaZulu-Natal (KZN).

BACKGROUND: The long-term goal of the EGPAF care and treatment program in South Africa is to increase life expectancy amongst HIV-infected persons. This will be achieved through focusing on increasing access to care and treatment services and service utilization. To achieve these goals and objectives, project Help Expand ART (HEART) will expand the geographic coverage of services during FY 2007. HEART/South Africa is part of a larger worldwide initiative by EGPAF to support care and treatment services, and receives both Track 1 and in-country PEPFAR funding. The program's focus is on integrating PMTCT services to provide a family-centered model of care that includes access to treatment for HIV-infected pregnant women, couple counseling, partner testing and screening for TB.

EGPAF utilizes external resources to complement those of the KwaZulu-Natal (KZN) Department of Health (DOH) and private partners, such as FBOs and other NGOs. These resources are utilized to fund staff, infrastructure, drugs, laboratory testing and provide technical support. EGPAF will identify gaps in the program at the individual site level and implement activities to address the needs. The intent is to facilitate national and provincial plans and work together with the government and partners to transition programs to South Africa government (SAG) support.

EGPAF has a partnership with a private NGO, the AIDS Health Care Foundation (AHF); this is a cost-sharing relationship (drugs and staff) to support the AHF care and treatment program. McCord Hospital, a faith-based organization, is a sub-grantee of EGPAF. The EGPAF partnership with the DOH includes support for human capacity development, infrastructure rehabilitation and technical support for sites in KZN.

The existing sites are: 1. McCord Hospital, Durban 2. AHF (Ithembalabantu Clinic), Umlazi, Durban 3. KZN DOH, Pietermaritzburg Up/Down-referral program (Edendale Hospital and four referral clinics, Northdale Hospital and five referral clinics), 4. KZN DOH, KwaMsane Clinic in the Hlabisa Sub-district of uMkhanyekude District. 5. KZN DOH, Vryheid Hospital plus three referral clinics, Benedictine Hospital and three referral clinics, and Edumbe Community Health Centre (CHC) plus one referral clinic, in Zululand District.

New HEART partners include KZNDOH at Ceza Hospital, Nkonjeni Hospital, St Francis Hospital, Itshelejuba Hospital and two referral clinics per hospital, in Zululand District.


ACTIVITY 1: Human Capacity Development EGPAF will support training of healthcare providers on the following: 1. Screening and treatment of TB/HIV and opportunistic infections, ART in pregnancy, and referral systems (between PMTCT and ART) 2. Supporting systems to improve access to care and treatment of children (including early infant diagnosis) 3. Capacity building at sites for implementation and management of the comprehensive care, management and treatment support program 4. Monitoring and evaluation

5. Project management 6. Completing a HIV and AIDS Diploma at the University of KwaZulu-Natal.

In addition EGPAF will provide technical assistance for the creation of outreach programs to build capacity at primary healthcare (PHC) clinics for downward and upward referral in order to maintain patients on ART, initiate new patients on therapy, and decongest treatment sites that have reached capacity.

ACTIVITY 2: Down Referral Process The KwaZulu-Natal Health Department (KZNDOH) started providing comprehensive care and treatment services to HIV-infected patients in May 2004 at hospital level. PHC clinics will be capacitated so that they are able to manage stable patients on ART referred down from the hospitals or community health centers (CHCs), and also up refer those that are eligible for initiation of ART to hospital or CHCs that are ARV rollout sites.

The KZNDOH aims to make ART accessible to all by expanding and strengthening existing HIV and AIDS care and treatment service delivery. A number of CHCs have been accredited by the national and provincial health departments and will initiate ART. The PHC clinics conduct rapid HIV testing, CD4 testing and provide the first, second and third adherence counseling sessions, which is also done at CHC and hospital level, and then refer patients to accredited CHCs or hospitals for initiation. The KZNDOH has identified the Pietermaritzburg and Zululand Districts as areas needing immediate support as they are poorly resourced with high HIV seroprevalence rates. The KZNDOH has requested that EGPAF support be extended to these districts. The districts will identify clinics where stable patients on treatment can be referred to continue management.

ACTIVITY 3: Pediatric Care and Treatment The goal for EGPAF is to ensure that 10 percent of all patients on treatment are children, which has not been achieved in the Zululand district. To strengthen pediatric HIV care and treatment, EGPAF will provide training on early infant diagnosis, pediatric HIV clinical staging and diagnosis and ART in children, in addition to provision of staff, strengthening the linkages between PMTCT and care and treatment.

The Edendale and Northdale pediatric HIV clinic has the largest cohort of pediatrics in the province on ART. The hospital down refers stable patients to the care of the PHC clinics to free up space for new pediatric patients.

EGPAF aims to: 1. Increase the rate of down referral of stable children on ART 2. Increase the up referral of new eligible children for initiation of therapy 3. Improve linkages between PMTCT programs and care and treatment programs

EGPAF will provide financial and technical support to eight PHC clinics in the catchment area of the Edendale and Northdale hospital in Pietermaritzburg, thus capacitating them to: (1) receive and manage transferred stable pediatric patients on ART from the pediatric HIV clinic; and (2) provide screening and preparation of eligible HIV-infected patients at these PHC facilities for up referral and initiation of ART at Edendale Hospital Pediatric HIV clinic.

ACTIVITY 4: Counseling and Testing The focus will be on strengthening the comprehensive HIV and AIDS care and treatment services using the family-centered approach to increase access to voluntary counseling and testing, by fast-tracking TB, STI, and family planning patients to VCT; to integrate PMTCT with HIV and AIDS care and treatment; to improve the referral of eligible pregnant mothers, partners, family members, and HIV-infected infants and children to treatment sites; to screen for opportunistic infections. With this focus, EGPAF will increase pediatric care and treatment, couple counseling, partner testing, and testing for siblings. The overall goal is to expand the coverage of HIV and AIDS care and treatment services to reach mothers, partners and children who would not otherwise have access to these services.

By supporting HIV care and treatment services, EGPAF contributes to the 2-7-10 goals of PEPFAR and the USG Five-Year Strategic Plan.

Subpartners Total: $2,600,000
McCord Hospital: $2,600,000
Africa Centre Kwamsane Clinic: NA
AIDS Healthcare Foundation: NA
Free State Department of Health: NA
KwaZulu-Natal Department of Health: NA