Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 4653
Country/Region: South Africa
Year: 2007
Main Partner: University Research Corporation, LLC
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: HHS/CDC
Total Funding: $1,400,000

Funding for Testing: HIV Testing and Counseling (HVCT): $1,400,000


This activity also relates to activities in Basic Health Care and Support (#7429), ARV Services (#7428), TB/HIV (#7430), PMTCT (#7431) and TB/HIV (#7626).


University Research Corporation (URC) works with the national and provincial Departments of Health in South Africa to expand access and uptake of HIV counseling and testing (CT). URC's major strategy is to introduce provider-initiated CT, with the option to opt-out, to reduce missed opportunities for HIV identification and further spread of HIV in the country. URC will use a collaborative approach for rapidly expanding the CT services. The approach will include: integrating services (CT with antenatal care, sexually transmitted infections (STI), tuberculosis (TB) and general clinical service areas); training program managers and healthcare providers; placing temporary clinical staff to launch the CT services; and strengthening supervision and monitoring systems. Support will also be provided to improve recording and reporting at all levels. The major emphasis area is local organization capacity development, with minor emphasis on quality assurance and supportive supervision, network/linkages/referral systems, and training. The activity targets public health workers, community-based organizations (CBOs) and faith-based organizations (FBOs), program managers and community volunteers, youth and adults, and STI, TB, and general clinic attendees.

BACKGROUND: Uptake of CT remains low due to stigma, as well as perceptions about poor follow-up and treatment options available for people with HIV and AIDS. In 2006, URC was awarded the provider-initiated CT program in South Africa. The current program is focusing on seven provinces (Mpumalanga, KwaZulu-Natal, Limpopo, Gauteng, North West, Free State and Eastern Cape) to increase uptake of CT services. The basic strategy is to help healthcare facilities introduce provider-initiated CT. This is is achieved by integrating provider-initiated CT, with the option to opt-out, with TB, STI, antenatal care and other general clinical services targeting both adults and youth.

In FY 2007, URC will continue using the district-based CT service expansion model whereby CBOs and FBOs as well as public and private healthcare facilities will play a role in increasing uptake of CT through referrals and direct provision of high quality provider-initiated services. In clinics that lack the requisite number of staff or the existing staff does not have the appropriate skills for initiating CT, URC will place temporary staff (counselors and testers) to rollout the CT services. The maximum duration of temporary staff assignments to a facility will not exceed six months. URC will develop the capacity of healthcare workers in their ability to provide high quality provider-initiated CT services, including post-test counseling for both HIV-infected and HIV-negative persons.


URC will carry out seven separate activities in FY 2007.

ACTIVITY 1: Assist NDOH to Streamline Policies on Provider-initiated HIV CT

URC will work with the National Department of Health (NDOH) to develop a policy framework to streamline the integration of provider-initiated CT with various clinical services (TB, STI, antenatal care, pediatric care, etc.). URC will support policy dialogue workshops at national and provincial levels to expedite the development of the policy framework.

ACTIVITY 2: Develop District-based CT Expansion Strategy

URC, in consultation with provincial district health offices, will identify target districts. All facilities in a district will be covered under URC's CT program. URC will assist each focus district in developing a strategy for increasing uptake of provider-initiated CT services. A typical strategy will have the following elements: clinical services and facilities to be targeted for integration with provider-initiated CT; key performance indicators (number of people to be trained; number of people who will receive the CT services); training

schedule (who will be trained, when will they be trained); supervision and mentoring (who will be responsible for providing supervision and mentoring to facilities to ensure the CT is being integrated and the quality of services are per national standards, etc.). Each district will establish a CT expansion team representing HIV, maternal and child health, TB, and STI directorates. These teams will be responsible for reviewing results every three months to determine if CT expansion strategies are producing desired results.

ACTIVITY 3: Establish Baseline CT Uptake Levels in Each New Facility

URC staff will review clinic logs and patient records to establish baseline CT uptake, and referrals for antiretroviral treatment (ART) in various clinical settings (TB, STI, antenatal health clinic, etc.). These assessments will help the facility teams identify clinical services that are offering CT as well as the levels of uptake. The rapid assessments will also examine the quality of services that may be affecting the CT uptake. The assessments will target both service providers and CT clients (those who accept and those who opt-out). Observations, chart and record reviews, and interviews are some of the approaches that will be used for data collection.

ACTIVITY 4: Training

URC will work with the departments of health to train clinic staff (doctors, nurses, midwives, counselors, and testers) in provider-initiated CT. Training will focus on how to provide pre-test information and how to provide post-test counseling to HIV-infected and HIV-negative persons. The training will also include a module on the management of provider-initiated CT, which covers logistics, recording and reporting, referral systems for HIV testing (for sites that are unable to provide testing within their sites) and ART. Specific case studies will be used and participants will work in groups to identify gaps in CT services and suggest possible solutions. URC will provide job-aids, wall charts, and other needed materials to improve compliance with clinical and counseling guidelines.

ACTIVITY 5: Referrals and Linkages

Not all service providers or facilities will be able to offer CT within their facilities. In such cases, URC will work with provincial and district departments of health to develop referral linkages to ensure that clients have easy access to services. We will also develop linkages between CT sites and sites offering ARV treatment.

ACTIVITY 6: Compliance Audits

URC will conduct annual compliance assessments in a sample of participating facilities to assess whether the staff is in compliance with the national CT guidelines. These assessments will also examine the quality of performance data reported to the program.

ACTIVITY 7: Strengthening Quality Assurance and Supervision System

URC will train district and facility-level supervisors in quality assurance and quality improvement methods and facilitative supervision techniques for improving the quality of CT services.

These activities are expected to increase uptake of HIV CT in 500 healthcare facilities by assisting them to rapidly expand CT services. Facilities receiving URC assistance will provide HIV CT results to 205,000 men and women as a result of the integration of HIV CT with other high volume health services. URC will train 1,400 healthcare workers in CT integrated with antenatal care, TB, STI and general health services.

By focusing on promoting the uptake of counseling and testing through community structures and increasing local capacity, URC will contribute to the PEPFAR goals of 10 million people in care and 7 million infections averted.