Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 6156
Country/Region: South Africa
Year: 2007
Main Partner: Columbia University
Main Partner Program: Mailman School of Public Health
Organizational Type: University
Funding Agency: USAID
Total Funding: $3,750,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $550,000

Columbia is considered a new partner for the purposes of this plus-up/reprogramming. Plus up funds will support Columbia to expand PMTCT services in the Western Cape, Free State, and the Northern Cape. Activities include the provision of technical assistance at government sites, mentorship programs for general practitioners and nurses, both on-site and off-site training, and support group implementation. Provider initiated testing will be encouraged. Careful monitoring of women who test positive will be ongoing to ensure that treatment will be initiated as soon as women are eligible.

Funding for Care: Orphans and Vulnerable Children (HKID): $600,000

Columbia will use plus up funds to expand ART to children in OVC programs. Caregivers of these OVCs will be trained in adherence and support and will be linked to ongoing ART programs for children. Columbia will work with OVC partners and train them to promote early diagnosis and routine testing. Linkages will be made with ART services and systems for referral and follow up will be developed and implemented. OVC partners will be assisted to monitor all children in their programs who are on ART. Columbia will work with PMTCT and antenatal care providers to establish systems for early diagnosis, care, monitoring, and ART. OVC programs in seven provinces will be guided. These include, Western Cape, Eastern Cape, KZN, Northern Cape, Free State, Gauteng, and Limpopo provinces.

Funding for Treatment: Adult Treatment (HTXS): $2,600,000

Plus up funds will be used by Columbia University to expand ART to pregnant women, women who have been enrolled in PMTCT programs, and children. Funds will also be used to continue and expand pediatric ART training based at Tygerburg Hospital in the Western Cape. Training will be delivered in two additional provinces, the Free State and Northern Cape. Activities to expand these services include the improvement of pediatric treatment at government and NGO facilities, on-site technical assistance, development and implementation of systems to improve pediatric referral and retention in ART programs, and strengthening links between pediatric ART services and OVC programs. Mapping exercises are underway for OVC services and for pediatric ART services and these services will be formally linked. Clinical mentoring for pediatric ART for both general practitioners and nurses will be expanded.

Added February 2008: SUMMARY:

Columbia University is a Track 1 care and treatment partner in South Africa, implementing site-level activities in the Eastern Cape and KwaZulu-Natal with CDC funding. Since FY 2007, Columbia University's office in Western Cape has received funding from USAID to support treatment partners in Limpopo, North West, Gauteng, Mpumalanga and Western Cape to improve linkages with prevention of mother-to-child transmission (PMTCT) and pediatric antiretroviral treatment (ART). This is achieved by providing technical assistance, training, and mentoring in public and non-governmental (NGO) facilities. The emphasis areas are human capacity development and local organization capacity building.

PEPFAR funds will support the continuation and expansion of the South-to-South Partnership for Comprehensive Pediatric HIV/AIDS Care and Treatment Training Initiative (S2S), a pediatric HIV and AIDS training program implemented in partnership with Tygerberg Children's Hospital and the Stellenbosch University in the Western Cape. The S2S program's experience and materials will support the activities within this initiative.

ACTIVITY 1: On-site Skills Building, Task Shifting and Clinical Mentoring

The critical conduits for system implementation are the healthcare workers. ICAP will work with site staff and partners to implement a supportive supervision model that combines capacity-building elements such as (1) supportive and regular on-site presence; (2) on-site dynamic skills-building events that directly link to implementation and program improvement such as (a) clinical mentoring and modeling to promote the rapid application of in-service learning to the clinical settings and to improve the quality of clinical care and patient outcomes; and (b) on-the-job training to provide necessary knowledge and hands-on practice of skills needed to perform job tasks; and (3) structured training interventions that employ multiple skills building and transfer of learning strategies to reinforce and emphasize key PMTCT and pediatric ART content. Training interventions include instructional (didactic) activities that include case-based learning, group-discussions, problem solving exercises; one-on-one and small team clinical mentoring activities (across/within cadre) with responsive/dynamic coaching and modeling activities; and case study activities.

ACTIVITY 2: Utilize a Multidisciplinary Approach

ICAP will promote the strengthening of a comprehensive approach to patient care at each facility. This includes instituting distinct clinical reasoning skills among cadres, emphasizing collaborative decision making and recognizing the important contributions of all members of the team. Activities to support this will include routine and regular management meetings to discuss service delivery and patient cases, onsite skills building activities and implementation workshops.

ACTIVITY 3: Performance Support

ICAP will provide technical support to partners and site staff to develop content for simple tools, resources, and performance aids that will help providers to correctly perform tasks and make decisions. This includes the development of protocols, decision trees, flip charts and posters for clinical and counseling related services.

ACTIVITY 4: Improve Service Quality and Standards of Care

ICAP will support the adaptation and implementation of a simple standards of care (SOC) tool designed to help the staff rapidly monitor the quality and depth of PMTCT, pediatric and adult ART services being offered at a facility level. ICAP will do so in collaboration with facility staff and partners.

The approaches noted above will be applied to focus areas outlined below.

(1) Prioritizing ART for eligible pregnant woman: ICAP will build on existing PMTCT services to ensure that all HIV-infected pregnant women are assessed for ART eligibility. Eligible women will be fast-tracked to initiate ART regardless of point of entry. Depending on site attributes, ICAP will work with sites and partners to ensure the following: (a) HIV-infected pregnant women receive CD4 testing the same day they receive their HIV test results; (b) women accessing maternal and child health (MCH) services initiate ART at the nearest ART site and be given coordinated visits to ensure that both MCH and HIV and AIDS needs are met; and (c) development of additional service models that increase access to care and treatment services for families including family days at care and treatment clinics, weekend and afternoon care and treatment clinics.

(2) HIV-infected women of childbearing age and their partners: ICAP will continue to strengthen the quality of the clinical and psychosocial services available to HIV-infected women of childbearing age and males (especially partners) enrolled in care and treatment services. This includes supporting facilities to offer services and referrals to counsel HIV-infected women and partners intending to become pregnant.

(3) Ongoing support for PMTCT clients on ART: ICAP will support sites to improve clinical management of pregnant women and families on ART. The support will include assessing (a) clients for treatment failure; (b) ARV contraindication and adverse reaction; and (c) administration of appropriate drug substitution or regimen change.

(4) Psychosocial and Adherence Support (P&AS): Quality adherence and psychosocial support is the cornerstone of successful HIV care and treatment services and having healthier HIV-infected pregnant woman. ICAP will provide individual P&AS through (a) developing and routine implementation of psychosocial assessments to assess ART readiness during pregnancy and post-natal period; and (b) establishing support groups at sites to initiate or strengthen support groups for PMTCT clients. ICAP will also strengthen the roles of the Implementation Team to support P&AS programs. The Implementation Team will include pharmacists and nurses. This activity aims to ensure that facility staff understand the roles and responsibilities of each cadre and acquire the necessary skills to provide those services as part of the multidisciplinary team.

(5) Patient Follow-up: ICAP will develop a mechanism to track and trace patients that have discontinued services or missed appointments. Specifically, this includes (a) setting up a system for tracking no-shows and discontinuers; (b) implementing a follow-up system to reach out to clients soon after they fail to return to the clinic; and (c) developing strong linkages with community-based organizations and community health workers to support patients who have discontinued services.


Target Target Value Not Applicable Indirect number of ART service outlets providing treatment  Indirect number of individuals receiving treatment at ART sites  Indirect number of current clients receiving continuous ART for  more than 12 months at ART sites Number of service outlets providing antiretroviral therapy 50  Number of individuals who ever received antiretroviral therapy by 1,000  the end of the reporting period Number of individuals receiving antiretroviral therapy by the end of 900  the reporting period Number of individuals newly initiating antiretroviral therapy during 1,000  the reporting period Total number of health workers trained to deliver ART services, 100  according to national and/or international standards

Table 3.3.11: