Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 6183
Country/Region: South Africa
Year: 2007
Main Partner: TB/HIV Care Association
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: HHS/CDC
Total Funding: $1,500,000

Funding for Care: TB/HIV (HVTB): $1,500,000


Activities are carried out to support care and treatment services at three hospital-based clinics and eight primary health clinics (PHC). Training and mentoring on topics to ensure provision of quality care will be provided: clinical care, social support, monitoring & evaluation, and health system support. Referral systems, including community adherence support and coordination of services between hospital and PHC, will be strengthened through human resource, capacity development and programmatic support. People infected and affected by HIV, including health care providers will be the beneficiaries of this PEPFAR-supported program.


TB Care Association has been providing community based counselling, emergency material relief, and support, and TB treatment support in the Western Cape since 1992. Support for HIV care and treatment services in the West Coast Winelands is a new initiative. Training and mentoring activities will be done through collaboration with the Department of Health (DOH). Support has been requested by Western Cape Province and all program activities will occur within public health facilities; essential drugs and ARVs will be procured through DOH, and laboratory services will be provided by NHLS, through DOH.


Activity 1: Integration of services and quality assurance The first activity is human capacity development, focusing on integration of the HIV program into primary health care services, including paediatrics. Under the guidance of the clinical coordinator, two TBCA-employed nurse mentors with extensive experience in HIV care and treatment will work closely with DOH to identify training/mentoring needs. DOH clinicians will be trained through didactic and mentoring sessions, on topics including identification and counselling of victims of abuse, reducing stigma, clinical management of patients, integration of services, etc. HIV testing, care and treatment will be strengthened through ensuring all clinicians involved in patient care (doctors, nurses, pharmacists) in all areas of patient care services (EPI, IMCI, minor ailments, TB, family planning, OPD, ANC) are clinically competent in managing HIV positive clients. A quality assurance program will be implemented through support of the DOH multi-disciplinary team meetings, provision of clinical updates & in-services, and introduction of a formal routine chart review, in collaboration with clinic managers. National and provincial standards of care and guidelines will be followed. TBCA will work closely with DOH to facilitate coordination of services between the 3 hospitals and their affiliated clinics, anticipating provision of ART at clinic level by end of FY08. Systems support will be provided as needs are identified (down-referral of drugs, strengthening of patient referrals, etc.) Ten percent of the budget will be spent on promoting paediatric services.

Activity 2: Community mobilization related to care and treatment The second activity is to strengthen community involvement in HIV care and treatment services through outreach services provided by community health workers (CHW). In consultation with DOH, TBCA will employ one community team leader and ten CHWs for each clinical site supported. The province of the Western Cape has plans to expand CHW programs, therefore sustainability will be addressed. TBCA will train the CHWs on priority health issues so that they are multi-skilled to provide integrated community care. The role of the CHWs will be to promote IEC (information, education, communication) in the communities they serve, focusing on increasing awareness of comprehensive HIV services available, HIV prevention, including prevention with positives, to ensure family-cantered care through referrals of family members affected by HIV, and community-level follow-up of patients who have not returned for routine care (in collaboration with M&E). Existing community groups will be encouraged to become involved, and through collaboration with already-existing home-based care programs, community-based wellness programs will encourage patients to seek routine care. Peer counselling and education provided by the CHWs will target male behaviours. Links with social development programs, nutritional support programs, and other governmental and non-governmental services will be facilitated by the team leaders and TBCA-employed nurse mentors who supervise them.

Activity 3: Strengthening of clinical services through M&E support

The final activity is to assist with monitoring and evaluation of the national comprehensive HIV care and treatment program at supported sites. TBCA will employ a data capturer for each site to assist with all HIV/TB related reporting. Coordination of M&E with clinical services will ensure prompt follow-up of patients enrolled in care who do not return to clinic. Data collection will be facilitated through provision of computers to each clinic. Training needs related to capturing quality data will be identified and addressed. Gender equity in the HIV program will be revealed through collection of data showing breakdown of women and men receiving prevention, care and treatment services. The data capturers will liaise with Community Team Leaders to follow up patients referred from TBCA-supported VCT testing sites found to be HIV positive as well as those who have TB or STI symptoms.

These results contribute to the PEPFAR 2-7-10 goals by improving access to care and treatment services, thereby increasing the number of persons receiving ARV services, targeted at 500,000 individuals in South Africa by September 2008.

Subpartners Total: $82,400
University of the Western Cape: $50,000
University of Cape Town: $22,400
TB Alliance DOTS Support Association: $10,000