PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008
The approach taken by the Perinatal HIV Research Unit (PHRU) is one of comprehensive, high quality care
and support for people living with HIV and AIDS (PLHIV). The PHRU will use PEPFAR funds to provide high
quality coverage of prevention of mother-to-child transmission of HIV (PMTCT) in Soweto (Gauteng
province) and Mpumalanga provinces. This will include support to pregnant women for pre- and post- test
counseling and testing (CT), information on safe infant feeding choices, referral of women to appropriate
HIV and AIDS treatment programs and support for early testing of infants exposed to HIV. The major
emphasis area addressed is human resources; minor areas are information, education and communication,
local organization capacity development and training. The target populations are adults, pregnant women,
HIV-infected infants (0-5 years), PLHIV and their families.
In partnership with the Gauteng Provincial Department of Health (DOH) the PHRU has been running the
Soweto (Gauteng) PMTCT program since 2000. All pregnant women accessing public health antenatal
clinics are reached, resulting in very high uptake rates. The PHRU offers post-partum counseling and
testing (PPCT) in the maternity wards at the tertiary hospital (Chris Hani Baragwanath Hospital (Bara))
where most deliveries in Soweto take place, and provides post-exposure prophylaxis (PEP) to infants
exposed to HIV. The PHRU has supported the Mpumalanga Provincial DOH by providing PMTCT service in
the Bushbuckridge district since 2003. The PMTCT service is integrated into maternal and child health
services. All activities are ongoing and are funded by PEPFAR. The close partnership with the DOH and
emphasis on capacity building and training ensures sustainability of the programs. All PMTCT sites use
rapid HIV tests with results given on the same day. Each day a group health talk is given, followed by
individual pre-test counseling. After a pregnant woman voluntarily consents to testing, the test is conducted
and the results given during individual post-test counseling session. Women testing HIV-infected are then
provided with ARV prophylaxis following the South African Government (SAG) guidelines. The PMTCT
program is an important entry point for HIV-infected women to access palliative care and antiretroviral
treatment (ART) for themselves and their families. All women who test positive are referred for CD4 count
tests, those with CD4 counts<200 cells/mm3 are referred for ART. Infants born to positive women are given
nevirapine syrup in the labor wards and a PCR test is conducted at 4 to 6 weeks. Infants are given
cotrimoxazole prophylaxis and other basic preventive care. Psychosocial support is provided through
ongoing counseling and support groups. Information is provided on issues such as safe infant feeding
practices, formula, nutrition, general healthcare, family planning, prevention for positives and disclosure.
Negative women are provided with information on how to stay negative. Safe disclosure is encouraged to
reduce stigma and violence. All women are encouraged to bring their partners for testing to increase male
involvement in HIV and AIDS care and treatment programs and to improve male involvement in PMTCT and
reduce stigma. Health workers and lay counselors are mentored, provided with debriefing and continuous in
-service training on PMTCT and developments in the field.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: PMTCT, Gauteng (urban township)
The PMTCT program in Soweto is considered a best practice model for PMTCT in South Africa with greater
than 96% uptake at each stage of the cascade. The program is ongoing and will continue operating in all
Soweto public antenatal clinics with funding from PEPFAR and Gauteng DOH. Staff employed with
PEPFAR funding offer PMTCT to around 30,000 pregnant women annually. Around 30% are HIV-infected
and about 27,500 receive their results. Following SAG guidelines for PMTCT, positive women and their
babies are provided with ARV prophylaxis. Support groups run at all clinics with emphasis on HIV
information, prevention for positives, informed infant feeding choices, nutrition, safe disclosure to partners,
etc. Partners are encouraged to come for testing and be involved in PMTCT. All HIV-infected women are
referred for CD4 count tests and those with CD4<200 cells/mm3 are referred for ART. Currently over 60%
of women accept the CD4 count test with half receiving their results. The introduction of PCR testing for
infants by DOH provides the opportunity for early infant diagnosis of HIV and referral for appropriate
treatment and care, currently more than 50% of babies are tested. During FY 2008, the program will
become more closely integrated with ARV treatment and will improve gender equity in treatment programs.
ACTIVITY 2: Post-Partum Counseling and Testing (PPCT), Gauteng (urban township)
Each year, two thirds of births (around 20,000) in Soweto occur at Bara Hospital. Around 3,000 women at
the time of delivery present with an unknown HIV status. In this ongoing activity, staff funded by PEPFAR
work with DOH staff to provide PPCT. A PEP dose of nevirapine syrup is provided for HIV-infected mothers'
infants to reduce the risk of transmission. It has been shown that a post-exposure prophylactic dose of
nevirapine is effective if given to infants within 72 hours of birth. Approximately 2,500 women are offered
PPCT, about 2,000 accept and receive their results. Around 30% of these test HIV-infected. Over 98%
accept nevirapine for their infant. The uptake of the program is high and operates seven days a week to
ensure access for all women giving birth. Women who tested negative early in pregnancy will be offered a
follow-up test. Positive women identified at the time of delivery are provided with psychosocial support
through counseling and groups, referred for CD4 count tests and early infant diagnosis.
ACTIVITY 3: PMTCT, Mpumalanga (rural facilities)
PMTCT in the Bushbuckridge District is run by the provincial DOH. The PHRU and HIVSA, support PMTCT
at Tintswalo hospital with PEPFAR funding. Activities include mentoring the counselors, assisting with
referrals and providing education and support to pregnant women. Each year, around 4,000 women deliver
at the hospital; about 25% are HIV-infected. PHRU will liaise with the PMTCT service providers to ensure
increased uptake of HIV counseling and testing. Following SAG guidelines, ARV prophylaxis is given to the
mother and infant. Women testing positive are referred for CD4 count tests and to ART if
CD4<200cells/mm3. All women are encouraged to bring their infants for testing at 6 weeks. Support groups
and counseling are available with emphasis on informed safe infant feeding practices, nutrition, disclosure
to partners, early infant testing, HIV information, etc. HIVSA provides support groups in the district primary
care clinics assisted by a US-based volunteer.
Activity Narrative: These activities directly contribute to the PEPFAR 2-7-10 goals by improving access to and quality of
PMTCT services, testing pregnant women, identifying HIV-infected persons, reducing transmission to
infants and improving access to care and ARV treatment.
The approach taken by the Perinatal HIV Research Unit (PHRU) is one of comprehensive, high quality care
and support for PLHIV. Building on their 2006 workshop on the feasibility of scaling-up doctor-based male
circumcision, the PHRU are using FY 2007 funds to organize and facilitate a stakeholders workshop on the
feasibility, acceptability, and resource requirements of alternative models of delivering circumcision as a
part of a comprehensive HIV prevention program. The workshop compares three models of male
circumcision: the use of traditional healers (where they are culturally appropriate) as circumcisers; use of
trained doctors; and a nurse-based approach to circumcision. The workshop draws upon the work of
Human Sciences Research Council (HSRC) and PHRU's non-PEPFAR funded study of the feasibility and
acceptability of nurse-based male circumcision. This activity will be used by the Health Policy Initiative in
their policy analysis of the impact of pending South African legislation restricting male circumcision to doctor
-based programs and will be coordinated with JHPIEGO and the NDOH TBD support to the NDOH. FY
2008 funds will be used to conduct an additional symposium, similar to that held with FY 2007 funds, which
will continue to involve major stakeholders in the policy analysis, brainstorming, and other major issues
surrounding male circumcision. The major emphasis area addressed in this activity is human capacity
development. Healthcare workers, program managers, and local health officials are the target group for this
Although not widespread, prevalence rates for male circumcision in South Africa ranges from about 30%
national average to nearly universal among some ethnic groups. Male circumcision is a procedure that is
usually done for cultural or religious reasons rather than for health benefits. This is seen among certain
ethnic groups such as the Xhosa who routinely practice male circumcision as part of boys' initiation to the
transition to manhood. In such cases the circumcision is done by traditional healers rather than by medically
trained staff in a health facility. A recent study conducted in South Africa showed that male circumcision
reduces the risk of becoming HIV-infected. UNAIDS and WHO have stated that these results should be
confirmed prior to recommendations being issued regarding policy and program development. Two further
large scale studies of circumcision for HIV prevention are in progress in Uganda and Kenya, with results
anticipated later in 2007. Scaling-up male circumcision in South Africa may soon become a priority, as a
component of comprehensive HIV prevention programs. In anticipation of this development, the PHRU held
workshops in 2006 and 2007 on issues related to the feasibility of scaling-up male circumcision.
Contributions to this workshop were made by researchers who conducted the South African trial,
academics, surgeons, and included input on diverse aspects of possible interventions including training
requirements, legal and ethical concerns, traditional methods, anesthesia, cultural concerns, and potential
target groups. An important conclusion from this preliminary consultation was that there is little circumcision
being carried out by trained surgeons. A medical model with circumcision delivered by trained nurses could
also be considered. PHRU is currently conducting research, with non-PEPFAR funding, on the feasibility
and acceptability of a nurse-based approach to circumcision. Through non-PEPFAR funding, male
circumcision would be performed by trained nurses under the supervision of a surgeon in sterile operating
rooms at primary and tertiary health facilities. It is expected that this activity would impact male norms and
increasing equity in treatment programs.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Male Circumcision Using Nursing Staff
No male circumcision training or service delivery will take place without the express consent of the National
Department of Health. In the absence of such approval and based on discussions with the PEPFAR South
Africa team, funds could fully or partially be reprogrammed. Should the approval for safe clinical male
circumcision activities be given, PHRU is proposing the following male activities:
This activity assumes that the South African Government will change legislation to allow male circumcision
to take place on a large scale in South Africa. Recognizing that specialized surgical and other staff are in
short supply, this activity will look at alternative models to scale-up male circumcision. This will include
training nurses to do male circumcision, paying staff to perform circumcisions and paying for materials
required to perform male circumcision. Training, mentoring and implementation will be the main areas of
emphasis and developed in consultation with NDOH and JHPIEGO. It is likely that this activity will take
place initially in Gauteng, but may be expanded to other provinces on request of the National Department of
These activities will contribute to the PEPFAR goal of preventing 7 million new infections by exploring
innovative prevention possibilities, which will result in a lower transmission rate.
The Perinatal HIV Research Unit (PHRU) will use PEPFAR funds to continue to provide quality holistic care
for PLHIV comprising of elements in the preventive care package, medical care and psychosocial support
categories in Gauteng, rural Limpopo, Mpumalanga and Western Cape provinces. Clients are monitored,
prepared and referred for antiretroviral treatment (ART). Linkages to counseling and testing (CT), the
prevention of mother-to-child transmission (PMTCT) and referral to ARV services will be strengthened. The
major emphasis area is human resources, minor emphasis areas are development of networks, local
organization capacity development and training. A family-centered approach targets HIV-infected adults,
children and infants.
Since 2002, PHRU has established palliative care programs in Gauteng, rural Limpopo and Mpumalanga
provinces for people identified as HIV-infected through PMTCT and CT (also funded by PEPFAR). Primary
health care nurses are the main providers of care under physician supervision. The Department of Health
(NDOH) guidelines for HIV care and laboratory testing are used to ensure compatibility with South African
Government (SAG) treatment sites. In South Africa, a care program covers the period from testing positive
through end of life care. A holistic approach is taken comprising elements of the preventive care package
for adults and children, clinical services, psychosocial support, healthy lifestyle promotion and preparation
and transition of clients onto ART when required. These programs are predominately accessed by women;
however PHRU is attempting to redress this imbalance. Men are encouraged to participate through CT
programs which specifically target men. Clients are encouraged to bring partners, children and other family
members. A focus of the program is to identify HIV-infected infants and children and to provide family-
centered care and support. Quality assurance, client retention, monitoring and evaluation are integral parts
of the program. The aim of the programs is to delay progression of HIV to AIDS by providing palliative care
and support to HIV-infected clients who do not yet qualify for ART. Care includes: screening for active TB,
preventative treatment for latent TB infection, cotrimoxazole prophylaxis for OIs, syphilis screening,
symptomatic screening for syndromic STIs, screening for cervical cancer, provision of family planning and
regular CD4 counts. Opportunistic illnesses are treated using a formulary based on the South African
Essential Drug List. Support for clients, their families and community members is provided through support
groups and education sessions at all sites covering issues such as basic HIV and AIDS information, HIV
services, PMTCT, ART, opportunistic infections, TB, prevention, disclosure, prevention, nutrition, stigma,
positive living and adherence.
ACTIVITY 1: Soweto, Gauteng
The Soweto care program was initiated in 2002 serving over 4,500 adults with around 700 people being
transferred onto ART and others who have been referred to SAG rollout sites. Support groups and
education sessions are run by an NGO partner, HIVSA. Since 2004, a focus has been to identify children
requiring care, ART and psychosocial support through linkages to PMTCT and infant testing. Over 630
children are currently receiving care and referred for growth monitoring and routine immunizations. Support
programs are in development to assist caregivers and children, in particular around issues of bereavement,
disclosure, dealing with stigma and discrimination, positive living and life skills.
ACTIVITY 2: Bushbuckridge, Rural Mpumalanga/Limpopo
The Bushbuckridge District in Limpopo/Mpumalanga province is one of the poorest in South Africa. Access
to information and HIV healthcare and support is a basic need. The PHRU in partnership with Rural AIDS
Development Action Research Program (RADAR) and HIVSA established a wellness clinic at Tintswalo
hospital and a district wide support network for people living with HIV and AIDS. Since 2003, over 2,000
people have accessed the wellness clinic and 2,500 have accessed support groups running in the district
clinics. A training program has been implemented to train nurses, lay facilitators, counselors and local
NGOs to provide effective support to people living with HIV and AIDS and the preventive care package,
pain and symptom management, basic education on HIV, CT, HIV treatment services and related issues to
the broader community. Disclosure is encouraged to reduce stigma, discrimination, improve male norms
and attitudes and reduce violence. US-based volunteers have worked in these programs. Expansion of
medical care to the district primary health care clinics and to prepare for down referral from tertiary facilities
ACTIVITY 3: Tzaneen, Rural Limpopo
Since 2003, the University of Limpopo (UL) has been supporting the DOH to develop a district-wide
wellness program based in the primary health care clinics in the Letaba sub-district of the Mopani District in
Limpopo province. PHRU partnered with UL to formalize and expand the program. With PEPFAR funding
health workers have been trained in HIV care of adults and children and infrastructural support provided.
HIVSA has provided training to support group members to enable them to run more effective support
groups and provide better information to people in the district. The Mopani District (population 1 million) is
extremely poor. The program operates in the primary care clinics with support by a medical doctor and aims
expand to the whole district. Over 600 people have enrolled and more than 100 are now on treatment and
supported at the clinics. On going in-service training and mentoring occurs at the clinics. US-based
volunteers support the program. These activities will be continued and expanded to additional groups with
FY 2008 funding.
ACTIVITY 4: Western Cape
In 2006, PHRU partnered with a number of organizations in the Western Cape including the University of
Stellenbosch, Red Cross Hospital and the Desmond Tutu HIV/AIDS Foundation that support a number of
DOH ART sites. PEPFAR funds support these programs to improve linkages to primary care clinics for
down referral, and to provide holistic care and support to people on ART and their families. Training staff to
assist with scale-up and sustainability are focus areas. These activities will be continued and strengthened
and will reach additional people with FY 2007 funds. With FY 2008 funds PHRU will continue to support one
Activity Narrative: of its sub-partners, HIVSA, to expand palliative care services in rural areas in Mpumalanga, Western Cape,
and Limpopo and in urban areas in Gauteng Province. HIVSA utilizes male involvement, door to door, home
-based care, and youth friendly models. HIVSA will implement systems to ensure that all PHRU assisted
ART sites will reduce loss to ART initiation from the time tested positive until eligible for ART and will
improve uptake of ART as soon as a patient is eligible. Support group models will also be expanded. HIVSA
will also assist PHRU treatment programs to better monitor care provided to family members. Retention in
care after HIV diagnosis will be a focus for FY 2008.
In all of the above activities, PLHIV will receive at least one clinical and one other category of palliative care
service. Palliative care to family members of PLHIV or OVC will be provided in at least two of the five
categories of palliative care services.
These activities directly contribute to the PEPFAR 2-7-10 goals by improving access to and quality of
palliative care for HIV-infected individuals and their families.
and support for PLHIV. PHRU will use PEPFAR funds to continue its TB services to patients accessing care
in Soweto (Gauteng), rural Limpopo/Mpumalanga Provinces and in the Western Cape. The TB/HIV program
is integrated into all programs by providing screening, referring people with active TB to National TB
treatment sites and providing preventative treatment for latent TB. The program is also linked to National TB
treatment sites providing HIV care and treatment. The major emphasis areas are human capacity
development and local organization capacity building. The primary target populations are HIV-infected
adults and children.
PHRU established palliative care programs in Soweto (Gauteng) and in rural Limpopo and Mpumalanga
and have partnered with organizations in the Western Cape to provide care and support to people identified
as HIV-infected through PMTCT and CT. High rates of TB in South Africa continue to be challenging and
MDR-TB is considered to be on the rise. The PHRU will strengthen its emphasis on diagnosis of TB via its
PMTCT program (through screening during CT when possible), and through screening of all patients testing
positive. Once tested positive, all patients enter a wellness program where they will be screened and
treated according to WHO protocols for TB. In South Africa, a wellness program covers the period from
testing positive to needing treatment. The high HIV prevalence in South Africa requires a cost-effective
package of care and support for people with HIV prior to ARV treatment. Primary health care nurses are the
main providers of care under physician supervision in these programs. The programs follow the Department
of Health guidelines for HIV care and laboratory testing to ensure compatibility with South African
Government treatment sites. The programs have been approved by the medical ethical review board of the
University of the Witwatersrand. The aim of the programs is to delay the progression of HIV to AIDS by
providing palliative care and support to HIV-infected clients who do not yet qualify for ARV treatment. Care
includes: elements of the preventive care package, screening for active TB, preventative treatment for latent
TB infection, cotrimoxazole prophylaxis for opportunistic infections, syphilis screening, symptomatic
screening for syndromic STIs, screening for cervical cancer, provision of family planning and regular CD4
counts. Opportunistic illnesses are treated using a formulary based on the South African Essential Drug
List. Support for clients, their families and community members is provided by support groups and
education sessions at all sites covering issues such as basic HIV and AIDS information, HIV services,
PMTCT, ARV treatment, opportunistic infections, TB, prevention, disclosure, nutrition, stigma positive living
and adherence. Training of professional and lay staff takes place on a regular basis.
PHRU will continue to work with the national and provincial departments of health and specifically with the
HAST (HIV, AIDS STI, and TB) managers to prioritize interventions designed to address weaknesses
(identified by the departments of health) in the DOTS and TB/HIV programs. PHRU will focus on improving
policy adherence and patient follow-up. Individuals will be hired for each site as tracers to track patients and
ensure that referrals are completed. PHRU is setting aside funding to develop (with other relevant partners
or agreement counterparts) standardized tools to ensure that policies and guidelines recommended by
NDOH are followed, including guidelines for infection control. PHRU will continue to integrate TB/HIV
interventions with existing agreement programs as they work seamlessly and side by side with government
employees at government facilities.
In 2002 a care program was initiated in Soweto, a large urban area south-west of Johannesburg with very
high HIV prevalence (30% in the ante-natal clinics). A holistic approach is provided to all enrolled in the
wellness program and covers clinical services, psychosocial support, and healthy lifestyle promotion,
including exercise, nutrition, and decreasing the use of alcohol and tobacco. To date over 4,500 adults have
accessed the program with PEPFAR support. Support groups and education sessions, run by HIVSA, are
available to all clients. All clients are symptom screened for TB at each visit and are referred for TB
treatment to the government TB treatment clinics. PHRU is supporting the Charles Hurwitz Hospital, a
government TB treatment facility, to integrate TB and HIV care and treatment. Expanding the program with
FY 2008 funds, PHRU proposes to link TB screening into PMTCT service in Soweto and screen all
pregnant women for active TB and refer those with positive results to government TB treatment sites. PHRU
will work with public facilities to ensure that care for both TB and HIV is monitored and coordinated. Training
for health care professionals working at PHRU and its partners (including the provincial Department of
Health) in all aspects of HIV palliative care takes place on an ongoing basis.
Bushbuckridge district in Mpumalanga/Limpopo is one of the poorest in South Africa. Access to information
and HIV healthcare and support is a basic need for all people living with HIV. PHRU in partnership with
Rural AIDS Development Action Research Program (RADAR) and HIVSA established a wellness clinic at
Tintswalo hospital and a district-wide support network for people living with HIV and AIDS. Since 2003, over
2,000 people have accessed the wellness clinic and more than 2,500 have accessed the support groups. A
training program has been implemented to train nurses and lay facilitators, counselors and NGOs to provide
effective support to people living with HIV and AIDS and basic education on HIV, TB, CT, HIV services and
related issues to the broader community and build the capacity of linked local organizations. All clients are
screened for active TB at each visit.
Since 2003, the University of Limpopo has been supporting the Department of Health to develop a wellness
program based in primary healthcare clinics in Tzaneen District. In 2004 PHRU partnered with University of
Limpopo to formalize and expand the program. PHRU has mentored the program, assisted with training
health workers and has provided infrastructural support. In addition, HIVSA has provided training to support
group members to enable them to run more effective support groups, and provide better information to
people in the district. The program takes a district health approach and aims to operate throughout the
Activity Narrative: district. Over 600 people have enrolled in the program and more than 100 have been referred to ART sites
for ARV treatment. People on treatment are supported at primary care clinics through this program. The
program will be expanded to other sub-districts in the Tzaneen area. All clients attending Wellness services
will be screened for active TB at each visit. US-based volunteers have supported this program.
ACTIVITY 4: Western Cape
In 2006 PHRU partnered with a number of organizations in the Western Cape including the University of
Stellenbosch, Red Cross Children's Hospital and the Desmond Tutu HIV/AIDS Foundation. The aim is to
support government ART sites to scale-up and develop down referral systems. PHRU will continue to
screen HIV-infected clients for TB and those who are found to be co-infected will be referred to public sites
for treatment. Expansion of these activities is planned. These activities will contribute to the PEPFAR 2-7-10
goals by providing TB/HIV care and services to HIV-affected people.
and support for people living with HIV (PLHIV). PHRU will use PEPFAR funds to promote voluntary
counseling and testing (CT) through HIV prevention workshops and health promotion activities, and to
pregnant women at PMTCT to increase uptake of CT for HIV. In particular, services will be promoted to men
in an effort to increase gender equality in HIV and AIDS programs and make them available to adolescents
as part of a prevention program. The major emphasis area is human resources; minor areas include local
organization capacity development, community mobilization/participation, and information, education, and
communication. The target populations are the general population with a focus on men and adolescents.
This CT program is an ongoing activity operated in partnership with a local non-governmental organization,
HIVSA, and other CT organizations in Soweto (Gauteng). The program will be expanded to rural Limpopo
and Mpumalanga. Women have mainly accessed HIV services in Soweto and this project aims to improve
gender equity in these services. In June 2005, the IMBIZO project, which broadens access to HIV and AIDS
information, was established. This project was designed to enhance male involvement in counseling and
testing and other health services. IMBIZO drop-in centers operate five days a week and are located close to
areas where men congregate and are easily accessible. The concept of the IMBIZO program is one
designed by men for men and evolved from research that indicated that men preferred to be counseled by
men at locations away from the primary healthcare clinics. Within the project, marginalized communities
such as men who have sex with men are encouraged to access CT. A focus of this program is to reduce
stigma associated with HIV, to encourage disclosure, to support partners and family members with HIV and
to promote active engagement with HIV services. A program promoting IMBIZO to partners of pregnant
women is being run in the antenatal clinics, with the aim of increasing male involvement in PMTCT and
fatherhood. Reduction of violence and coercion, also main components of IMBIZO, is a major focus of the
program. Outreach activities take place in prisons, workplaces, hostels, sports matches and other places
where men congregate. PHRU offers a couple counseling service called "Tshwarisanang" through external
foundation funding and all other PHRU CT services can refer to them.
ACTIVITY 1: IMBIZO - Men's Health Centers
Male IMBIZO centers are funded by PEPFAR. The project receives approximately 300 drop-in clients and
performs approximately 140 CT each month. A male registered nurse manages the program. Clients are
referred to local clinics for HIV services and treatment. Stigma decreases men's uptake of CT services and
innovative strategies to increase men using CT are being developed. At-risk male populations such as men
who have sex with men, migrants, and prisoners are focus populations. This program will expand to rural
Mpumalanga provinces. Information on TB, PMTCT, HIV services, prevention, nutrition, etc., is available.
Clients are counseled on prevention and condoms are distributed. Support is given to clients to encourage
disclosure, to decrease stigma, to mitigate domestic violence, and to provide support to partners. To
increase male support of PMTCT programs, pamphlets have been designed for male partners of pregnant
women that explain PMTCT, encourage active involvement in fatherhood, and encourage men to access
the IMBIZO centers and to go for CT. Outreach activities take place regularly with community organizations,
workplace programs, and health services. Mobile CT is used to take CT to communities that do not have
easy access to healthcare services. A focus of this program is to reduce stigma, increase male involvement
in all services relating to HIV thus increasing gender equity. U.S.-volunteers will support the rural program.
ACTIVITY 2: Adolescents
Adolescents have special healthcare needs which they are often reluctant to address; some of these are
sexuality, pregnancy, drug and alcohol abuse, sexually transmitted infections (STI), gender and mental
health issues, coercion, violence, transgenerational sex and abuse. They are at high risk of contacting HIV
and other STIs. Through a proposed specialized adolescent clinic PHRU will address these needs with FY
2007 PEPFAR funding by offering comprehensive counseling and care services that are youth-friendly,
confidential and empowering to clients so that they may make informed and responsible healthcare choices,
including being empowered to abstain and delay sexual debut. Through CT, education and counseling,
PHRU will increase awareness of HIV. The clinic in Soweto will be based close to places to where
adolescents congregate. Services will comprise CT and confidential and free care; information, education
and counseling on sexual and reproductive health; health information; counseling and appropriate referral
for violence abuse and mental health issues; contraceptive information and counseling on individual
choices; STI information, including information on effective prevention; and syndromic management of STIs.
PEPFAR funds will be used to establish and staff this project.
ACTIVITY 3: CT Plus
In the Western Cape a mobile CT program providing counseling and testing, point of care CD4 counts, TB
screening and referral into care and ART services programs will be supported. The Western Cape has very
high TB prevalence. This program will provide CT to underserved populations.
ACTIVITY 4: Couple Counseling
PEPFAR funds will be used to expand an existing couple counseling program operating at the PHRU in
Soweto. Specialized counseling for couples has proven to be effective for preventing further infection
particularly in discordant couples. In many programs lay counselors do not have sufficient expertise to
counsel couples and therefore a referral service is essential.
ACTIVITY 5: Farm Workers
A CT activity linked to care and ART for farm workers in the Westcoast winelands region of the Western
Cape will be expanded to other districts in the region. The male CT program will expand to target all men
including men who have sex with men and other vulnerable male groups in Soweto (Gauteng) and
Activity Narrative: Bushbuckridge (Mpumalanga).
These activities will contribute to the PEPFAR 2-7-10 goals by increasing access to and improving quality of
CT services, particularly to hard-to-reach populations of men and adolescents in urban and rural districts in
The approach taken by the Perinatal HIV Research Unit (PHRU) is one of comprehensive, high-quality care
and support for people living with HIV (PLHIV). The PHRU will use FY 2008 funds to continue to provide
high-quality holistic antiretroviral treatment (ART) and psychosocial support in Gauteng, rural Limpopo and
Mpumalanga, and Western Cape. These funds will contribute towards antiretroviral (ARV) drugs and
services. Clients are provided with ART, pre-treatment literacy, adherence counseling and adherence
support groups. Linkages from CT, PMTCT, basic care and support will be strengthened. The emphasis
areas are human capacity development and local organization capacity building. The family-centered
approach targets HIV-infected adults, children and infants.
Since 1998 the PHRU has provided comprehensive treatment, care and support to people living with HIV
(PLHIV). The PHRU has received funding from PEPFAR since 2004 to support ART services in Gauteng,
rural Limpopo and Mpumalanga, and Western Cape provinces. PHRU directly purchases ARVs with
PEPFAR funds and has demonstrated the ability to rapidly scale up treatment. PHRU has adopted a family-
centered approach and clients are encouraged to bring partners and other family members for testing and
treatment. Of patients supported by the PHRU, about one-third is supported through PEPFAR-funded ARV
drugs. PHRU is expanding activities to directly support scale-up at government ART sites and support down
referral systems. PHRU works with the provincial health departments to ensure safe transfer for the
participants to ongoing care within the South African Government (SAG) rollout program to ensure
sustainability. PHRU works only in government facilities, where government takes the lead in all aspects of
the program. The PHRU together with government counterparts identify gaps that will slow down
implementation according to national and provincial guidelines. Upon request from the facility, PHRU
provides support through a Memorandum of Understanding to fill the gaps and work towards the provincial
financing of related activities. PHRU supports, trains and mentors healthcare workers involved in the
management, care and treatment of HIV-infected individuals. All programs follow national guidelines for
ARV treatment. Training is adequately and broadly proclaimed by provincial government through training
programs that are approved by the province and adhere to all guidelines and standards of the national
government. Quality assurance, client retention, monitoring and evaluation form an integral part of the
program. PHRU provides regular training for professional and lay staff on ART issues such as adherence,
medical treatment, and appropriate regimens.
All sites have psychosocial support programs which provide community-based assistance, support groups
and education covering issues such as basic HIV and AIDS information, HIV services, HIV treatment,
treatment literacy, adherence, TB, positive living, nutrition, prevention, opportunistic infections and TB. The
comprehensive care approach leads to stigma reduction, increased disclosure, and improved adherence to
ACTIVITY 1: Adults, Soweto
Funding from PEPFAR supports adults on treatment in the family-centered PMTCT program. The adult
treatment program is ongoing and drugs are purchased for patients at the PHRU clinic based at Chris Hani
Baragwanath Hospital (Bara). The program provides treatment, monitoring and support for adults who meet
the SAG guidelines for treatment. HIVSA, an NGO partner, provides treatment literacy and adherence
support. This activity will be continued and expanded with FY 2008 funds.
ACTIVITY 2: Pregnant Women, Soweto
This program was started in the maternity section at Bara in July 2005 by PHRU in partnership with the
Department of Obstetrics and Gynecology. In Soweto 8,000 pregnant women annually are identified as
positive with an estimated 1,600 needing treatment. Following SAG guidelines, pregnant women who are
eligible for treatment are offered HAART. In order to fast-track women onto treatment, PHRU is training and
mentoring the doctors and nurses. The program is being expanded to other ART sites in the area with FY
2008 funds. HIVSA, an NGO partner, will continue to provide treatment literacy and adherence support.
ACTIVITY 3: Children, Soweto
The PHRU clinic identifies HIV-infected children who need treatment through PMTCT and children of adults
who are already on treatment. This activity will continue and will be strengthened through additional
counselors with FY 2008 funds. As part of a comprehensive family-centered approach, children are put onto
treatment following SAG treatment guidelines with ARVs purchased by PHRU according to USG and SAG
guidelines. ARV drugs for children are supplied through the PHRU pharmacy system. Staff is trained on an
ongoing basis in pediatric ARV provision.
ACTIVITY 4: Franchise, Gauteng
This program targets uninsured workers in densely populated areas in Johannesburg. ARVs are made
available and affordable through a franchising scheme, and supplied free of charge or at a significantly
discounted rate to patients unable to purchase their own medication. Those who can afford to pay for all or
a portion of their drugs are expected to do so. ARV drugs are procured and supplied within the service by
trained providers. This program provides a stand-alone ART full service clinic in downtown Johannesburg
and provides lessons learned about demand for ART outside the public sector, willingness and ability to pay
for services, and the cost-effectiveness of this model of delivery.
ACTIVITY 5: Sub-partners
A number of partners in the Western Cape have been identified and are supported to provide ARV
treatment. Most of these partners receive ARV drugs from the Department of Health and PEPFAR funds are
provided to support the services to expand and develop down-referral systems. Pediatric treatment is a
priority. It is likely that additional partners will be identified to enable increased access to treatment.
These activities will contribute substantially to the PEPFAR 2-7-10 goals of providing ARV treatment to two
The Perinatal HIV Research Unit (PHRU) provides comprehensive care and support for people living with
HIV (PLHIV). PHRU will use PEPFAR funds to provide high quality, holistic ARV treatment and
psychosocial support in Soweto (Gauteng), rural Limpopo and Mpumalanga, and the Western Cape. PHRU
will also use PEPFAR funds to provide personnel and ARV drugs for these services. Clients are provided
with ART, pre-treatment literacy, adherence counseling and access to adherence support groups. Linkages
from CT, PMTCT, and palliative care will be strengthened. The emphasis areas for ARV services are
renovation, gender, human capacity development, local organization capacity building, and TB. A family-
centered approach targets HIV-infected adults and children.
Since 1998 PHRU has provided comprehensive treatment, care and support to PLHIV. Since 2004,
PEPFAR funding has supported ARV treatment and South African Government (SAG) ART sites in
Gauteng, rural Limpopo and Mpumalanga provinces, and the Western Cape. PHRU purchases ARVs and
provides treatment for adults and children. PHRU's family-centered approach encourages clients to bring
partners and other family members for testing and treatment. PHRU is expanding activities to scale up
government ART sites and to investigate down referral systems. With FY 2008 funds, PHRU will work with
provincial health departments to ensure safe transfer of participants to ongoing care within the SAG rollout
program. PHRU will support, train and mentor healthcare workers involved in the management, care and
treatment of HIV-infected individuals. All programs follow national guidelines for ART. PHRU provides
regular training on ART issues such as adherence, medical treatment, and appropriate regimens. A NGO
partner, HIVSA, provides all sites with psychosocial support programs providing community-based support,
support groups and education. They cover issues such as basic HIV and AIDS information, HIV services
and treatment, treatment literacy, adherence, TB, positive living, nutrition, prevention, opportunistic
infections and TB. The comprehensive care approach leads to stigma reduction, increased disclosure, and
improved adherence to ART. Throughout the comprehensive program, PHRU has established a continuous
set of assessment functions to improve the quality of care at ART service sites.
All of the activities described in this section will be continued and expanded with FY 2008 funds.
Funding from PEPFAR supports women on treatment in the family-centered PMTCT program. The program
is ongoing and provides treatment, monitoring and support for adults who meet SAG guidelines for
treatment. HIVSA provides treatment literacy and adherence support.
This program has been initiated in the maternity section at Bara in July 2005 by PHRU in partnership with
the Department of Obstetrics and Gynecology. In Soweto 8,000 pregnant women are identified annually as
HIV-infected, with around 1,600 needing treatment. Following SAG guidelines, pregnant women eligible for
treatment are offered HAART. In order to fast-track women onto treatment, PHRU is training and mentoring
doctors and nurses. The program is being expanded to other ART sites in the area through FY 2008 funds.
HIVSA provides treatment literacy and adherence support.
The PHRU identifies HIV-infected children who need treatment through PMTCT and children of adults who
are already on treatment. As part of a comprehensive family-centered approach, these children are put onto
guidelines. Staff is trained on an ongoing basis in pediatric ART.
ACTIVITY 4: Rural Mpumalanga and Limpopo
At Tintswalo Hospital, Limpopo, in partnership with Rural AIDS Development Action Research Program
(RADAR), adults and children are identified as needing treatment in the palliative care and PMTCT
programs. RADAR supports the ART site at this hospital, as well as Mapulaneng hospital, and is assisting
other sites for ART accreditation. Human capacity building is fundamental to sustainability of the program
and PHRU provides staff, training and mentoring existing treatment staff. HIVSA offers district-wide support
in the primary care clinics that includes treatment literacy, adherence counseling and group support for
ACTIVITY 5: Tzaneen, Limpopo
PHRU in partnership with the University of Limpopo is supporting the Limpopo Department of Health
wellness program operating in the district's primary healthcare clinics. Currently clients are referred to the
ART sites including Letaba hospital and CN Phatudi hospital. Through Choice, a local NGO, clients are
provided with a treatment readiness program, referred to rollout sites when they become eligible for
treatment and given adherence support. Due to vast distances to the hospitals, clients on ART are
supported in local primary care clinics.
ACTIVITY 6: Franchise, Gauteng
available and affordable through a franchising scheme, and supplied free of charge or at significantly
discounted rates to patients unable to purchase their own medication. ARV drugs are procured and supplied
within the service by trained providers. This program provides a stand-alone ART full service clinic in
Johannesburg and provides lessons learned about demand for ART outside the public sector, willingness
and ability to pay for services, and the cost-effectiveness of this model of delivery.
ACTIVITY 7: Western Cape
A number of partners and SAG ART sites have been identified in the Western Cape that need support to
scale up their activities. These include the Desmond Tutu HIV/AIDS Foundation, the University of Cape
Town and Stellenbosch University. These partners are supporting SAG ART sites and provide training,
mentoring and support. Many ART sites in tertiary hospitals are reaching capacity and the PHRU is
establishing innovative down referral mechanisms.
In FY 2008, all activities will expand. Additional partners are likely to be identified in order to increase
access to treatment. A specific emphasis will be placed on pediatric treatment. In addition, tracing and
tracking programs will be implemented to ensure retention in care. Renovations will be made as necessary
per facility. Training for all categories of health workers and task shifting strategies will be implemented in
FY 2008. Task shifting focuses on the effective utilization of existing staffing skills.
These activities will contribute substantially to the PEPFAR 2-7-10 goal of providing ARV treatment to two
million people by supporting SAG treatment sites.