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
Aurum will provide PMTCT services to patients in South African government clinics, GP practices and non-
governmental sites. Emphasis will include the implementation of the PMTCT diagnosis and treatment
protocols at the service outlets, early counseling and testing of pregnant mothers, provision of antiretroviral
prophylaxis to HIV infected mothers both during the pregnancy and during delivery. Emphasis will also
include provision of ARV to infants born to HIV mothers according to protocols and PCR of infants born to
HIV-infected mothers. Also included in this activity is counseling on safe infant feeding practices and
prevention of STI and HIV infection during pregnancy and while breast feeding. The primary target
populations are HIV-infected pregnant women and their infants.
Aurum Institute for Health Research (Aurum) is a not-for-profit, public benefit organization that is committed
to improving the health of disadvantaged individuals and communities through transformational research
(the research programs are not PEPFAR-funded), management of TB and HIV programs and provision of
HIV testing, treatment and care. Aurum has received PEPFAR funding since October 2004. The main focus
of the Aurum program in the public, private and non-governmental sector is to provide HIV care and
treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality of
counseling, patient care and patient monitoring. The model is centrally coordinated and designed to be
implemented on a large scale in peripheral sites that are resource-constrained and lacking basic resources
such as HIV specialists, information technology (IT) infrastructure, and laboratory and pharmacy capacity.
Aurum has established a centralized system of support which includes the following: (1) training of all levels
of healthcare workers to ensure capacity building of clinicians to manage patients in resource limited
settings with remote HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive
therapy (including INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child
transmission and VCT; (3) clinical and administrative support through site visits by staff involved in
psychological support, training, clinical support and monitoring data management systems; and (4)
centralized distribution of medication and laboratory testing. This program will supplement the South African
government's ARV rollout and therefore the program adheres to national guidelines and protocols.
ACTIVITIES AND EXPECTED RESULTS:
Aurum will carry out five activities in this Program Area. All of the activities are aimed at the provision of
quality PMTCT service delivery.
ACTIVITY 1. Establishing Capacity for PMTCT at Service Outlets
This activity will include the dissemination of information on the importance of PMTCT and the application of
PMTCT protocols to all South African government clinics, GP and NGO sites funded supported through the
Aurum grant. This is also linked to the training of health workers (activity 7 below).
ACTIVITY 2: Counseling and Testing of Pregnant women
Pregnant women will receive provider-initiated counseling and testing as soon as they present to the health
care service outlet. Women who test negative during the initial testing will be encouraged to repeat testing
during the pregnancy to detect early HIV infection and ensure proper clinical care for the mother and infant.
ACTIVITY 3: Provision of Prophylactic ART
Women who are HIV-infected and pregnant will be provided with prophylactic ARVs to prevent transmission
of HIV from the mother to the unborn child. As part of the minimum service package, newborn infants will
receive the recommended prophylactic ART. Following pregnancy women will be enrolled onto the HIV care
ACTIVITY 4: Early infant diagnosis using PCR
Training will be given to health care providers at South African government clinics, GP sites and NGO sites
on the importance of early infant HIV diagnosis and the correct use of the PCR test. Data collection will
include a compilation of results of all PCR tests performed.
ACTIVITY 5: Prevention of STI and HIV in pregnancy and during breast-feeding period
Counseling given to pregnant mothers will emphasize the risk of contracting STI and new HIV infections
during pregnancy and how that increases the risk of transmission to the unborn child.
ACTIVITY 6: Promotion of safe infant feeding practices
Aurum will provide education and counseling to support mothers to make correct choices around infant
feeding practices to ensure reduced risk of HIV transmission in the post-partum period while safeguarding
the health of the infant.
ACTIVITY 7: Training of Health Care Workers to provide PMTCT
Aurum will incorporate training around the provision of PMTCT into its existing training curriculum for
doctors and professional nurses and counselors. This training will include counseling of pregnant women to
encourage them to test for HIV, the prophylactic antiretroviral therapy, the modification and continuation of
antiretroviral therapy in mothers already receiving therapy the use of PCR for early infant diagnosis and
counseling around other prevention methods for STI and HIV and safe infant feeding practices. Aurum's
PMTCT activities contribute to the achievement of the PEPFAR 2-7-10 goals.
SUMMARY: The Aurum SME Project commenced in September 2007. The project seeks to extend access
of HIV related services such as prevention, counseling, testing and treatment to people that currently are
not accessing services through the existing health care system. The project specifically targets employees
of small, micro and medium sized (SME) companies as well as their partners and dependents. In the
second year of this project, the focus will be on strengthening service provision at the existing service points
as well as extending the service offering to four additional fixed sites in Mpumalanga, Limpopo and Gauteng
BACKGROUND: Aurum provides services to SMEs at the workplace, through the use of mobile vehicles
and through a fixed testing site at the Bree Street Taxi Rank which is the busiest taxi rank in Johannesburg,
catering for an estimated 400,000 commuters a day in addition to 500 traders and 2000 taxi drivers.
ACTIVITIES AND EXPECTED RESULTS: Prevention activities will comprise prevention messaging
targeting youth and young adults that utilize the fixed Bree centre as well as a campaign that will involve the
use of counselors visiting educational institutions, sports facilities and entertainment venues within the
targeted areas. In FY 2008 these activities will be expanded through the employment and training of
additional counselors. It is anticipated that 7000 people will be reached with specific abstinence and be
faithful messaging. Messaging that specifically targets the young men and young women will encourage
abstinence, delayed sexual debut, avoidance of risk taking behavior and reduction in the number of sexual
partners. All the messaging will be provided in languages understood by the targeted group and the project
will involve an ongoing conversation with the community as opposed to short-term information blitzes. In
addition 300 individuals from the targeted companies and communities will be trained as peer educators to
use A/B focused materials.
ACTIVITY 1: Recruitment and training of youth community mobilization counselors.
Aurum intends to recruit additional youth counselors who will be trained and then tasked with the provision
of youth focused messaging and education to students at educational institutions within the targeted areas,
mainly high schools and tertiary educational colleges. Young commuters that frequent the taxi ranks will
also be targeted with the specific A/B message. The training provided to the youth counselors will include
basic counseling skills, sexuality, modes of HIV transmission, gender as related to the HIV epidemic,
prevention methods, counseling for behavioral change, group and individual counseling.
ACTIVITY 2: Delivery of specific AB message to targeted youth.
An ongoing activity under this grant will be the delivery of targeted messaging to youth, attending
educational institutions in the targeted areas. Youth will also be targeted at sports venues and other
entertainment venues and the abstinence, be faithful and delay in sexual début will be delivered in one on
one and small group information and education sessions. Messaging will specifically targets young men and
young women and will encourage abstinence, delayed sexual debut, avoidance of risk taking behavior and
reduction in the number of sexual partners. All the messaging will be provided in languages understood by
the targeted group and the project will involve an ongoing conversation with the targeted communities.
This activity will building on the existing program components (care, treatment and TB-HIV) to include a
prevention activity, integrated into existing services. Aurum currently provides services in three sectors:
public, private and NGO. This funding will allow Aurum to address prevention awareness and promote
behavior change among the target populations, many of whom are at high risk (prisoners, refugees, miners
and other mobile populations), including prevention messaging for people in the care and treatment
As per the South African Government ABC strategy, Aurum will address all these aspects, including
messaging and training that promotes the correct and consistent use of condoms at South African
government clinics, GP clinics and NGO sites. Aurum will continue to develop messaging for specific target
groups such as young males, young women, pregnant women, mobile populations, and other target groups
identified as being at risk in conjunction with other expert organizations. Aurum will emphasize messages
that promote healthy choices regarding sexual behaviors and avoiding risky behaviors, especially
concurrent multiple partnerships. Emphasis will be placed on avoidance of drug and alcohol abuse, delaying
sexual debut and addressing transactional sex. One of the focus areas of this program is gender with a
particular focus on addressing male norms and behaviors. Male circumcision will be encouraged within the
context of local policy and guidelines. Aurum is working with one corrections facility and aim to be working
with approximately four additional prison facilities in the next year. In one of the supported NGO facilities,
based in central Hillbrow, Aurum is targeting homeless populations and street youth. The primary target
populations are men, women, youth, prisoners and other most at risk populations (MARPs). For patients
currently enrolled on the program (HIV-infected patients) messages about HIV prevention are continuously
FY 2008 represents the second year of activity of the SME project which has a significant focus on
prevention activities. The partnership with City of Johannesburg has enabled the establishment of a fixed
site within the Bree Street Taxi Rank. In FY 2008, Aurum plans to undertake targeted prevention activities
involving taxi drivers at a number of taxi ranks in the three targeted provinces. Attention will be paid to
intensifying prevention activities in these groups through the syndromic management of STIs, peer
education and active screening and counseling for substance use/abuse. This will include venue-based
interventions aimed at targeting substance abuse and other risk behavior.
Aurum supports activities which reduce the transmission of HIV through engaging target populations to
provide messaging that encourages positive choices around sexual behaviors. The target population
currently services with HIV care and treatment services are poor, underserved, and mobile. In partnership
with ReAction! Consulting, another PEPFAR partner, community messaging is delivered to communities in
the vicinity of NGO clinics in Mpumalanga through door-to-door campaigns. Utilizing the experience and
tools from this facility, Aurum will expand its prevention activities in the other settings currently supported by
Aurum. Health care workers that work in government clinics, GP clinics and NGOs will receive training from
ReAction! Consulting in order to provide support in these activities.
The mining sector is a key platform to reach men. Stepping Stones is a workshop series designed to
promote sexual and reproductive health. It addresses questions of gender, sexual health, HIV and AIDS,
gender violence, communication and relationship skills. Stepping Stones has been shown to reduce high
risk behavior and HIV incidence in a program in Africa. Aurum intends using this program in both the mining
setting and in the prison population.
The SME Project targets workers in small, micro and medium sized companies, including market traders
and taxi drivers who previously did not have access to HIV prevention, counseling and testing and treatment
services due to incompatibility of their working hours with the operating hours of the public health facilities
and the fact that the majority of SME employees do not have private health insurance. In placing services
within taxi ranks and markets, partners and dependents of SME employees will also have access to these
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Targeted Training to Specific Groups
Men will be targeted, especially the large prison populations supported by Aurum, and in mining settings.
Messages to men will be developed and training provided promoting behavior change, and addressing
cultural norms of manhood and masculinity. This will be done in partnership with other PEPFAR partners.
This includes messages to young men encouraging them to use condoms, reduce the number of sexual
partners and avoid risky behavior. Messaging to young women, who make up the bulk of the current
population served with Aurum's care and treatment services, will empower them to be involved in decision-
making regarding sexual choices, requiring their partners to use condoms, empowering them to use female
condoms, delaying sexual debut and avoiding gender violence. Young women will be encouraged to
develop a positive self-image.
Aurum currently offers a number of courses that cover positive living and information on HIV prevention.
The training, provided by Aurum social workers and a psychologist, will be offered to incarcerated
communities, nurses, lay counselors and peers. The trainees will become implementers and peer
educators. The training curriculum includes understanding the challenges of disclosure, how to help clients
disclose safely, and how to address HIV and AIDS stigma, and is offered twice a year. In addition a module
on Prevention with Positives will be included in the training provided to the counselors in the SME fixed and
mobile sites as well as the health care workers and peer educators.
ACTIVITY 2: Promotion of Male Circumcision as a Method of Reducing Transmission
Based on existing evidence, male circumcision has been show to have an effect on the rate of HIV
transmission. Aurum plans to undertake a situational analysis to understand the beliefs, attitudes and
practices of male circumcision to understand the barriers for widespread circumcision implementation in
limited a number of industrial and community sites. In settings where it is possible to provide circumcision,
Aurum will provide training to ensure safe methods and encourage males to opt for this procedure. Activities
will not be conducted without consent from the National Department of Health.
ACTIVITY 3: Prevention and Treatment of Sexually Transmitted Infections (STIs)
Aurum will continue to provide training to health care workers on the syndromic management of STIs as a
means of preventing the transmission of HIV, as many of the populations currently served with HIV care and
treatment services are at high risk. Aurum will encourage the use of male and female condoms to prevent
the spread of STIs. In FY08 the SME Project will focus on the issue of identification and treatment of STIs in
taxi drivers and will provide these services within the Bree Street taxi rank.
ACTIVITY 4: Education to Prisoners and Miners on Gender
Various organizations that are involved in gender issues and a framework will be established to provide
education and programs to males based at the corrections facility and a company within the mining industry.
One of these is the Stepping Stones workshops to be implemented with peer groups. The 14 sessions for
the separate peer groups cover the following topics: introduction for the group and development of group
skills; Images of Men and Women: Exploration of Ideals and Realities; Images of Sex and Sexual Health
Problems; Exploration of Love: What We Look for and Expect to Give; Exploring our Sexuality: Problems
and Concerns about Sex and Reproductive Health; Conception and Contraception; STDs and HIV; Safer
Sex; Gender-based Violence; Let's Look Deeper: Why we Behave in the Ways We Do; Assertiveness Skills:
Part 1; Assertiveness Skills: Part 2; Dealing with Loss; Let's Prepare for the Future: Future Decisions and
Activity 5: Prevention with Positives
People that are identified as being HIV positive through counseling or testing will be rapidly assessed for
additional risk behaviors. Once these have been identified the counselor will negotiate with the HIV positive
client around methods of reducing the risk of transmitting the infection to other people or of becoming
infected with additional strains of the virus. The session will end with the client either being referred for
additional support or arranging a follow-up session with the counselor. This service will be provided at all
fixed and mobile sites as well as within the workplace and in occupational clinics within the SME project.
Activity 6: Venue-based Interventions targeted at reducing substance abuse and other risky behavior.
In FY 2008, Aurum will commence venue-based interventions that will target nightclubs, shebeens, taxi
ranks and sports venues and will involve one on one encounters where a rapid assessment will be made of
an individuals risk behavior such as substance and alcohol abuse. The counseling session will aim to
identify the risk that that behavior places the individual in terms for transmission of HIV and other STIs and
will involve referral of the individual for further assistance.
Aurum's palliative care program provides care to patients infected with HIV following HIV counseling and
testing, and screening for treatment eligibility in accordance with South African Government (SAG)
guidelines. The facilities where palliative care is provided include general practitioners' clinics, non-
governmental clinics and public sector sites. These sites are located mainly in the Gauteng, North West
Mpumalanga and KwaZulu-Natal. Patients are also assessed for opportunistic infections and eligibility for
ART and provided with preventive therapy i.e. INH and cotrimoxazole. Emphasis areas include human
resources, commodity procurement, logistics, quality assurance and training. The primary target populations
are people living with HIV (PLHIV), HIV-infected children, prisoners, homeless people and street youth.
This is an ongoing program funded by PEPFAR since October 2004. The PEPFAR-funded project aims to
rapidly expand access to HIV care and treatment to South Africans living with HIV, and especially in areas
(such as mining areas) where Aurum is familiar and other partners are less likely to work. Aurum has
established a number of general practitioner (GP) clinics which are capable of providing care to large
numbers of HIV-infected individuals and achieving high quality results. In order to ensure sustainability of
this model, Aurum has partnered with Faranani Solutions, a network of general practitioners from a
previously disadvantaged population. Advantages of this model, now termed the Auranani model, are that
Aurum has been able to secure lower consultation rates for GPs and GPs are encouraged to provide
assistance at their local hospital clinics. The presence of trained individuals in these public health facilities
will enable the transfer of knowledge to nurses and doctors in the public sector. It is hoped that this model
can be used to rapidly scale up delivery of HIV services in South Africa, in partnership with government
efforts. Sites are located throughout the country, but are concentrated in Gauteng, North West province and
KwaZulu-Natal. There is only one site each in the Northern Cape and the Western Cape. A further
extension of Aurum's program is to include care and treatment services in HIV prevention trial sites of the
Aurum Institute in the North West and KwaZulu-Natal. Thus patients are being diagnosed in early stages of
their disease and are being counseled and prepared for antiretroviral therapy (ART) and palliative care. In
both these provinces there is a close collaboration with SAG, and patients are referred to public sector
facilities for ART initiation. These clinics are will be used in the future as down referral facilities In FY 2006
Aurum fostered new relationships with non-governmental organizations (NGOs) and public sector sites. A
number of primary healthcare clinics attached to NGO and faith-based organizations (FBOs) have been
established. Metro Evangelical Services, a sub-partner, is a FBO providing training, housing and health
services for the homeless and street youth of Hillbrow, Johannesburg. An HIV center has been established
to provide CT and HIV services to this population. In Gauteng, a contract has been concluded with Chris
Hani-Baragwanath hospital for support and a contract for extension of these services to other parts of
Gauteng is being negotiated with the provincial health departments. In the North West, Aurum supports the
provision of HIV Care at Tshepong Hospital through the provision of medical and nursing staff. In addition,
through the establishment of a walk-in clinic at Jade Square in Klerksdorp Aurum provides care for HIV
patients that are not able to currently access care through the public hospital. Aurum has met with the
KwaZulu-Natal Department of Health about sites attached to the Medical Research Council. Furthermore, in
Mpumalanga, one of Aurum's sub-partners, Reaction Consulting, has worked with the provincial health
department to strengthen support for Ermelo Hospital, and in the Northern Cape, Aurum's public-private
partnership with De Beers Consolidated Mines in the Danielskuil area has been discussed. In the Limpopo
area, discussions are underway with Anglo Platinum and the Limpopo Department of Health to provide
support to a down-referral clinic based in the Capricorn district close to one of the Anglo Platinum mines.
Aurum intends to continue to support the Department of Correctional Services in Johannesburg but also to
expand activities to other Gauteng-based correctional facilities, namely Pretoria. A number of Aurum's sites,
Caritas Care, MES and Duff Scott collaborate with the local health departments that provide funding for
inpatient care to palliative care patients. In FY 2008, the SME project will commence the provision of care
and support services to HIV positive SME employees including market traders and taxi drivers and their
partners and dependents in targeted sites in Gauteng, Mpumalanga and Limpopo provinces.
PEPFAR funding will be used to fund all central staff responsible for monitoring and evaluation of the
program. FY 2008 funds will also be used to provide training and human resources at the sites. Focus areas
of training include how to run support groups, disclosure and stigma, special counseling situations such as
couples and children, and the prevention of mother-to-child transmission. Care will be provided through
occupational health care clinics, the mobile vehicles, the GP network and at the fixed service points such as
Bree Street site.
ACTIVITY 1: Monitoring for Opportunistic Infections
At each of the patient visits, a full physical examination including pain and symptom management of the
patient is conducted to exclude the existence of opportunistic infections (OI). If a client presents with an OI,
further investigations and management of the infection including the provision of cotrimoxazole may occur
at the site, or the patient may be referred to another healthcare service. Adherence to OI medications
(including cotrimoxazole prophylaxis and TB treatment) is also part of the package of services. Effort will be
made to ensure equitable access to care services for both males and females.
ACTIVITY 2: Provision of Prophylactic Medication
Patients with CD4 below 200 will receive elements of the preventive care package including cotrimoxazole
preventative therapy. It is expected that 30% of all patients receiving palliative care will be receiving
cotrimoxazole preventive therapy.
ACTIVITY 3: Psychosocial and Spiritual Support As part of a holistic approach to palliative care, patients
receive counseling by trained staff member at each clinic visit. A psychologist, a dietician and a social
worker based within the central office is responsible for education, training and support of site staff. Some of
the sites have established psychological and spiritual support groups. The Basic Package of Care including
acceptance of status, disclosure, prevention with positives, opportunistic infections, adherence counseling,
treatment literacy and nutrition counseling will be included at all Aurum funded sites (private sector).
ACTIVITY 4: Work with prisons
Aurum provides technical assistance to the Department of Corrections in Gauteng province in three areas:
1) assist in the development of the ART and care delivery system, 2) training health care workers on ART
and holistic palliative care, and; 3) development of a data management system to track prisoners who are
Activity Narrative: receiving ART and care support. Patients will be encouraged to bring family members in the facilities.
Training on couple counseling and counseling for children is given to the health providers. Family members
will be encouraged to test for HIV and will be provided education and counseling on HIV and TB. Those
family members that test HIV positive will be enrolled into Aurum's care program and will be provided with
all the services as already described above. 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 or the five categories of palliative care services. Aurum's palliative care
services contribute to the PEPFAR goals of 10 million people in care by increasing the quality of care.
ACTIVITY 5: Work with SME Employees
Aurum has established a project that strengthens the provision of services to SME employees, their
partners and dependents initially within the Johannesburg CBD. The project will be expanded to an
additional site in Gauteng as well as to Witbank and Polokwane. Aurum has developed partnerships with
the Johannesburg City Council and with individual companies that have existing occupational health care
clinics. Utilizing these partnerships and the mobile vehicles and GP network, HIV positive clients will be
screened for the presence of opportunistic infections, provided prophylactic therapy and provided education
Aurum's TB/HIV program aims to integrate HIV care with TB prevention and treatment. This integration is
planned at all the HIV treatment sites which include general practitioners' clinics and community clinics
throughout the country. In addition, Aurum plans to improve TB/HIV integration at Chris Hani-Baragwanath
Hospital in Gauteng by providing support to the TB clinic in the form of nursing staff and data management
support. In addition, Aurum plans to work with the Platinum mining industry to insure TB/HIV integration
within the mining health services and to provide mobile services to contacts of miners who are treated with
TB. In the Eastern Cape, Aurum intends to provide support to Themba TB hospital to ensure they receive
accreditation to provide HIV services. Emphasis areas include human resources, infrastructure, commodity
procurement, logistics, quality assurance and training. The primary target populations are people living with
HIV (PLHIV), HIV-infected children, prisoners, homeless people and street youth. TB/HIV Care is a new
activity under the SME Project. The screening and identification of TB
cases among the employed sector and taxi drivers is of particular importance as they come into contact with
a large number of people each day and successful treatment will result in the prevention of several new
infections. In addition, successful identification and treatment of TB in the employed sector, including
Traders and Taxi drivers will ensure they continue to be economically active and are able to support
themselves and their dependents and continue to run a viable business. SMEs contribute half of the total
employment in South Africa and 75% of the employed people in Johannesburg utilize Taxis to commute to
and from work.
The main focus of the Aurum program in the public, private and NGO sector is to provide HIV care and
treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality of
counseling, patient care and patient monitoring. The model is centrally coordinated and designed to be
implemented on a large scale where the peripheral sites are in resource-constrained settings and lack HIV
specialists, information technology (IT) infrastructure, and laboratory and pharmacy capacity. Aurum has
developed a centralized system of support which includes the following: (1) training of all levels of
healthcare workers to ensure capacity building of clinicians to manage patients in resource-poor settings
with remote HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive therapy
(including INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child
transmission and voluntary counseling and testing; (3) clinical and administrative support through site visits
by staff involved in psychological support, training, clinical support and monitoring data management
system; and (4) centralized distribution of medication and laboratory testing.
This program will supplement the South African government ARV rollout plan and therefore the program
adheres to national guidelines and protocols.
This is a new activity that only received PEPFAR funding since FY 2007, although Aurum has received
PEPFAR funds for other activities such as TB preventive therapy described in the FY 2006 COP under
palliative care. In most areas, clients are referred to the public health clinics for definitive diagnosis and
treatment of TB. Aurum is initiating a program where healthcare workers at sites are able to diagnose TB
patients using algorithms and guidelines that are in line with the National Department of Health (NDOH).
Healthcare workers then refer patients to public sector clinics for treatment. In addition, patients who test
HIV-infected under the counseling and testing program will be screened for TB.
There are seven main activities in this program area.
ACTIVITY 1: TB Preventive Therapy for HIV-infected Individuals
CD4 count testing is done 6-monthly or 3-monthly in patients with CD4 above or below 350 respectively.
Patients are given TB preventive therapy with 300mg isoniazid taken daily for 6 months after exclusion of
TB, repeated every 2 years. Aurum expects that a minimum of 10% of all palliative care patients will require
TB preventive therapy. This integration will be implemented at all the HIV treatment sites run by general
practitioners and community clinics throughout the country. Sites include the Metro Evangelical Services
Clinic, which provides services for the homeless population and street youth of Hillbrow, Johannesburg, and
the Medical Research Council (MRC) sites, providing care primarily to women. Aurum's sites are located
primarily in Gauteng, North West and KwaZulu-Natal. There are sites in all the other provinces but only one
site in each of Northern Cape and Western Cape
ACTIVITY 2: Diagnosis and Treatment of TB in the HIV-infected
When initiating the ARV program or the palliative care program, a symptom screen and a chest radiograph
will be done on each patient. At each clinic visit, there is symptom screening by trained nurses. Guidelines
for screening tuberculosis will be followed and monitored. An evaluation of current screening practices is
currently underway and this will be used to ensure improved monitoring of screening and standardization of
the TB screening process. At Tshepong hospital the project will be enrolling new patients who are started
on treatment onto a TB screening process (including symptom screening, sputum testing and chest
radiography) to identify the most appropriate screening methods.
ACTIVITY 3: Support for HIV-TB integration services at Chris Hani-Baragwanath hospital
Aurum will provide support to provide TB/HIV integration services at the Chris Hani-Baragwanath hospital, a
large government hospital in Gauteng. Aurum will employ a nurse and counselor who will provide HIV
counseling and testing to all TB patients and ensure referral of those who test positive to the HIV clinic. In
addition, Aurum will develop a data system that will assist in ensuring successful incorporation of these
patients in the HIV care program.
ACTIVITY 4: Public-Private Partnership within Platinum Mining Industry
Aurum is establishing a partnership with Anglo Platinum and other platinum mining companies to strengthen
Activity Narrative: their TB/HIV integration activities within their mining facilities. In addition, a program to trace dependents
and household contacts of miners diagnosed with TB will be introduced. This program will include
household visits with HIV education and counseling, HIV testing, TB screening and referral for TB and HIV
services. Aurum aims to visit around 800 households with approximately 5 persons per household. In
addition, public TB services in the communities will be strengthened to cope with the increased workload.
Originally support to the platinum mining industry was to include a PHE, but as this PHE was not approved,
the funding is reprogrammed back into the TB-HIV services to support service delivery in this industry.
ACTIVITY 5: Support at Eastern Cape Themba TB hospital
Aurum will provide support to the Eastern Cape Themba hospital to assist them to obtain accreditation for
the national CCMT program. This support will include provision of limited renovation, staff and technical
ACTIVITY 6: TB screening at Johannesburg Correctional Facility
Aurum will be undertaking a TB and HIV screening project at Johannesburg Correctional Facility. This will
determine HIV and TB prevalence and appropriateness of various screening methods. In addition it will
determine yield and cost-effectiveness of routine screening within the prison. This will be started with FY
2007 funding and completed in FY 2008. The project is expected to provide information that may lead to
routine screening in other facilities.
ACTIVITY 7: TB Activities in the SME Project
People identified as HIV infected through the counselling and testing process performed by the SME Project
will be screened for the presence of TB symptoms and referred for treatment to the nearest TB centre for
follow-up. At some sites, sputum collection will be performed according to South African government
protocols and the clients will then be informed of the results and referred for treatment. All HIV positive
clients who do not have active TB will be offered IPT and training on the use of IPT will be provided to
Aurum clinical staff, counselors, peer educators and staff at occupational health clinics. Education sessions
to SME employees will include the simple identification of TB symptoms, importance of treatment and
importance of IPT in HIV and their contacts.
ACTIVITY 8: Tembisa HIV-TB Integration
With FY08 reprogramming funds, Aurum will implement an integrated TB-HIV model for Tembisa (outside
Johannesburg) that will utilize the principles of intensive case finding, isoniazid prophylaxis and infection
control to improve TB-HIV services at Tembisa hospital, Tembisa Main Clinic and Winnie Mandela Clinic.
Additional clinics in the sub-district will also be identified for strengthening activities. This activity would aim
to engage private and civil society partners to ensure horizontal integration at the household level, utilizing
mobile services and capacity development of clinics.
In addition to these activities, Aurum will conduct a public health evaluation, described elsewhere in the
Title of study:
A preliminary study of screening for tuberculosis in a South Africa Correctional Facility
June 2007 - June 2009 (Please note that this timeline is already delayed as the protocol development has
not been completed)
June 2007 - December 2007: Protocol development; Submission for ethical approval; Development of
participant information sheet and data collection forms
January 2008 - March 2008: Sourcing screening tools (sputum microscopy, culture and drug susceptibility
testing, CXR, urine test for HIV and LAM testing); Translation of all forms into relevant languages; Piloting of
all relevant forms; Design of database; Appointment of research nurses; Training of research nurses; TB
awareness campaigns within the correctional facility
April 2008 - December 2008: Recruitment of participants; Follow up of participants
January 2009 - May 2009: Finish follow up of participants; Begin write up of papers; Analysis of initial data
May 2009 - June 2009: Finish analysis of data; Finish write up of report; Dissemination of results
Total Projected Budget: $109,000
Aurum Institute for Health Research:
a) Dr. Lilanganee Telisinghe: Study design, study management, data analysis, report writing
b) Dr. Mikateko Shisana: Study design, study management, negotiation with relevant authorities, data
analysis, report writing
c) Dr. Salome Charalambous: Study design, advice on study implementation, data analysis, report writing,
managerial oversight and support at the site
d) Professor Gavin Churchyard: Study design, advice on study implementation
Chris Hani Baragwanath Hospital:
a) Dr. Alan Karstaedt: Study design, advice on study implementation
Department of Correctional Services:
a) Dr. Gladys Nthageni: Study design, advice and assistance with implementation and support at the site
b) Dr. David Mathabathe: Study design, advice and assistance with implementation, support at the site and
liaison with prison authorities
London School of Hygiene & Tropical Medicine:
a) Dr. Alison Grant: Study design, advice on study implementation, data analysis, and report writing
b) Dr. Katherine Fielding: Study design, advice on study implementation, data analysis, and report writing
Correctional facilities provide a unique environment for the spread of tuberculosis. Currently in South
African correctional facilities, all new enrollees are seen by the medical team and screened for tuberculosis
using past history and current symptoms. We propose to actively screen a representative population of the
Johannesburg correctional facility, and we will also be offering screening to the staff, to determine the
prevalence of tuberculosis, among the offenders, and the staff. This will give a more accurate picture of the
burden of the disease and aid the control program by demonstrating how best to use new and existing
Primary objective: Determine the prevalence of active tuberculosis among offenders in the Johannesburg
correctional facility in South Africa.
a) Determine the proportion of prevalent TB that is undiagnosed
b) Comparing screening methods (symptoms, CXR, sputum microscopy, sputum culture and the new urine
LAM - Mycobacterial Lipoarabinomannan testing) to determine the optimal screening tool for active TB
c) Investigate risk factors for prevalent TB, including HIV infection
d) Explore the prevalence of drug resistant TB
e) Explore the prevalence of TB among correctional facility staff that have volunteered to be tested
Anticipated study outcomes:
The results of this study will give a more accurate picture of the burden of tuberculosis within the
correctional facility. Screening will be done using a symptom questionnaire, sputum for microscopy and
culture, chest X-ray and the new urine Lipoarabinomannan test. Study participants will also we offered
testing for HIV. These results will aid the control programme by demonstrating how best to use new and
existing screening tools or tuberculosis. This, will not only improving the health of the offenders but also the
health of the staff.
The new experimental urine LAM (Mycobacterial Lipoarabinomannan) test for TB will be used in this study,
and its sensitivity and specificity and positive and negative predictive values will be calculated. This may
guide the future use of this tool in screening for tuberculosis.
Following informed voluntary consent, all study participants will be screened for TB using a questionnaire
(with information on demographics and symptoms of active tuberculosis), two sputum specimens for
microscopy and culture, a chest X-ray and a urine specimen for LAM testing.
Activity Narrative: All study participants will be offered voluntary counselling and testing for HIV. If consent is provided, a rapid
test will be performed, and the results made available to the individual. The results of the rapid test will not
be used in the study. A second urine sample will be collected, for research purposes, if consent is provided.
It will be anonymously linked to the data gathered and will be anonymously tested for HIV. The results of
the urine tests will not be given to the study participants.
Any participant with a positive result on screening for TB will be recalled and reviewed with a further
symptom screen, two further sputum samples for microscopy and culture and a repeat CXR, for evidence of
active TB. All positive results obtained for an offender will be made available to the medical unit at the
correctional facility, so that they can be further evaluated and treated if appropriate.
If a diagnosis of TB has been made, we will ask the health services staff at the correctional facility to collect
extra information for these offenders on a study questionnaire, at 2 months, to judge response to treatment.
All offenders will have their medical records reviewed at 3 and 6 months, and if necessary at a later stage,
to see if they have been diagnosed with TB or any other condition.
If treatment is required for a staff member, a referral letter will be written to their preferred provider. With
their permission, we will contact staff members at 3 and 6 months to see if they have been diagnosed with
TB or any other condition.
The duration of recruitment will be April 2008 to December 2008 (9 months). Follow up of medical files will
be completed by May 2009.
Population of Interest:
The setting is a Medium B, Johannesburg correctional facility in Johannesburg, South Africa. The
population studied will be:
a) A representative sample of the Medium B, correctional facility population - both new admissions and
currently incarcerated offenders who have already been sentenced
b) All "members" (staff) working in Medium B of the facility (total estimated at 200-300) will be offered
confidential screening on a voluntary basis
The sampling procedure will be as follows:
OFFENDERS - Medium B: Total Sample Size 1000
a) New Entrants
b) Sample size 500
c) Consecutive new admissions
a) Sentenced Incarcerated Offenders
c) Random sample from a list of existing offenders with a predicted stay greater than 6 months
STAFF - Medium B
All staff members will be offered confidential screening on a voluntary basis
All data will initially be presented to the Department of Corrections. Following this, we aim to present the
preliminary data at an appropriate conference and to publish the findings in a peer reviewed journal if
Budget for Year 1:
Object Classification Amount
Salaries/Fringe benefits $54,500
Participant Incentives $0
Laboratory testing $31,500
The Aurum program provides HIV counseling and testing (CT) for patients in private general practitioner
(GP) practices and non-governmental sites. Where Aurum provides support in the public sector, the
voluntary counseling and testing (CT) human resources and commodities are provided by the South African
government. Emphasis areas include human resources, commodity procurement and quality assurance.
The primary target populations are people living with HIV (PLHIV), HIV-infected children, prisoners,
homeless people and street youth. The SME Project will continue and expand counseling and testing
services offered to SME employees, their partners and dependents through fixed and mobile sites located
within targeted workplaces, mobile clinics and sites located within taxi ranks.
Aurum Institute for Health Research (Aurum) is a not-for-profit, public benefit organization that is committed
to improving the health of disadvantaged individuals and communities through transformational research
(the research programs are not PEPFAR-funded), management of TB and HIV programs and provision of
HIV testing, treatment and care. The main focus of the Aurum program in the public, private and non-
governmental sector is to provide HIV care and treatment to a large number of persons in a cost-effective
standardized manner ensuring a high quality of counseling, patient care and patient monitoring. The model
is centrally coordinated and designed to be implemented on a large scale in peripheral sites that are
resource-constrained and lacking basic resources such as HIV specialists, information technology (IT)
infrastructure, and laboratory and pharmacy capacity. Aurum has established a centralized system of
support which includes (1) training of all levels of healthcare workers to ensure capacity building of
clinicians to manage patients in resource limited settings with remote HIV specialist support; (2) providing
and maintaining guidelines for HIV preventive therapy (including INH and cotrimoxazole), treatment of
adults and children, prevention of mother-to-child transmission and CT; (3) providing clinical and
administrative support through site visits by staff involved in psychological support, training, clinical support
and monitoring data management systems; and (4) maintaining a centralized distribution of medication and
laboratory testing. This program will supplement the South African government's antiretroviral rollout and
therefore the program adheres to national guidelines and protocols. This is an ongoing program funded by
PEPFAR since October 2004. It is a facility-based program in which Aurum works with general practitioners,
a faith-based organization (FBO) and within the public sector. In addition the SME Project will expand its
services to three additional fixed sites and two additional mobile clinics within Gauteng, Mpumalanga and
ACTIVITY 1: Establishing Capacity for CT
This activity will take place in two primary health clinics and two prison clinics. This activity will include the
provision of and training of staff in these clinics as well as provision of running expenses for these clinics.
ACTIVITY 2: Counseling and Testing
HIV counseling and testing is conducted at selected GP sites, primary health centers and mobile units. The
counseling and testing includes pre- and post -test counseling and rapid finger prick testing with a screening
and a confirmatory test. Provision has been made for the mobile units.
ACTIVITY 3: Quality Control of HIV Testing
External Quality control is done at Aurum CT sites. Specimens are supplied on a monthly basis to the CT
sites and each staff member on site tests these. This is reported to Aurum by Thistle. Feedback on these
results is given at the quarterly refresher training.
ACTIVITY 4: Training on Voluntary Counseling and Testing
A five-day course is given to all new personnel involved in CT. In addition, an annual meeting is held and
new findings, discussions on counseling, running of support groups are covered. Training includes a focus
on stigma and discrimination.
ACTIVITY 5: Data Management
All encounters are recorded on a standardized form and then captured onto a centralized database that is
used for reporting.
ACTIVITY 6: Supply and Distribution of Testing Kits
Kits are ordered using a form that is faxed to, and authorized at, Aurum. The supplier then delivers the kits
to the sites.
ACTIVITY 7: Marketing and Promotion
Educational pamphlets and campaigns are provided. Various methods are being used to market and
encourage counseling and testing. Some sites (MES and Aurum Klerksdorp) run CT campaigns over short
periods of time. Other sites run activities on commemorative days such as Valentine's Day and World AIDS
Day. Marketing material is developed locally by the site according to their needs.
ACTIVITY 8: Expansion of Counseling and Testing in SME Sector
Activities in FY08 will include the expansion of counseling and testing services to additional sites in SMES
in Witbank Central Business District and Polokwane Central Business District. In addition an additional fixed
site will be established in partnership with the City of Johannesburg. This will enable market traders, taxi
drivers, commuters and SME employees and their dependents to access counseling and testing.
Partnerships will continue to be to be developed with individual SMEs to provide counseling and testing
onsite, within occupational health clinics where they exist or within Aurum's mobile vehicles. Additional staff
Activity Narrative: will be hired and trained to provide these services. In addition, occupational health staff will also be trained
and supplied with testing kits. As yet there remain restrictions of the use of rapid test kits by persons not
registered with the Health Professions Council but in the event of a change in the regulations, Aurum will be
in apposition to test and equip a number of lay counselors to also perform rapid testing.
Aurum will contribute to the PEPFAR 2-7-10 goals by promoting and providing counseling and testing
services to allow for entry into HIV care and treatment programs.
Aurum Health Research (Aurum) will use FY 2008 PEPFAR funding to continue an ongoing clinical program
that works through general practitioners and community clinics throughout the country, and to expand the
program to three public hospitals in the Eastern Cape, North West and Gauteng provinces. The emphasis
areas for this activity are human capacity development, local organization capacity building, and strategic
information. Target populations include infants, children and youth; adults, including men and women of
childbearing age; and people living with HIV (PLHIV), including HIV-infected pregnant women, infants and
The focus of the Aurum program in the public, private, and non-governmental sector is to provide HIV care
and treatment to a large number of persons in a cost-effective standardized manner ensuring a high quality
of counseling, patient care and patient monitoring. The model is centrally coordinated and implemented on
a large scale in peripheral sites that are resource-constrained and lacking in HIV specialists, information
technology (IT) infrastructure, and laboratory and pharmacy capacity. Aurum achieves this by having a
centralized system of support which includes the following: (1) training of all levels of healthcare workers to
ensure capacity building of clinicians to be able to manage patients in resource-poor settings with remote
HIV specialist support; (2) provision and maintenance of guidelines for HIV preventive therapy (including
INH and cotrimoxazole), treatment of adults and children, prevention of mother-to-child transmission and
voluntary counseling and testing; (3) clinical and administrative support through site visits by staff involved
in psychological support, training, clinical support and monitoring data management system; and (4)
centralized distribution of medication and laboratory testing.
The S Buys group (a private company) is responsible for the centralized procurement and distribution of
antiretroviral and preventive therapy. Negotiations with research-based pharmaceutical companies have
ensured that GlaxoSmithKline (GSK) drugs are available at access prices and members of the community
without medical insurance are able to access these medications.
ACTIVITIES AND EXPECTED RESULTS:
PEPFAR funds will be used in this program area to purchase, store and distribute ARV drugs. Patients who
are medically eligible for, but cannot afford, antiretroviral therapy will receive the drugs at no cost from
enrolled sites. The drugs will be prescribed using the South African Government's (SAG) eligibility criteria
and drug regimens. Generic medications purchased comply with the USG PEPFAR Task Force requirement
of U.S. Federal Drug Administration approval as well as approval from the Medicines Control Council of
The pharmacy plan comprises:
(1) Warehousing and stock control of drugs: A computerized system of stock control will ensure an audit
trail and batching abilities from the warehouse to patients.
(2) National distribution of medication: Through a courier service, S Buys is able to distribute medication
anywhere in South Africa within 24 hours of receiving the request. ARV drugs are dispensed centrally on a
monthly basis, and Aurum has not experienced any stock-outs.
(3) Named patient dispensing: Dispensing centrally at the pharmacy ensures that medication is controlled
and it facilitates a strict audit trail to the patient.
(4) S Buys pharmacy has in place stock control, pricing based on volume purchasing (where possible) and
has a process for checking compliance with ART guidelines.
(5) Integration with the Aurum Health Research (AHR) Project: This integration will help ensure adherence
to protocols, as well as communication between pharmacists and AHR. It will also allow for the integration
of data from drug dispensing sites.
(5) Aurum is working with sub-partners to ensure Department of Health accreditation for a number of sites,
allowing drugs to be provided by the government. A number of sites have already been accredited.
(6) Aurum will participate in the training of professional nurses in pharmacy skills.
Aurum's activities in ARV drugs contribute to the 2-7-10 PEPFAR goal of 2 million people receiving
This activity provides support services at public facilities providing antiretroviral therapy as part of the
national ARV rollout and HIV care and treatment at primary health centers, clinical trial sites and general
practitioner (GP) practices. ART is provided in accordance with the National Department of Health (NDOH)
guidelines. The emphasis areas are renovation, human capacity development, and local organization
capacity building. The primary target populations are people affected by HIV and AIDS, HIV-infected
children, prisoners, homeless people and street youth.
This is an ongoing activity funded since FY 2004, providing access to HIV care and treatment in the public,
private and NGO sector. This activity takes place in the following NDOH ARV sites: (1) Madwaleni Hospital,
Eastern Cape; (2) Tshepong Hospital, North West; and (3) Chris Hani-Baragwanath Hospital, Gauteng. In
addition Aurum intends to provide ARV services in FY 2008 to sites added in FY 2007: (4) Ermelo Hospital,
Mpumalanga, and (5) Thembisa Hospital, Gauteng. In FY 2008, Aurum intends to provide support to a
further two public sector hospitals. Aurum plans to provide support for down-referral in the following areas:
North West Province (Kanana clinic), Limpopo Province (Mathe-bathe clinic), Madwaleni-linked primary
health centers, Gauteng down-referral program and Northern Cape (Danielskuil clinic).
A number of sub-partners are involved in implementation of this activity:
1. Faranani Network is described in the Basic Health Care and Support activity and this network supports
treatment of people without medical insurance in general practitioner (GP) sites.
2. Reaction Consulting is based in the Mpumalanga Area. This is a public-private partnership with X-Strata
which provides the clinics. This organization received direct PEPFAR funding in FY 2007.
3. MES Impilo, a faith-based organization based in Hillbrow, Johannesburg, functions as a home-based
care center for the homeless population of Hillbrow, including street youth.
4. Medical Research Council (MRC) site based in KwaZulu-Natal, provides HIV services to prevention trial
participants (microbicides, diaphragms) who are found on screening to be HIV-infected.
5. De Beers Consolidated Diamond Mines has developed a public-private partnership in the town of
Danielskuil, Northern Cape where contractors and partners of employees are treated for HIV.
In addition, new sub-partners are envisaged as follows:
8. Department of Correctional Services: Aurum will provide support for HIV services including HIV
counseling, laboratory monitoring and preventive therapy in two correctional facilities - the Johannesburg
Correctional Facility and one other facility. The drug and laboratory costs would be funded by the South
Africa Government (SAG).
Additional sub-partners involved in the implementation of central activities include:
9. S Buys will be involved with procurement, dispensing and distribution of medications and will provide
pharmacy support at the Chris Hani-Baragwanath Hospital.
10. Toga Laboratories will assist with laboratory testing. Toga has negotiated with Bayer to secure reduced
pricing for viral load testing for the Aurum program. Toga is piloting a new initiative to place point-of-care
lactate tests at some of Aurum facilities to facilitate early recognition of ART adverse events.
11. Kimera Solutions will provide specialist HIV clinical support to doctors in the form of training and onsite
mentoring with regular site visits.
The program activities include:
ACTIVITY 1: Wellness of HIV-infected Individuals
Human resources, laboratory monitoring and counseling services for patients who are enrolled into HIV care
are included (described in other sections of the COP). Aurum provides a continuum of care from provision
of counseling, preventive therapy and preparation for ART. In some sites (MRC, Reaction) patients are
referred to public health facilities for initiation of ART.
ACTIVITY 2: Provision of ARVs to Children
Provision of ARVs to children is a recent focus of the program. Aurum has partnered with Wits Paediatrics
(sub-partner of Reproductive Health Research Unit) to provide training for two Aurum clinicians. These
clinicians attend a pediatric clinic once a week to gain experience in pediatric care. This will help capacitate
Aurum to provide ARV services at pediatric units. Aurum is actively encouraging partners to provide
services to children and have provided for HIV PCR testing for children in this COP. One of the Aurum GPs
is involved in routine treatment of orphans and vulnerable children and has enrolled onto the Aurum
program as a provider. Also, Metro Evangelical Services and Caritas Care Centre have a few orphans
enrolled onto their hospice. We will attempt to expand to other partners who provide care to orphans and
ACTIVITY 3: M&E
M&E is a central component of the Aurum program. Every patient contact is recorded on a standardized
form and a unique patient identifier is allocated by the central Aurum office. The information is then
couriered or faxed to the central office where the data is captured in a database. Monitoring visits take place
at the sites to ensure adherence to guidelines and completeness of data collection. Quarterly reports are
Activity Narrative: produced for all stakeholders. Aurum also provides a data management system for the Adult ARV clinic at
Chris Hani-Baragwanath and Tshepong hospital in North West program. This system will also be
implemented at Thembisa hospital.
Provision of laboratory services is per a standardized schedule of follow-up in accordance with SAG
The program started in March 2005 and has established 60 treatment sites where about 7000 patients are
receiving ART and 80% achieve virological success at 6 months.
Aurum will contribute to the PEPFAR 2-7-10 goals by providing quality HIV care and treatment services in
the public, private and NGO sector.