The PEPFAR-funded CAPRISA AIDS Treatment (CAT) Program started in 2004 with two innovative approaches; integration of AIDS care with TB treatment at an urban TB clinic in eThekwini and a nurse-driven AIDS care service in a rural community in Vulindlela. Specific objectives include; expanding access to HIV counselling, care and treatment activities by supporting the South African Government health services in the Vulindlela sub-district and in facilities in eThekwini, strengthening the programme of pre-ART care in the facilities we support, maintaining survival or AIDS free events in 85% of the enrolled population for up to 12 months of follow-up in facilities we support, supporting counseling and testing activities, specifically for TB-HIV co-infected patients, adolescents and young women in Vulindlela, expanding MMC and other HIV prevention interventions in an effort to prevent new infections and halt the further spread of HIV, expanding TB HIV integration services, and TB prevention services in the facilities we support, which includes implementing quality improvement strategies in facilities managing drug sensitive and drug resistant tuberculosis, conducting operational research via our PHE award on improving our understanding of recurrent tuberculosis on populations on ART, and improving access to sexual reproductive health services among adolescent girls by facilitating specific counseling among these populations on: know your HIV status, delaying sexual debut, self- reporting of STI’s and facilitating referral for contraceptive services. CAPRISA will also conduct research and improve quality of services as they relate to systems strengthening in the response to TB and HIV.
Cross-Cutting Budget Attribution(s)
(No data provided.)
TBD Details
(No data provided.)
Key Issues
(No data provided.)
Budget Code Information
Mechanism ID:
Mechanism Name:
Prime Partner Name:
9821
CAPRISA
University of Kwazulu-Natal, Nelson Mandela School of Medicine, Comprehensive International Program for Research on AIDS
The CAT program will support SAG facilities in prolonging and optimizing quality of life of HIV-infected adults and their families. -Integration of TB-HIV services- CAPRISA has gained years of experience and clinical expertise in TB-HIV co-infection and patient management. The NIMART Mentoring program will serve as the conduit through which this expertise is transmitted to PHC nurses. - Nutrition assessment will be implemented to identify vulnerable patients eg. poor nutritional status, children, pregnant women and TB co-infected. Those identified will be followed up with specific nutrition counseling and support - Provision of peer support groups and psychosocial support will be maintained within CAPRISA’s current ART –related activities - All HCT patients accessing health services, will have a TB symptom screen. Patients positive for HIV or TB will be rapidly linked to treatment and care services - Field DOT program – This community project conducts door to door visits and CCGs offer support and treatment supervision to patients hence reducing patient load and decreasing costs to the patients for accessing care and increasing Treatment adherence -Patient retention and referrals-CAPRISA has well established linkages with DoH facilities to make referrals. The CAPRISA program has a retention rate of >90%. Development of tools, standards for retention and monitoring and evaluation of patient outcomes have served to improve and inform retention strategies. The mentoring program will include training on lessons learned from the CAPRISA Cohort Retention team. Pre-ART registers will be implemented to reduce pre-ART losses to follow-up, morbidity and mortality. -Monitoring and Evaluation- assist the SAG facilities that we support, CAPRISA staff will provide mentorship for analysis of program data , data audits, on site supervision of M&E officers and building technical skills (e.g. computer skills, data capturing skills).-The PWP strategy is ongoing with targeted efforts aimed at reducing transmission of HIV from PLWHA through counseling, education, motivation and monitoring of critical aspects patient high risk behaviour, clinical care and treatment adherence.
Strategic Area
Budget Code
Planned Amount
On Hold Amount
Care
HVTB
0
0
Narrative:
The CAPRISA program will provide technical assistance to support the expansion, decentralization and integration of TB and HIV services. - Symptomatic TB screening for contacts of TB patients in health services and linkage to care will be strengthened. TB HIV co-infected patients(including MDR/XDR) who default clinic appointments will be traced after missed visits- Advocacy Communication and Social Mobilisation- Expand current advocacy and social mobilisation activities with respect to increasing awareness of TB, STI's and HIV, aimed at changing and encouraging health seeking behaviour with respect to reducing risk to these diseases among those unaffected and increasing access to diagnosis, care and support for those affected by these diseases
- All pregnant women and children accessing health facilities will have access to HCT and TB screening. Patients that screen positive for TB or HIV will be linked to care and treatment services. Services PLWA not yet eligible for ART include short PMTCT, IPT and cotrimoxazole. - Processes ensuring uninterrupted supply of drugs using iDART technology, will be expanded. This includes ordering procedures, manual stock card management systems with routine inventory checks aimed at effective drug supply chain management to the patients under our care.- Expand coverage of HIV testing in TB patients, and TB screening in HIV infected patients
-Implement a program of treatment literacy and adherence support for TB therapy and ART -Provide technical support and training for expansion of for Nurse initiated management of integrated TB and HIV care-Implement a TB preventive strategy in HIV infected patients by incorporating the 5 principles of TB infection control, IPT rollout in HCW’s and HIV infected patients, intensified case finding and contact tracing, integration of HIV and TB services, and early initiation of treatment in HIV TB co-infected patients.-Offer technical capacity to strengthen systems with respect to monitoring and evaluation activities: Ensure high quality data on national registers, and conducting data audits aimed at improving quality of routine patient data.
Strategic Area
Budget Code
Planned Amount
On Hold Amount
Governance and Systems
OHSS
0
0
Narrative:
CAPRISA will support systems strengthening specifically in response to TB and HIV by conducting specific research in aimed at improving our understanding of TB HIV co-infections in order to tailor health and wellness interventions appropriately, improving quality of services offered by ensuring that patients are screened for TB and HIV, receive results promptly and that all patients diagnosed with TB and HIV receive the appropriate care and follow-up, providing training and mentorship to PHC facilities in the geographic area we support to ensure that the community based facilities are capacitated to provide comprehensive package of services for TB and HIV,strengthening patient tracking systems and supporting Monitoring and Evaluation systems by direct supervision and data audit systems.
Strategic Area
Budget Code
Planned Amount
On Hold Amount
Prevention
CIRC
400,000
0
Narrative:
The CIRC program will prioritise young male learners between 15-20 years to increase access of MC within a context of comprehensive HIV risk reduction and sexual reproductive health services. Increasing coverage of MC in this group will have a substantially higher impact on reducing HIV infection rates in the Vulindlela community through additionally impacting HIV infection rates in young women. A range of activities that will provide safe high quality MC service with a client support system includes: 1. A multi-pronged approach to community outreach that is not limited to:
o Distribution of materials i.e. pamphlets o Meetings with relevant groups i.e. school learners, school leadership, parents, adolescents, men from the communityo Providing information about HIV/AIDS and the role of MC in reducing this risk and where MC services can be accessed. 2. A clinic with multiple surgical bays geared to provide 10 MCs per day and 60 MC’s per Saturday as part of a comprehensive HIV prevention package i.e: o MC education and counselling on risk reduction and safer sex with provision of condoms o HCT and appropriate referral if required o Provision and promotion of male and female condoms o Comprehensive medical examination including STI screening and syndromic treatment and TB screening
o Efficient patient schedulin o The use of electrocautery and the forceps guided method o Follow-up post surgery with 24hour emergency support o Post-operative review at 2days, 7 days and 21 days with a non-compulsory visit between 1-6 months post surgery. HIV test will be offered and HIV risk assessed. o Adverse events will be noted and post-surgical recovery will be assessed. 3. Expansion and accessibility of services is facilitated through providing HCT, screening and conducting reviews at the schools and local PHC clinics. 4. Monitoring and evaluation through rigorous record keeping with quality assurance being monitored by a Specialist Surgeon/Urologist.
Strategic Area
Budget Code
Planned Amount
On Hold Amount
Prevention
HVOP
300,000
0
Narrative:
The CAPRISA program will implement a School-based initiative of Sexual Reproductive Health (SRH) services in Vulindlela. There are 42 secondary schools in the district with 6 high schools that have an estimated enrolment of 1970 adloscent girls who will be targeted to pilot this project. The girls are aged between 12 and 22 years old. CAPRISA monitors, as part of ongoing epidemiological studies, the temporal trends in HIV infection in the Vulindlela sub-district and this research has consistently shown a very high HIV prevalence in the district with young women being most at risk for HIV infection. Description of the intervention: The following activities are therefore planned for this project: A mobile unit will be placed at some of the schools to provide a comprehensive Sexual Reproductive Health (SRH) service to the learners. The services offered will include:• STI screening and syndromic management thereof;
• Voluntary HIV testing with pre- and post-test counselling;• Fertility control counselling and service provision;
• Pregnancy testing and referrals where required;• Provision of male and female condoms;• Linkage to care for those who may test HIV positive;How activities are linked to other services: The provision of SRH is a part of other HIV prevention and health services offered at the CAPRISA Vulindlela Clinic that includes:• Medical Male Circumcision• Support services for HIV infected individuals and their families• Infant, Adolescent and Adult treatment, support and care
Strategic Area
Budget Code
Planned Amount
On Hold Amount
Treatment
HTXS
0
0
Narrative:
The CAT program will implement a range of activities to strengthen the availability of treatment for adult HIV infected patients at PHC facilities.This includes 1. A structured mentorship program - where nurses at PHC’s will be offered hands on training on Nurse Initiated Management of ART (NIMART), management of HIV associated complications and implementation of guidelines for chronic care management and treatment of HIV, Guidelines on TB management, and guidelines on TB prevention, among others.2. CAPRISA staff will provide on - site supervision and training on optimizing clinical processes, clinic flow, and integration of HIV into existing health services. This will facilitate continued expansion of services. 3. Targeted activity toward strengthening systems specifically with respect to and monitoring and evaluation activities; implementation of the Tiered M and E system, and data audits aimed improving quality of routinely recorded and reported performance measurement data.4. Tracking of performance measurement data over time, to identify program weaknesses. This information will be used to improve quality and efficiency of service delivery at the SAG facilities where we work.5. CAPRISA has developed both excellent tools to enhance patient adherence to treatment, and tracking patients’ retention in our programs. These skills and tools will be transferred to sites we support to strengthen existing tracking systems. 6. To expand coverage of HIV services, including the provision of ART, cotrimoxazole prophylaxis, and TB screening to adolescents and young women in rural communities and TB HIV integration services, including ART and cotrimoxazole, to TB HIV co-infected patients.7. To provide health systems strengthening including human resources and ART services including laboratory monitoring where not available, to support the provison of ART to patients.
Implementing Mechanism Details
Mechanism ID: 9832
Mechanism Name: AIHA
Funding Agency: U.S. Department of Health and Human Services/Health Resources and Services Administration
Procurement Type: Cooperative Agreement
Prime Partner Name: American International Health Alliance Twinning Center
The Twinning Center is a PEPFAR-supported American International Health Alliance (AIHA) program that effectively and rapidly supports local capacity to train needed Human Resources for Health (HRH) and strengthens health related institutional systems. The Twinning Center will support the development of various health professions education programs, including Clinical Associates, a new cadre of mid-level health workers to provide HIV and AIDS prevention, care and treatment as well as other public health services, particularly in rural areas. This program will contribute to the objectives of the USG-SAG Partnership Framework. The program will provide a needed infusion of HRH, facilitating deployment of HRH needed to support PHC re-engineering. Geographic coverage is national as Clinical Associates and other supported cadres will be trained and deployed throughout the country, and target populations include rural populations and HIV-positive people and their families. Resources will be targeted to programs with greatest need, and US partners will donate significant in-kind contributions. The program will strengthen programs at South African universities which are fully supported with local funds, and staff posts will be created at DOH so graduates have places to work in facilities throughout the country, ensuring local ownership. The program will support M&E efforts at all universities to document the quality of training and the impact of graduates on the South African health system.
Cross-Cutting Budget Attribution(s)
Human Resources for Health
875,000
TBD Details
(No data provided.)
Key Issues
(No data provided.)
Budget Code Information
Mechanism ID:
Mechanism Name:
Prime Partner Name:
9832
AIHA
American International Health Alliance Twinning Center
Strategic Area
Budget Code
Planned Amount
On Hold Amount
Governance and Systems
OHSS
875,000
0
Narrative:
In FY12 the Twinning Center will develop the capacity of South African universities to train Clinical Associates and other cadres, contributing to the overall PEPFAR goal of deploying 140,000 additional healthcare workers into the field (±13,000 in South Africa), and addressing the shortage of 83,043 health workers as identified in the NDoH Human Resource Strategy for the Health Sector. The program will continue twinning partnerships linking the three universities currently training Clinical Associates (UP, Wits and WSU) with US universities training physician assistants (Arcadia, Emory and Colorado). The partnerships will focus on improving the quality of the programs through curriculum development, faculty development, quality improvement, etc. while scaling up student enrollment where possible. The Twinning Center will establish additional twinning partnerships linking South African universities launching new Clinical Associates programs (Stellenbosch, UFS and UKZN are considering starting the program) with selected US universities training physician assistants. Adding new programs will increase the student pipeline. The twinning partnerships will leverage significant in-kind contributions of professional time and other resources from US partners. The Twinning Center will continue to support the Clinical Associates Forum of all participating South African universities to collaborate on cross-cutting issues that affect the establishment and sustainability of the profession. The Forum will address needs related to professional association building, advocacy, career pathing, student assessment, volunteer preceptors, data collection and coordinated research. The Forum will provide the South African universities with the opportunity to meet and discuss best practices and lessons learned, and coordinate strategies for the future of the programs and the profession. The Twinning Center will support national mechanisms to address issues crucial to the success of the Clinical Associates profession, including establishment of public health posts for graduates; administrative, financial and human resource management for the new profession; and proper orientation and introduction of graduates to management and healthcare teams in district hospitals. The Twinning Center will facilitate regular national coordinating meetings for DOH, participating universities, and other stakeholders to address these and other issues in support of the introduction of this new cadre of health worker in South Africa. The Twinning Center will provide direct technical assistance to the Clinical Associate program. Through its Volunteer Healthcare Corps (VHC) mechanism, US experts will be deployed on mid-to-long term field assignments to conduct courses/training for Clinical Associates and provide mentoring to local staff to increase their capacity to teach and support the program. The Twinning Center will direct efforts to increase access to online and offline information resources (including clinical practice guidelines) for faculty and students, and provide training to ensure that students improve information literacy and IT skills and utilize the available evidence to inform their studies and practice. Twinning partnerships, VHC experts, and information resources support may be implemented in support of initiatives for other cadres of health workers, such as pharmacists, pharmacy assistants and pharmacy technicians.
