Problem statement: due to massive burden of HIV, DOH introduced Nurse Initiated and Managed ART (NIMART) ART which requires that ART be integrated into a PHC setting.
Goal: i) NIMART model is fully deployed providing integrated HIV/TA care for adults, adolescents and children; ii) model (NIM)ART sties established that meet the highest national standard. Key Activities in partnership with DOH include: provide expert programmatic HIV and NIMART TA to DMT to inform strategies, evidence-based interventions and best practice and compliance with national policy; TA to DMT to ensure appropriate planning for NIMART and ART programs in district strategic and operational planning, target setting and budgeting processes; support HAST programs to formulate and implement work plans, targets and budgets in line with population needs, district priority areas and NDOH policy and clinical guidelines; map ART services and reported performance against estimated need, to identify service gaps and inform district HIV strategies and related work plans; undertake formative evaluation and baseline assessment of (NIM)ART related activities in each district; engage community organizations in communication and behavior change strategies to address stigma and discrimination; support RTC to develop (NIM)ART training plan; train NIMART, mentorship, ART, TB/HIV/STI, tier. Through roving mentor teams: provide supportive supervision to facility based staff and ensure continuity of training to mentorship to competency in NIMART and related programs; mentor staff to integrate (NIM)ART, adherence, TB/HIV/STI, PICT, TB, ANC, MCH, GBV and mental health services and implement according to policy; TA systems to fast track low CD4 counts, pregnant females and TB patients onto ART; support NIMART certification of nurses; identify and establish model NIMART sites for benchmarking; strengthen hospital-based ART clinics for complicated case referral; increase detection of cryptococcal meningitis; improve cervical cancer screening, cotrimox, TB screening and treatment, INH in line with guidelines; improve viral load and drug resistance monitoring and appropriateness of regimens; support adherence counseling and adherence improvement initiatives; support HCW soft skills, debriefing and coping skills; TA to improve dispensing and stock control; strengthen program monitoring using clinical stationery and tier cohort data; promote total quality assurance and compliance with guidelines; promote family/male/gogo/youth friendly HIV services; link roving mentor teams with district specialist teams to support complicated HIV; strengthen recording, reporting and data use of HIS (Tier and DHIS) and related data management tools (e.g. clinical stationery); facilitate use of innovative SI tools to facilitate program review and decision making; undertake operational research to explore, test, document and disseminate streamlined and/or best practice NIMART modalities; strengthen referral and patient tracing between and within health services; support CHW to integrate patient tracing and adherence into PHC outreach activities. Intended outputs: # trained (100); # patients (% facilities) initiating ART (45,000), by dist. & age group & TB/Preg; # total remaining on ART, by dist. & age gr (150,000). Intended outcomes: Increased ART coverage rate, by age group & district, Increased baseline CD4 at initiation, Increased viral load suppression rate, Improved ART patient retention rate
Strategic Area
Budget Code
Planned Amount
On Hold Amount
Treatment
PDTX
2,001,274
0
Narrative:
Problem statement: due to massive burden of pediatric HIV, DOH introduced Nurse Initiated and Managed ART (NIMART) ART which requires that ART be integrated into a PHC setting. Goal: i) NIMART model is fully deployed providing integrated HIV/TA care for adolescents and children; ii) model (NIM)ART sties established that meet the highest national standard. Key Activities in partnership with DOH include: provide expert programmatic (pediatric) HIV and NIMART TA to DMT to inform strategies, evidence-based interventions and best practice and compliance with national policy; TA to DMT to ensure appropriate planning for pediatric and adolescent ART programs in district strategic and operational planning, target setting and budgeting processes; support reviews using cohort data; support HAST programs to formulate and implement work plans, targets and budgets in line with population needs, district priority areas and NDOH policy and clinical guidelines; map ART services and reported performance against estimated need, to identify service gaps and inform district HIV strategies and related work plans; undertake formative evaluation and baseline assessment of pediatric ART related activities in each district; engage community organizations in implementing communication and behavior change strategies to address stigma and discrimination; engage with stakeholders to undertake campaigns and mobilize around pediatric HIV testing and treatment; support RTC to develop pediatric (NIM)ART training plan; train IMCI, NIMART, mentorship, ART, pediatric ART, PMTCT, TB/HIV/STI, tier. Through roving mentor teams: provide supportive supervision to facility based staff and ensure continuity of training to mentorship to competency in pediatric ART related programs; mentor staff to integrate (NIM)ART, adherence, TB/HIV/STI, PICT, TB, ANC, nutrition, MCH, GBV and mental health services and implement according to policy; TA systems to fast track children; mentor doctors and nurses in pediatric ART; support NIMART certification of nurses; support family-friendly and youth-friendly clinics; identify and establish model NIMART sites for benchmarking; strengthen hospital-based ART clinics for complicated case referral; support adherence counseling and adherence improvement initiatives with target for babies, children, adolescence and guardians; TA to improve dispensing and stock control of pads drugs; promote total QI linked to treatment outcomes & cohort data; link with district specialist teams to support complicated HIV and MCH; strengthen recording, reporting and data use of HIS (Tier and DHIS) and related data management tools (e.g. clinical stationery); facilitate use of innovative SI tools to facilitate program review and decision making; undertake operational research to explore, test, document and disseminate streamlined and/or best practice pediatric ART modalities; strengthen referral and patient tracing between and within health services; support CHW to baby, child and adolescent HIV testing uptake, integrate patient tracing and adherence into PHC outreach activities. Intended outputs: # trained (100); # children (% facilities) initiating ART (4,000), by dist; # total remaining on ART, by dist. & age gr (10,000). Intended outcomes: Increased pediatric ART coverage rate, by district, Increased baseline CD4 at initiation, Increased viral load suppression rate, Improved ART patient retention rate.
Implementing Mechanism Details
Mechanism ID: 17037
Mechanism Name: Systems Strengthening for Better HIV/TB Patient Outcomes
Funding Agency: U.S. Agency for International Development
Procurement Type: Cooperative Agreement
Prime Partner Name: Wits Reproductive Health& HIV Institute
Agreement Start Date: Redacted
Agreement End Date: Redacted
TBD: No
New Mechanism: Yes
Global Fund / Multilateral Engagement: No
G2G: No
Managing Agency:
Total Funding: 12,755,474
Funding Source
Funding Amount
GHP-State
12,755,474
Sub Partner Name(s)
Africa Health Placements
Empilweni Services and Research Unit (ESRU)
Overview Narrative
The goal of the project is to improve HIV-related population outcomes by strengthening management systems at facilities, build the capacity of facility teams & management systems in coordination with the North West & Gauteng Provinces to support & integrate TB/HIV related services with overall health system strengthening as well as supporting facilities in identifying & setting up policies & programmes to improve the district’s facility response to providing HIV/TB care, treatment, laboratory & prevention services & to support transition to a sustained national comprehensive HIV/TB care & treatment programme that supports two key priorities of the government including PHC re-engineering & national health insurance. The overall strategy involves a roving team allocated to each sub-district’s PHCs & CHCs, who are managed by a sub-district manager & supported by a back-up team based in the sub-district. These teams will develop the capacity of DoH staff through targeted, on-site training & mentoring & will mentor facility staff to apply their learning from previous training interventions to improve quality of care & services. Roving teams will also provide additional training as required with follow on mentoring. To ensure that facility staff are mentored & trained effectively without disruption to services, two of the roving team will provide counselling & clinical service delivery whilst staff are trained & mentored by the rest of the WRHI team during that visit. This model will also provide additional opportunities for mentoring & training when integrated into the service delivery support. WRHI’s technical specialist team & organisational management structures based at their head office will support teams based in the district.
