South Africa - FY 2009 Approved Funding by Program Area, Agency and Funding Source
*Only appropriations from the GHCS (State) fund account are notified by the Global AIDS Coordinator.
With over 500,000 persons supported on ART through PEPFAR programming in FY 2008, PEPFAR programs will build on the achievements of the last five years of supporting the largest ART program in the world. The USG will develop human capacity (especially at primary healthcare level), strengthen integration of HIV care and treatment into primary health care, build capacity for nurse-initiated ART, improve pediatric HIV care and treatment, and encourage early identification of those in need of HIV care and treatment services through provider-initiated CT and improved linkages to CT services. Partners will also ensure CD4 testing for those that test positive for HIV, integrate TB care for HIV-infected clients (including screening and treatment), continue to strengthen the integration of treatment programs within other health interventions (e.g., PMTCT, cervical cancer screening and reproductive health), and reduce loss to initiation of treatment of people that test positive for HIV and loss-to-follow-up once on ART.
The USG will support primary prevention activities with special emphasis on normative change and responsible sexual behavior including abstinence and being faithful, focus on sexually active adolescents and adults through increasing risk perception to reduce multiple and concurrent partners and intergenerational sex among young women, as well as increase focus on correct and consistent condom use. Media activities will be complemented by expanded community outreach to adult populations, especially men, and grassroots social mobilization to shape new community norms of responsible sexual behavior. In addition, new workplace programs will target small and medium enterprises and selected government departments. Prevention programs will continue to be integrated with PMTCT, as well as care and treatment programs. The USG will support the South African Government (SAG) in developing a national HIV prevention implementation strategy and accelerating the scale-up of prevention. In response to the 2010 Soccer World Cup to be held in South Africa, the USG will develop and implement targeted prevention media campaigns and prevention interventions. The role of alcohol and substance abuse in risky behaviors will be integrated into all prevention education. The USG will continue and reinforce work with most-at-risk populations with an emphasis on formal and informal sex workers, men who have sex with men, and migrant and mobile populations. Post-exposure prophylaxis (PEP) services and training on sexual assault will be expanded through a comprehensive training program aimed at healthcare workers and the judicial service to ensure better implementation of PEP services throughout the country.
The PEPFAR PMTCT program will work with the SAG on implementing the 2008 National PMTCT policy of dual therapy by increasing training and re-training for healthcare workers, implementing and rolling out the new PMTCT policy and guidelines, building capacity for early infant diagnosis, and follow-up of mother-baby pairs post delivery by improving linkages between PMTCT service points. In addition, the PMTCT program will address other programmatic gaps in service delivery, including ongoing support and supervision for health-care providers and community healthcare workers, the promotion of the routine offering of CT, quality improvement, management and prevention of associated infections, and scale-up of early infant diagnosis services. Furthermore, activities will include addressing cultural attitudes to infant feeding, male involvement in PMTCT, and increased uptake of services.
In the arena of CT, USG programs will support the SAG in their efforts to update policy, guidelines, training, and mentoring to increase the demand for and the availability of quality CT services that are primarily conducted in government facilities. All USG CT activities are linked to clinical care, support, and treatment activities in order to ensure that individuals who test positive for HIV have access to needed services. USG programs use several different models to achieve the best results including mobile CT programs targeting high-risk populations, underserved communities, and men, as well as stand-alone and traditional VCT services, home-based CT in rural areas where services are not easily accessible, couple HIV counseling and testing, and workplace CT services. PEPFAR will also support and strengthen the integration of the basic care package and family-centered services across all care and treatment programs for adults and children living with HIV, increase the number of trained healthcare providers, build multidisciplinary teams to deliver quality care with symptom control, and improve human resource strategies. PEPFAR partners will also ensure active referral systems between community home-based caregivers and facility services.
PEPFAR activities will improve surveillance of TB/HIV and Multi-Drug Resistant TB (MDR-TB), provide training and technical assistance for staff working in integrated TB/HIV programs, increase access to TB/HIV services, and ensure effective referral linkages between TB and HIV services as well as between these services and community and home-based care. The USG program will provide intensified TB case finding in HIV services and referrals to TB programs for diagnosis and treatment as well as routinely offered HIV counseling, testing, and referral in TB clinics. USG partners will work to improve infection control policies and systems in hospitals and clinics, scale up timely quality assured laboratory services for TB/HIV and rapid diagnostics for TB and MDR-TB to improve early detection and management of persons suspected with MDR- or Extensively Drug Resistant (XDR-) TB.
USG care and support of OVC encompass the entire care and support continuum, including psychosocial and nutritional support, maximizing OVC access to SAG benefits, and strengthening OVC support through referrals for health care, support groups, and training. Working with the SAG, USG will document the effects and effectiveness of two models of care and support for OVC that the SAG would like to scale up and replicate. In collaboration with the SAG, the USG will support the development of a vulnerable children service directory and web database that will increase comprehensive services coverage for vulnerable children and guide strategic expanded or new service sites for OVC. In FY 2009, the USG will develop innovative gender and child participation interventions, provide technical skills and training in gender integration to enable the partners to integrate gender into all their programs, and support training to measure and ensure progress and quality monitoring and evaluation.
During FY 2009, PEPFAR will support the National Institute for Communicable Diseases (NICD) and the National Health Laboratory Service (NHLS) to improve the quality of HIV diagnostic tests and expand access to HIV, CD4, and TB testing nationally. PEPFAR programs will assist the SAG in training staff in 4,000 CT sites on proper HIV testing procedures and quality management systems and training South African epidemiologists and laboratory workers.
In FY 2009, PEPFAR will also support the government's efforts in meeting the demand for ARV drugs. PEPFAR will provide $60 million in both FY 2009 and FY 2010 (subject to the availability of funds), for a total of $120 million. This funding is not considered to be a part of the regularly programmed South Africa country budget and is described in the Technical Leadership and Support section of this document (see Section V).
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