HIV Combination Prevention Programme
Unfinished Business Initiative in KwaZulu-Natal – ELMA
This proposed investment aims to address the unfinished business of paediatric and adolescent HIV in KwaZulu-Natal by using a quality improvement strategy to accelerate the identification and enrollment of HIV positive children and adolescents on treatment, and ensuring that clinical and community care and linkages is improved so that they are retained in care. This is a unique opportunity to build on the momentum created by the national commitment to reach 90% ART coverage, and prevent new HIV infections in adolescent girls and young women.
Led by the KwaZulu-Natal Department of Health (KZNDOH) as a provincial initiative, the proposed cluster of grants will accelerate access to ART in the high-burden, eThekwini, uMgungundlovu, Zululand and uMkhanyakude districts. The KZNDOH seeks rapid gains through a strategic surge of support targeting high-volume health facilities and community hotspots and by building the capacity of health workers and community partners. By targeting the same districts receiving PEPFAR and Global Fund investment for HIV prevention, ELMA support will help ensure linkage to care and treatment services for HIV-positive children and adolescents, specifically adolescent girls.
Goal: This initiative will aim to find an additional 38,000 HIV positive children and an estimated 11,000 adolescents, and enroll those eligible on ART, to achieve the 90-90-90 goals by 2018, ahead of schedule. If targets are met by the end of the grant, 17% of the national gap between children and adolescent eligible for ART but not yet on treatment will be closed.
This is a collaborative of nine partners led by Zoë-Life, whose KidzAlive model is the National Department of Health (NDOH) paediatric HIV strategy for child case finding and adherence through targeting the children of adult HIV/TB clients, and orphaned and other vulnerable children. Zoë-Life will capacitate and support facility and community-based partners and health workers to rollout KidzAlive, lead the quality improvement approach, and provide overall program coordination.
The two district support partners, MatCH and Health Systems Trust, will leverage their comprehensive HIV and TB support in targeted facilities, to improve testing uptake, case finding and paediatric and adolescent ART. CHIVA will work with MatCH to provide targeted support to high-volume sites to improve adolescent treatment and care services. The three community partners – NACOSA, AFSA and NACCW – will support community-based organizations (CBOs) implementing orphans and vulnerable children programs, to increase testing, case finding, linkage and adherence support.
Prevention Services: Provide TA and/or DSD to scale-up and strengthen the delivery of quality HIV and TB/HIV prevention services within community sites – MatCH
Goal: The aim of this initiative is to support the RSA in achieving the UNAIDS 90-90-90 goals for HIV control, and the STOP TB 90-90-90 goals (proposed) for TB control; and improved efficiency and effectiveness of TA and direct service delivery (DSD) for general and priority populations within the districts of eThekwini, UMgungundlovu and Harry Gwala in
- To increase access, coverage and uptake of HIV testing services and strengthen linkages to treatment and care in high burden communities;
- To enhance protective parenting practices that are associated with reduced sexual risk among adolescents and promote parent-child communication about sexuality and sexual risk reduction;
- To improve sexual health through building stronger, more gender-equitable relationships with better communication between partners;
- To expand condom supply and accessibility through facilitating alternative channels of distribution.
- Implement evidence based behavioural interventions, for example: Stepping Stones, FMP and reduce GBV to motivate behavioural change in individuals, couples, families, peers groups or networks, institutions, and entire communities and structural prevention activities;
- Provide HIV counselling and testing and TB screening in non-health care environments and at mobile clinic service points and ensuring the realignment of activities to ensure that “hot spots” (areas of high transmission) are covered with sufficient intensity of quality interventions within the community and facilitate linkages to prevention; treatment and care (access to condoms, VMMC, TB and PEP, PMTCT, treatment, care and support).
DREAMS is a global partnership between PEPFAR, the Bill & Melinda Gates Foundation and Girl Effect that seeks to reduce new HIV infections among adolescent girls and young women in 10 sub-Saharan African countries by addressing the structural drivers that directly and indirectly increase girls’ HIV risk.
Goal: Help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women. In South Africa, DREAMS will expand and intensify prevention interventions for AGYW in 5 high burden districts, leveraging PEPFAR clinical/PMTCT and community/OVC platforms to support this effort. It aims to reduce new HIV infections in 15-24 year old adolescent girls and young women by 25% by the end of 2016, and 40% by the end of 2017.
15-24 YEAR OLD GIRLS &
YOUNG WOMEN IN 2016
15-24 YEAR OLD GIRLS &
YOUNG WOMEN IN 2017
Objectives: Improve the lives of adolescent girls and young women leading to decreased risk for HIV, increasing secondary school enrollment, attendance and completion, decreasing violence and unintended pregnancy.
The AIDS Foundation of South Africa has been identified as one of the DREAMS implementing partners in KwaZulu-Natal, and will cover the districts of EThekwini (South region), UMgungundlovu (Umngeni, Umshwathi, Umsunduzi, Umkhambathini, Mooi-Mpofana and Richmond) and UMkhanyakude (Hlabisa & Mtubatuba).
AFSA is delivering on the three DREAMS core packages, empowering girls and young women (condom promotion and provision – male and female – and HTS); mobilize communities (school-based HIV and violence prevention and community mobilization); Stepping Stones Programme; norms change (Parenting/Caregiver Programs); and Families Matter! Programme.
Social Mobilisation Programme
Over the period of three years, the project will target the priority population which is young people between ages 15 and 35 (female and male) in KwaZulu-Natal (Harry Gwala District, Umgungundlovu District, Ethekwini Metro, uMzinyathi District, ILembe District and Amajuba District, and King Cetshwayo District). The survey found significant differences in HIV prevalence between people who lived in urban informal areas and those living in the other three locality types. Rural informal area residents have a significantly higher HIV prevalence than do urban formal area residents. Although the epidemic in South Africa is generalised, there are specific groups with HIV prevalence above the national average. These are classified as priority populations with higher risk of HIV exposure and require targeted interventions.
The project will target the following groups:
- Young women and girls;
- Young men;
- Vulnerable populations residing and/or working in ‘hot spots’;
- Infants and children of HIV positive parent/s.
Activity 1: Mobilise young people for Increased Uptake of Community Based
HIV Testing Services
AFSA has been contracted to conduct community based testing in eThekwini; uMgungundlovu; & Harry Gwala through the MatCH grant and TVET colleges Ethekwini, Zululand and King Cetshwayo through the Global Fund grant. To increase reach and uptake, ‘demand generation’ is necessary to create awareness about the importance and benefits of HTS and how and where community based HTS can be accessed including the points of different services beyond HTS (Linkages). Therefore social mobilisation and awareness are demand-side interventions that improve risk perception and awareness and acceptability of prevention approaches, allowing the interventions to reach more individuals to test and know their status, especially hard-to-reach and underserved individuals and populations.
Activity 2: Mobilise men and boys for Increased Uptake of Community Based
HIV Testing Services
The project will mobilise and activate 18,000 men and boys to play a positive role in fighting gender based violence and HIV in communities. AFSA will implement the Men Championing Change (MCC) Model. Men and boys will be engaged through community dialogues, open days and workshops. Themes covered will be substance abuse, human rights, women rights, gender equality, gender based violence and sexual reproductive health rights. MCC will be driven by a cadre of 32 young men and women employed from communities as community and family motivators. Their role will be to mobilise men and boys, and conduct community dialogues and workshops in communities in the targeted districts.
Recreational activities such as sports, traditional dance and music, talent shows, and traditional stick fighting will be used to mobilise the interest and attention of boys and men. Due to the nature of the social mobilisation methods and the target group, this activity will be implemented throughout the week including weekends. Also, the project will work very closely with traditional structures, partly to influence them, but also to ensure that the project messages are sustained in communities. Further, as part of the MCC interventions, men and boys will be encouraged to go for HIV Testing as a direct response to the first 90. Men and boys will be linked to the HTS team and local clinics for treatment as a direct response to the second 90.