2. CDC Projects

CDC Projects

HARMless PWID program

The PWID harm reduction program, known as the HARMLess program, provided comprehensive services to more than 3200 unique PWID across the two districts. One thousand five hundred and sixteen (1516) clients were tested for HIV during COP20. Six hundred and seventy-five (44.5%) of these clients tested positive for HIV and 530 (78.5%) of these were initiated on Anti-Retroviral Treatment (ART). Three hundred and fifty-eight (358) clients were initiated on PrEP during COP20. The HARMLess program distributed 931000 clean needles and syringes to its PWID clients and 958000 were returned at an NSP return rate of 102%. This was possibly due to clients returning needles that were procured elsewhere.

During COP20, FPD introduced innovative modalities to the PWID program to improve retention rates and viral load suppression. These included employing peer linkage tracers, starting ART and PrEP Adherence clubs and implementing a viral load campaign. PWID clients were offered incentives when reporting for Viral load testing and were rewarded when found virally suppressed.

FPD collaborated with Jive media to produce a second set of twelve comic strips which is used as information, education, and communication (IEC) material for PWID clients enrolled on the comprehensive harm reduction program in Tshwane and Ehlanzeni.

Collaboration with Mainline International, resulted in the official launch of the publication: Reducing harms in the work environment-Recommendations for employing and managing peers in harm reduction programmes in South Africa[1][1]The online launch was attended by local and international participants engaged in PWID program implementation. During the second half of COP20, Mainline international also supported development and implementation of an online course based on said publication. Mainline, commissioned by FPD, implemented survey on Women who Use Drugs (WWUD), identified gaps in service delivery and made recommendations based on peer involvement. Finalization of the document named Sisters Spaces: Needs, challenges, and services for women who use drugs in South Africa, is expected in November 2021.

STIR MSM Program

FPD and CareWorks collaborated to provide MSM program implementation. This included direct service delivery (through community service organizations (CSOs) in 4 districts), national social media mobilization (through Facebook, Twitter, Instagram, Grindr and the STIR website (www.stirprogramme.co.za/home)), case management and e-pharmacy services.

The STIR (Seek, Test, Initiate and Retain) MSM program was implemented through community service organizations in Dr Kenneth Kaunda and Ngaka Modiri Molema districts (North West Province), Sedibeng district (Gauteng) and Nkangala district (Mpumalanga). STIR program COP20 performance was satisfactory, despite COVID restrictions, with the program reaching 3641 unique MSM during that period, testing 2383 of these clients, finding 326 (13.7%) positive clients and initiating 274 (84%) of these on ART. Eight hundred and eight of the negative clients were initiated on PrEP during the same period. A client satisfaction survey showed 99.1% satisfaction index among respondents.

FPD created a highly successful social marketing and mobilization plan, with 19.1 million reached via Facebook, 1.2 million reached on Twitter and close to 77 000 via Instagram. One thousand four hundred and thirty-three unique users visited the website. FPD followed a peer led process to develop MSM IEC material, which resulted in creation of pamphlets, posters, a video and numerous social media posts, directed at hard to reach/hidden MSM with a call to action and increased health seeking behaviour, based on self-risk rating tool that was available on the STIR website.

The first of its kind, highly successful Key Population (MSM and Transgender) e-pharmacy service, implemented by FPD’s Sub-grantee, CareWorks, distributed 10058 HIV self-screening test kits. The call centre received 879 PrEP related calls and screened 878 people for PrEP eligibility. Through the call centre, 208 people were initiated on PrEP, and 20 (who were confirmed HIV positive) were initiated on ART.

Above site PrEP support to NDOH

FPD was appointed by CDC and USAID for the procurement and supply of PrEP to PEPFAR partner sites on a national basis. Approval was received from NDoH to procure against state tender contract prices and distribute to registered facilities in South Africa for collection and distribution by the PrEP partner sites.

The Above Site PrEP program was able to process 130 orders for the supply of 394,111 packs of PrEP to 79 CDC/USAID partner sites to the value of R24.6m during the reporting year.

FPD cancelled its agreement with Imperial Health Sciences and contracted Kawari Wholesalers (Pty) Ltd in Sep 2020 to store and distribute PrEP on behalf of FPD to all the partners sites via the government facilities. This contract was extended until Mar 2022.

Following approval of COP20 carry over funds, the FPD team procured an additional 106,848 packs of PrEP from Macleods and 45,792 from Mylan during Aug 2021 to bring the total number of PrEP in stock at the end of Sep ’21 to 278,919. This stock was earmarked as safety stock by the donors which will only be distributed to Correctional Services sites, but also to government sites should the government supply chain through the provincial depots fail to provide to facilities’ demand.

The FPD pharmacist and post-basic pharmacist assistant conducted 134 on-site support visits to partners to monitor compliance with Good Pharmacy Practice and to provide technical advice on demand planning and forecasting to ensure sufficient stock available but to prevent any short-dated stock.

Above site Support: High Transmission Area Program

FPD provided technical assistance and support to strengthen the National Department of Health's High Transmission Area (HTA) program. During COP20, the second year of support, the renamed Key Population Implementation Plan (KP-HIP) Guideline document was refined to include Standard Operating Procedures (SOP’s) and job descriptions for peer educators in healthcare facilities. In response to the COVID restrictions, FPD changed the existing I-Tech Key Population Sensitization Competency Development training toolkit to an e-learning course. FPD provided training to 1899 government employees through both face to face and online mediums. FPD supported the development of KP-HIP related monitoring and evolution plan. A national stakeholder engagement meeting brought together national and provincial managers and HTA coordinators and implementing partners during June 2021, during which vital inputs was gathered to improve the draft KP-HIP. Thereafter several provincial based engagements followed in support of creating key population centers of excellence in 5 priority provinces- Gauteng, Mpumalanga, North West and Eastern Cape.

Advanced Clinical Care:

The Foundation for Professional Development (FPD) and Wits RHI were jointly mandated to deliver HIV advanced clinical care (ACC) master training for trainers (ToT) at national level, during a structured five-day face-to-face contact session. ACC master trainers who successfully completed all curricular modules and passed all summative assessments would thereafter cascade further ACC training across all districts in South Africa. However, the global COVID-19 pandemic has caused major disruptions to planned activities, including the execution of training. An e-learning approach therefore had to be followed to deliver the ACC master training in staggered sub-modular format.

The ACC master training was delivered through Nation Department of Health’s (NDoH) Knowledge Hub, which is a virtual, online training platform. Although the FPD Classroom was envisaged to be the primary online training platform, FPD pivoted to the NDoH Knowledge Hub to host the ACC Master Training. FPD collaborated closely with Aurum, the prime CDC-recipient for Knowledge Hub support, as well as their sub-awardee, Neil Butcher & Associates, during COP19.

To ensure maximum facilitator-participant interaction, real time facilitation sessions were delivered on consecutive afternoons. The pre-agreed collaboration between FPD, Wits RHI and CHAI remained applicable, with FPD and Wits RHI equitably assigning their respective facilitators to lead each module. The master training was fully CPD accredited and all medical practitioners who completed the training and passed all assessments were awarded 30 clinical CPD points. FPD provided data bundles to NDoH participants as well as tablet devices, seconded to various regional training sessions, to enable seamless access, for the duration of the master training.

The NDoH Knowledge Hub makes use of Zoom to facilitate maximum online interaction between participants, through both audio and text functions, and allows for recordings of each session. Recordings of each module can be accessed online on the NDoH Knowledge Hub after completion of the training for participants to revise and revisit sessions. The repository of recorded facilitation sessions furthermore enables future online self-study for additional cohorts of master trainers as well as sustainability of ACC capacity development.

Due to pivoting from in-person sessions to an online approach, FPD was able to accommodate additional delegates. The original target was 96 delegates, 64 NDoH delegates and 32 DSP. The result was that the 1st enrolment had 93 NDoH delegates and 31 DSP delegates respectively. Further cohorts of master trainers in COP20 resulted in 1944 healthcare providers certified as master trainers. Regional Training Center Managers attended the ACC master training to familiarize themselves with the curricular contents and to draft cascaded training plans for the respective master trainers, after completion of the ToT. Master trainers further cascaded training to 546 health care workers. FPD arranged CPD certification for master and cascaded training, Hosted 6 webinars attended by 440 people and provided ACC M&E training to DSP staff during 3 courses.

Referral pathway mapping was completed. This allows for the monitoring of ACC in terms of location, proximity, staff distribution and patient volumes. ACC services may have both receiving and referring sites, However, rather than centralising services to a physical location, the ACC approach includes capacitation and building networks of healthcare workers who see patients daily for them to be able to identify, refer and manage ACC patients depending on their skillset and available resources. Furthermore, referral pathway mapping fully supports COVID-19 home testing and screening Program, and cases requiring hospital admission, by tapping into the knowledge base of existing referral networks and local expertise

Zenzele Adherence communication program

2021 Saw the third revitalization of the Zenzele adherence communication program. FPD was requested to support NDOH with Undetectable = Untransmittable (U=U) IEC material. FPD responded by updating the Zenzele website and adding a pamphlet and video. This was further supported by a highly successful radio and social media campaign implemented during September 2021, with an estimated reach of 14 million. Cumulative reach on Facebook was close to 60 million, on Twitter was 1.4 million and the website had 5759 unique visitors.