In 2014, FPD was awarded USAID funding to implement Communities Forward – a Comprehensive Community-Based HIV Prevention, Counselling and Testing Programme for Reduced HIV Incidence. FPD is the prime recipient with Society for Family Health (SFH) and Humana People to People South Africa (HPPSA) contracted as sub recipients. The goal of this five-year grant is to expand and strengthen high quality Community-Based HIV Counselling and Testing (CBCT) models supported with effective and sustainable linkage and referral systems. The aim of the grant is to increase knowledge of HIV status, as well as access to appropriate and effective HIV and TB prevention, care and treatment services in high incident communities and key populations in South Africa. This programme is being implemented in thirteen districts of six provinces and endeavours to provide combination prevention strategies and test 1.2 million people for HIV.
FPD implements CB-HTS through four donors. Through these funding sources, FPD expanded CB-HTS to cover a total of twenty districts and six provinces.
The overarching goal of FPD’s Comprehensive Health Systems Strengthening (HSS) program is to improve district performance to reach 90-90-90 HIV and TB targets and contribute to HIV and TB epidemic control. To achieve this goal, FPD has aligned to the 90-90-90 strategy as defined by UNAIDS and endorsed by PEPFAR and the South African National Department of Health.: 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral treatment; and 90% of all people receiving antiretroviral treatment will have viral suppression.
The Comprehensive HSS program is implemented by means of a Technical Assistance (TA) package comprising of training, mentoring and quality assurance (QA), targeted HSS interventions and expert technical advice, and HIV program-focussed, time-limited direct service delivery (DSD) at high volume/high yield sites. By implementing strategic and evidence-based, combination interventions at community, health facility and District level, FPD aims to strengthen District Health Systems (DHS) performance and build district capacity to identify, initiate, retain and maintain People Living with HIV (PLHIV) on lifelong treatment. By improving linkages and program planning between donor and South African Government (SAG)-funded prevention, treatment and retention, Key Population (KP) and Orphans, Vulnerable Children and Youth (OVCY) programs at the community, health facility and district levels, FPD supports the SAG to coordinate and optimally combine evidence-based HIV and TB prevention and treatment interventions to maximize population-level impact.
Comprehensive HSS is implemented in four of PEPFAR’s focus districts, Buffalo City Metro (Eastern Cape), Capricorn (Limpopo), Nkangala (Mpumalanga) and Tshwane (Gauteng) with the following objectives:
1. To improve HIV-Related patient outcomes by strengthening health and patient management systems at facility, Sub-district and District Levels;
2. To build the capacity of district management teams and management systems in coordination with the respective provinces to support HIV/TB-related services and overall health system strengthening
3. To provide support to the district and/or sub-district to identify and implement policies and programs that guide facilities’ response to providing HIV/TB care, treatment and prevention services 4. To support transition to a sustainable national comprehensive HIV/TB care and treatment program that supports two key priorities of the SAG: Primary Health Care Re-engineering and National Health Insurance
Technical assistance to improve strategic information focuses on strengthening data management systems, namely the SAG Tier.net, DHIS, and etr.net, implementation of the District Health Management Information System (DHMIS) policy and the use of quality epidemiological and programme information to inform planning, policy, and decisionmaking. It is a cross-cutting Department that provide focused technical assistance internally to FPD programs and initiatives, DOH and NGOs to ensure appropriate M&E is linked to all major activities.
Ensure compliance with programme strategy, stated goals and objectives, and key deliverables through appropriate data use:
1. Monitor achievements towards district and programmatic targets on a monthly and quarterly basis to ensure that programme goals and objectives are being met via implementation of planned activities.
2. Standardize and define data use forums, structures, tools and intended outcomes.
3. Use information collected feedback on progress of implementation and results achieved, to identify and rectify early indicators of problems and to ensure programme appropriateness, effectiveness and efficiency.
4. Ensure responsiveness to programme stakeholders by collecting, processing and providing valid, reliable and timely information, to assess whether the benefits are resulting in systems changes and measurable improvements in health outcomes
5. Assess whether the interventions are contributing to achievement of the defined strategic objectives.
6. Ensure availability of data to document the baseline and changes in terms of programme strategy areas that can be directly and indirectly attributed to FPD’s technical assistance contribution and its health systems strengthening approach. Strengthen the quality of program M&E data collected in order to improve the quality of health services provided and the use of data for decision making
Provide technical assistance based on the results of needs assessments and requests in the following areas:
1. Support the development, implementation and revision of M&E tools to monitor and evaluate progress against FPD (including PEPFAR) and Department of Health priority programmes and projects;
2. Audit existing M&E tools and systems to streamline and synchronise M&E data collection and collation processes;
3. Develop and implement strategic information tools to assist with the effective and efficient use of information from facility up to headquarters level;
4. Strengthen and use existing governmental data management systems to enhance monitoring of service provision and to streamline data collection, dissemination and use;
5. Routinely assess quality of reported data and the collection process and provide tailored feedback to FPD and DOH structures at facility, district and headquarters levels; Monitoring, Evaluation and Reporting Plan 12
6. Support data analysis, presentation and use of routinely collected data to support decision-making, program planning and data use for health systems management improvement in FPD and DOH performance management structures;
7. Implement program evaluations (through formal evaluation methods and action research) as needed to assess program effectiveness, results achieved
8. Provide routine mentoring/training to facility and district counterparts to ensure that data collected, collated and reported into the district health information system (HIS) is valid, reliable, accurate, precise, timely and full of integrity
Within TASI is the Compass Project, a mapping and data dissemination project that aims to:
The Compass Project was launched to ascertain the following in order to effectively address HIV needs in South Africa:
FPD’s Research Unit (RU) was established in 2014, and is tasked with applying scientific and epidemiologic methods to study, advance, and inform public health programmes and policy development. The Research Unit focuses on the following research areas:
1) Prevention of Mother-To-Child Transmission of HIV and STIs (PMTCT)
2) HIV prevention in adolescents
3) TB case finding and the TB continuum of care
4) Non-communicable diseases (NCD) and health conditions associated with communicable diseases (e.g., HIV, HPV)
5) Mental health
6) Interpersonal and gender-based violence FPD recently received significant funding from the U.S. NIH and USAID to investigate:
1) STIs in HIV positive pregnant women and their impact on MTCT of HIV
2) Home-based TB case finding and testing using the new GeneXpert Omni instrument
3) The FHI360 study evaluating an intervention integrating economic strengthening and HIV prevention programs for vulnerable youth
Our strategic goals are to:
· Develop and conduct rigorous scientific and epidemiologic research
· Advance evidence-based policy recommendations
· Develop local, regional and international partnerships that bring expertise to bear on issues of South African public health importance
· Cultivate current and next generation public health researchers and epidemiologists through training and mentorship
· Contribute to the global body of scientific knowledge that directly informs public health programs and policy
The study aims to determine the acceptability and feasibility of using point-of-care technology (GeneXpert OMNI) to perform home-based TB testing of household contacts of TB patients and to describe the outcomes of household contacts screened and tested for TB in their home compared to those screened and referred for testing in a health facility. This study will recruit TB index patients from the 6 health facilities that serve the Duncan Village Informal Settlement Area (DVIS) in Buffalo City Metro Health District (BCM), Eastern Cape Province, South Africa, and TB screening and testing will be performed at households of TB patients.The findings from this project may represent a new strategy for increasing TB case finding and improving LTC for the 3 million missed cases of TB annually. Furthermore, early detection of TB disease, with improved LTC rates, may reduce TB transmission and prevalence in high-burden settings. Findings from this exploratory research could lay the foundation for multi-year research projects to establish the effectiveness of home-based TB testing on reducing TB morbidity and mortality.
In the low and medium income countries, over half the women have inadequate menstrual hygiene management.Poor menstrual hygiene management impacts on important social, reproductive and mental health challenges that require adequate attention among adolescents.There is limited rigorous research on school attendance and performance as a result of menstrual hygiene challenges faced by adolescent girls. Although up to 1 in 10 South African girls drop out of the school system before Grade 12 and the trend being more evident after the thirteenth birthday, which coincide with the menarche period, no empirical evidence exist to suggest a link between menstrual hygiene management challenges and school performance including absenteeism and drop out. More health problems still need to be unpacked in relation to psychological and reproductive health challenges facing adolescent girls in resource limited communities. The study aims to investigate menstrual hygiene management (MHM) knowledge and practices in relation to school performance and socio-health outcomes among adolescent girls in secondary schools in two provinces, South Africa. We hypothesise that there is a relationship between MHM and missing school among adolescent girls. Our proposed project has the following four Specific Aims:
1. To conduct an exploratory qualitative research to identify MHM practices and challenges in the study communities
2. To assess the knowledge and practices of MHM by school girls
3. To assess the impact of MHM on girls’ school outcomes
4. To assess the psychological and reproductive health aspects related to girls’ MHM
5. To estimate the average economic cost of managing a menstrual cycle by adolescent girls
At the request of the Prevention and Orphans and Vulnerable Children (OVC) Team of the Health Development Office of USAID South Africa, FHI 360’s Accelerating Strategies for Practical Innovation & Research in Economic Strengthening (ASPIRES) project1 is carrying out a 4-year, $10 million program to improve the long-term economic security and HIV prevention knowledge and skills of at-risk youth in South Africa. ASPIRES will do so through the application of integrated combinations of evidence-based, gender-sensitive economic strengthening (ES) and HIV prevention education interventions, carried out in close collaboration with five PEPFAR Implementing Partners (IPs), including FPD, who support or implement programs to assist OVC and their caregivers in South Africa. To build the evidence base around the efficacy of such interventions, ASPIRES will carry out rigorous qualitative and quantitative research.
Central to the project’s research efforts is a study to assess whether the integration of an ES program with an HIV-prevention education program produces synergistic effects on economic and health outcomes. HIV prevention education has been shown to educate and build skills, which leads to safer sex practices and lower rates of sexually-transmitted infections (STIs), HIV, and unintended pregnancies. Economic strengthening interventions, such as financial education and savings, can reduce economic vulnerability and risk behaviors. This study seeks to identify if the combination of these two types of interventions leads to greater results than each intervention might have alone.