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Past Country Experience

South Africa: Past Projects

Helping Expand Antiretroviral Treatment for Families and Children (Project HEART)
(CDC: 2004 -2012)
Project HEART was launched in 2004 in Côte d’Ivoire, South Africa, Tanzania, and Zambia, and in 2006 in Mozambique. This eight-year project, funded through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Centers for Disease Control and Prevention (CDC) saw dramatic results. By early 2012, more than one million men, women, and children received HIV care and support; more than 2.5 million pregnant women received HIV counseling and testing; more than 66,500 pediatric HIV infections were prevented; and more than half a million people started lifesaving antiretroviral therapy (ART). In 2010, one out of every 10 PEPFAR-supported ART patients in sub-Saharan Africa received their treatment through Project HEART.

Working with a network of more than 215 international and local partners, Project HEART dramatically improved delivery of HIV/AIDS services and ultimately strengthened national health systems by:

• Supporting HIV prevention, care, and treatment services at more than 510 ART sites and 1,053 PMTCT sites throughout five countries
• Building the clinical, managerial, financial, and administrative capacity of local health providers and partners to more effectively provide HIV services
• Strengthening program and data quality
• Improving the technological and physical infrastructure of health facilities
• Providing sub-awards to local partners and the ministries of health (MOHs) at the district and provincial/regional levels, in coordination with capacity building

Project HEART’s innovative practices – most notably using a decentralized district approach, scaling up performance-based financing, and piloting new, easy-to-use technology – have served as best practices that have been authorized and disseminated by ministries of health and other implementing partners.

Through Project HEART’s South Africa program, EGPAF supported 54 care and treatment sites and 280 PMTCT sites in 12 districts and one sub-district in five different South African provinces. The project worked closely with the South African Department of Health to implement HIV prevention, care and treatment services using an integrated approach based on improving quality of services through didactic and on-the-job training and mentoring; capacity building; infrastructure improvements; family-centered approaches to comprehensive care; community education, sensitization, and mobilization; support for the development of guidelines; and creation of an enabling policy environment at the national level.

EGPAF helped enroll more than 215,000 people into HIV care in South Africa, of whom more than 140,000 started on ART, including more than 14,000 children under the age of 15. More than 515,000 women in South Africa received PMTCT services under EGPAF support.


Call to Action Project
(USAID: 2002 - 2010)
With funding from the United States Agency for International Development (USAID), EGPAF implemented the eight‐year Call to Action (CTA) project in 12 countries, including South Africa (from 2003 through 2008). This project sought to improve access and expand care and support for quality prevention of mother-to-child transmission (PMTCT) services, while enhancing technical leadership and documenting successful program models. By project end, EGPAF had provided nearly 4 million women with access to PMTCT and antenatal care services.

Maternal Events and Pregnancy Outcomes in a Cohort of HIV-Infected Women Receiving Antiretroviral Therapy in Sub-Saharan Africa (MEP)
(CDC: 2010- 2013)
This multi-country study will be one of the first in sub-Saharan Africa to evaluate maternal and infant outcomes in women receiving ART at time of conception and during pregnancy as part of routine HIV service delivery. The primary study objectives are to describe both the frequency of severe adverse events including major congenital defects, adverse pregnancy outcomes and death among infants or fetuses born to mothers exposed to antiretroviral treatment (ART) during conception and pregnancy and these events within a section of the general population, regardless of maternal or infantile HIV‐1 infectivity status. A secondary objective of the study is to describe the distribution of major congenital defects, adverse pregnancy outcomes, and infant death by various ART regimens being used in resource‐limited countries.

The study involves the observational surveillance of a cohort of HIV-positive pregnant women that were taking combination ART before becoming pregnant in South Africa and Zambia. In each country, 300 mothers were enrolled in the cohort. Infants born to these women are examined for major congenital defects at birth or as soon as possible thereafter and until one year of age. Data on prevalence of major congenital defects and adverse pregnancy outcomes within the general population are abstracted from facility records during the same time period as data from the cohort is collected. Data collection is ongoing and the study is anticipated to finish in early 2013, once all children in the cohort have been followed to one year of age.

With the expansion of the use of ART in pregnancy both for treatment and infant prophylaxis, it is critical that the safety of these drugs in women and their infants be evaluated in the African context. Outcomes of how ART protects infants from HIV infection in the actual ART program setting will also be determined. Data from this initial pilot will provide the building blocks for further work in this area and will help in the scale‐up of pharmacovigilance activities in sub-Saharan Africa.