NU2GGH002393

Improving Mental Health and HIV/TB Service Integration (IMHSI) in South Africa under the President's Emergency Plan for AIDS Relief (PEPFAR)

A. Purpose:
The purpose of the application is to introduce data-driven, evidence-based approaches to address HIV/TB program implementation gaps. The goals are to improve access, retention, and adherence to effective HIV services, decrease stigma/discrimination for people living with HIV (PLHIV) affected by common mental health (MH) disorders (anxiety, depression), complex MH disorders (neurotic and psychotic disorders), and harmful substance use including alcohol abuse. Additionally, the aim is to decrease healthcare worker (HCW) stress, anxiety, and burnout to increase the quality of HIV/TB services in South Africa (SA).

B. Outcomes:
By the end of the project, the expected outcomes are a decrease in morbidity and mortality of PLHIV affected by MH issues and an increase in the wellbeing of HCWs facing stressful working conditions. The short-term (SOS) and intermediate outcomes (IOS) include:

Strategic 1: Policies/Guidelines/SOPs:
- SOS 1: Strengthened MH activities within the National Department of Health (NDOH) primary healthcare (PHC) policies and guidelines
- IOS 1: Enhanced access to quality MH services for PLHIV affected by MH disorders
- SOS 2: Strengthened policies, guidelines, and standard operating procedures (SOPs) for HCWs suffering from unhealthy stress, anxiety, and burnout
- IOS 2: Improved access to MH services for HCWs suffering from unhealthy stress, anxiety, and burnout

Strategic 2: Capacity Building:
- SOS 3: Improved MH training of PHC providers
- SOS 4: Improved mentoring of PHC providers and community health workers (CHWs) on MH needs of PLHIV
- SOS 5: Improved competency of district support partners (DSPs) to support the delivery of quality MH services at PHC facilities
- IOS 3: Improved empathy of HCWs on MH needs of PLHIV
- IOS 4: Improved retention in HIV care of PLHIV with MH disorders
- IOS 5: Improved HIV viral load suppression of PLHIV with MH issues

Strategic 3: Referral Networks:
- SOS 6: Increased access to appropriate levels of MH services for PLHIV
- IOS 6: Enhanced access to MH specialty care for PLHIV with complex MH issues
- SOS 7: Increased access to appropriate levels of MH services for HCWs experiencing stress, anxiety, and burnout
- IOS 7: Decrease in absenteeism of HCWs providing HIV services

Strategic 4: Stakeholder Engagement:
- SOS 8: Increased community awareness of common MH disorders, their health impact, and available MH services
- IOS 8: Decreased stigma and discrimination against PLHIV with MH issues
- SOS 9: Increased meaningful involvement of key stakeholders in the development, implementation, monitoring, and improvement of MH activities at the PHC setting
- IOS 9: Increased community awareness of MH services available to PLHIV
- IOS 10: Accelerated buy-in of key stakeholders in support of the implementation of South African Government (SAG) MH activities

C. Consortium Capacity:
The consortium includes three leading indigenous South African organizations supported by Columbia University Department of Psychiatry, a leader in global mental health. FPD (Prime Recipient) is a leading health educator with extensive PEPFAR implementation experience, reaching 480,000 students. FPD and Vula Mobile are implementing a SAG-supported MH service improvement project focused on training PHC HCWs linked to improving referrals. Heartlines is a leader in behavioral communication and community engagement. Consortium members have excellent relations with the SAG, serve on national advisory structures, and are acknowledged SAG partners for piloting innovation and reform.

D. Strategic Approach:
Our approach is based on an in-depth understanding of the challenges and opportunities for integrating MH care within the HIV/TB treatment environment. We have extensive data analytical ability, allowing district-specific situation analysis of performance gaps. We will leverage existing relationships with the SAG at all levels to fast-track start-up. Our interventions are designed to ensure coordination and prevent duplication of efforts by the SAG, PEPFAR, and other funded implementing partners, UN agencies, and civil society organizations. Additionally, our interventions are flexible and adaptable to policy reforms and are based on evidence-based practices.

Foundation For Professional Development (Pty)

NOT APPLICABLE

93.283 - Centers for Disease Control and Prevention Investigations and Technical Assistance

CDC Office of Financial Resources (OFR) [HHS - CDC]

Center for Global Health (CGH) [HHS - CDC]

South Africa

Foreign

Improving Mental Health and HIV/TB Service Integration (IMHSI) in South Africa under the President's Emergency Plan for AIDS Relief (PEPFAR) (CDC-RFA-GH21-2124)

Amendment Since initial award the total obligations have increased 703% from $650,000 to $5,222,500.