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Partnership with U.S Centers for Disease Control and Prevention

​The Health Systems Trust continues long-standing partnership with the U.S. Centers for Disease Control and Prevention in the fight against HIV and TB in South Africa

The Health Systems Trust (HST) is pleased to announce that its flagship project entitled ‘Programmatic Implementation for HIV/AIDS and TB Prevention, Care, and Treatment Services’ (SA SURE) has been awarded a third five-year grant under the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR) programme for ‘Sustaining HIV/TB Epidemic Control in South Africa.’

“HST has grown to be one of the highest-performing and largest District Support Partner (DSP) funded by the U.S. Centers for Disease Control and Prevention (CDC),” says Chief Executive Officer, Dr Themba Moeti. “The SA SURE project focuses on the provincial, district, facility and community levels of the health system to support Department of Health (DoH) facilities in four PEPFAR focus districts in KwaZulu-Natal (KZN) province: eThekwini, uMgungundlovu, uThukela, and Zululand.”

The key areas for HST’s support in all four districts are: HIV and TB care and treatment; TB prevention; integrated services; provision of Advanced Clinical Care; strengthened treatment adherence counselling; improved paediatric HIV prevention and treatment; improving health systems through the clinic−lab interface and use of eLABS; patient management systems for quality health services; and the implementation of CCMDD/Dablapmeds (Central Chronic Medicine Dispensing and Distribution). HST currently supports 459 456 patients in differentiated care. 

Programme Manager Joslyn Walker describes the SA SURE project’s core provision of a strategic mix of community- and facility-based services: “Community-based services entail strategic partnerships with community structures − such as War Rooms and clinic committees − to strengthen entry and mobilisation for delivery of our HIV testing, treatment and care services, and providing access to chronic medicine through CCMDD, with support to all external pick-up points.”

“The Health Systems Trust continues to provide technical assistance and direct service delivery in 344 DoH facilities across the province, 111 of which are high-volume ‘Siyenza’ facilities. Through this support, we ensure the continuity of approximately 850 000 patients on antiretroviral therapy (ART) and sustained impetus towards reaching the 95-95-95 targets says Walker.”

Despite significant challenges during the year due to the second and third waves of COVID-19, resultant lockdowns and reduced access to primary health care, HST-supported facilities continued to increase the number of patients on ART by 35 955 in the last funded period. 

HST uses innovative case-finding strategies to identify patients as yet undiagnosed with HIV as well as a client-centred approach to bring patients with interrupted treatment back to care. Central to the success of this strategy has been the development of the Case Management Model – an innovation so effective that it has been shared across all DSPs and forms the basis of the DoH case management directive. Application of this model has enabled the HST team to deliver a consistently strong performance in supporting continuity of care, with 164 904 patients being traced back into care this year. Case management relies on patient-centred communication, strong and functional appointment systems, and regular tracing of patients who miss appointments due to their busy lives and possible external stressors. 

HST continues to support provincial and district operationalisation of the COVID-19 Resurgence Plans and planning and implementation of the Provincial COVID-19 Vaccination Roll-out Plan, including resource mobilisation, implementation, and reporting to provincial government leadership and the DoH.

The SA SURE project’s pandemic mitigation efforts included deploying our ‘Elite 8’ − eight staff members who could not be in the field due to co-morbidities − to educate, inform and encourage patients to make better choices for their treatment. In a two-month period, this team supported 8 994 patients to switch to a TLD-based regimen.

HST has also worked closely with the NDoH to increase the number of patients accessing medicines through the CCMDD programme since its inception in February 2014 in 10 National Health Insurance (NHI) districts across eight provinces, notes HST’s Director for Health Systems Strengthening, Ronel Visser. “With an initial conservative target of 500 000 enrolled patients, roll-out of the programme achieved registration of just under 5 million patients by October 2021,” says Visser.

HST has played a pivotal role in developing and piloting the web-based CCMDD system, Synchronised National Communication in Health (SyNCH), and in partnership with the NDoH, will continue to support its operation beyond December 2021. 

The CCMDD and SyNCH programmes have implemented specific interventions to reduce COVID-19 exposures in facilities: 12-month prescription extensions have been implemented to reduce physical contact, and no service delivery interruptions were reported during the COVID-19 lockdown period. An ARV Hotline continues to support those with queries related to treatment, and the ‘Get checked. Go collect’ Hotline assists patients from across South Africa regarding queries related to CCMDD. 

 “HST’s next five-year cycle of work towards strengthening the South African health system will entail an approach aligned with the PEPFAR Country Operational Plan and DoH objectives,” explains Visser, “with ongoing emphasis on sustainable capacity development and support on the ground to integrate national health priorities and contribute to rapid acceleration towards epidemic control.” 

Programmatic integration of COVID-19 pandemic responsiveness through improved facility preparedness and innovations in community-based services will also be maintained.


The Health Systems Trust (HST) is a leading role-player in the South African public health arena, focusing on health systems strengthening, research, and strategic support in the implementation of priority health programmes. Established in April 1992, on the brink of democracy in South Africa, HST has played a significant role in the evolution of the national health system. Today our strength lies in the knowledge, insight and experience we harness through synergising our research and implementation outputs towards a healthy life for all.