Overview of activities targeting the objectives of the Presentation – Global Campaign for Microbicides Dr Ian Sanne, 1

1. Overview of activities targeting the objectives of the Presentation – Global Campaign for Microbicides Dr Ian Sanne, 19 June 2008

2. About Right to Care (RTC) Overview of Right to Care • RTC is a non-profit, Section 21 company specialising in HIV disease management, (company registered 23 January 2003; PBO registration 2004) • Funded by the US Presidents Emergency Programme For Aids Relief through USAID • Clinicians of RTC have a long track record of ARV and TB research with NIH funding ACTG, CIPRA, R01’s, and are members of the WHO and South African guideline committees for adult and paediatric treatment. • Diversified management structure compliant with empowerment criteria • Corporate governance – much attention has been paid to Corporate Governance Vision: • All HIV positive patients receive high quality treatment, care and support improving their quality of life, productivity and survival Mission: • To facilitate access and build capacity to deliver innovative HIV treatment, care and support services • To develop HIV treatment capacity both in the public and private sectors Funding level employed: • Total of $35 Million PEPFAR funding spent to date • Current funding levels $27 Million for BY 08 ending Sept 08; $35 Million budget 09.

3. HPTN Foundation NIH Foundation K401 Trust/Foundation Administration and billing Service provider networks Claims processing and payment Financial and outcome reporting Accredited provider network Prevention trial accredited Management, Lab., Pharmacy etc. Structure for treatment provision Funding arrangement- actuarial calc. - Cell captive, Foundation Medical Scheme Administration Treatment implementation

4. Practical Implementation of our Clinical Services • Patient visits doctor of choice • Doctor sends medical report to RTC • Doctor can prescribe treatment • RTC processes script and offers education • Case manager proactively support patient treatment • Specialist physicians review GP medical report and lab results; and confirm script for processing Patient GP • Doctor can send blood sample to any certified lab • Lab sends result to Doctor and RTC Collection Lab • Patient can decide where drugs must be delivered for confidential collection • Clinical case managers enter data onto IT Platform • System programmed to alert potential problems RTC Medical Experts Distribution RTC Data Entry • RTC sends script to courier pharmacy for distribution to patient Advice & Counseling • Medical and psychological support available via 24 hour call centre

5. Implementation of Clinical Services

6. TherapyEdge-HIV developments at RTC 2007-08 VCT Module Laboratory IntegrationLancet, Toga, NHLS Implemented Beta Testing Development Request Result Data transfer for patient Mx Data outputs TherapyEdge-HIV Down referral PEPFAR and DORA Rapid data capture Reports Referral Implementation as “Live” system Pharmacy supply chain management Export to SAS™ Paediatric Module Private sectornetwork TB Management Module Cervical dysplasiaHPV

7. HIV Epidemiological information M+E Epidemiologists Statisticians TherapyEdge HIV clinical information Clinicians Data capturers Link Genotype to Therapy Linking genetic information with clinical outcome To measure impact of therapeutics and patients disease management ViroScore Suite HIV virological information Core DB Virologists

8. PEPFAR indicators

9. DORA

12. Paediatric data capture

14. Resistance testing Red bar indicates drugs with known resistance, green bar indicates no resistance. Note decrease in viral load after resistance is detected and correct treatment implemented

15. HIV ViroScore – TherapyEdge™

16. Used to develop six treatment models • Support for the Department of Health CCMT sites – responsible for 38 government sites in five provinces • Direct access to specialist care – drug resistance and complex opportunistic infections seen at Helen Joseph Hospital Site. Access to new and unregistered antiretroviral drugs for salvage therapy on section 21 approval. • Foundation funded community programs – funded by Oprah Winfrey Foundation and Housing for HIV • Community Clinics model – support six clinics with over 6000 patients on treatment, • SMME treatment model – area based clinic to provide the employer funded model to SMME’s • Private practitioners treating indigent patients – capitation fee model for the VCT and ARV treatment • Workplace model – Direct AIDS Intervention (DAI in partnership with Alexander Forbes Health Management Solutions)

17. Q1 Monitoring Evaluation -Treatment target

18. Government treatment sites • RTC sites are responsible for over 10% of all ART patients in SA • Themba Lethu Clinic at Helen Joseph Hospital • Largest and most efficient in South Africa • Over 11,000 patients initiated on ART since April 2004 • A further 5000 pre-ART patients • Development site for TherapyEdge, TB Focal Point, Down Referral, Laboratory Integration • CHRU research site • Public Private Interaction MOU’s – Gauteng, Mphumalanga, Northern Cape, Free State, Western Cape • 38 government sites

19. RTC supports government through… • Needs assessments at the sites included in the MOU • Recruitment and seconding personnel – currently over 700 employee seconded to DoH • Training of personnel – in-house HIV training program responsible for over 3500 health care workers trained in 2007 • On-site expertise – preceptors trained by RTC brought to site to increase confidence and capacity of on-site personnel • Provision of the TherapyEdge data system to DoH sites throughout the country • Infrastructure assessment and capacity building – over R35M spent in 2007 on department of health sites • Access to specialized laboratory testing not accessible to DoH e.g. Resistance testing

20. Partnerships with Community Organisations (1) • CHRU • Strategic founding partner of Right to Care • 12 Year track record of phase 2 and 3a and 3b clinical trials (ART, TB, MDR TB and opportunistic infections). Currently there over 500 patients participating in 35 clinical trials • Strong Epidemiology and Public Health Evaluation Agenda using the large database of Therapy Edge • ACTS • Based in the Masoyi Tribal Area near White River • 95% adherence rate • Rea’phela • An initiative of Right to Care, situated in Wynberg • Fastest growing clinic with a focus on ARV’s • Witkoppen Health and Welfare Centre • Services Diepsloot, Zevenfontein, Lion Park & Kya Sands • Over 250 patients on ART with 90% adherence rate

21. Partnerships with Community Organisations (2) • Ndlovu Medical Trust • Situated in Elandshoorn, Mpumalanga, servicing 30,000 – 40,000 people. • Initiate a number of community upliftment programmes • Babesi Medical Trust • Situated close to the Kruger National Park • Servicing a population of 100,000 people • Refilwe Community Project • Initially a palliative care centre • Focus on OVC • Care Organisations: • Community AIDS Response (CARE) • Friends for Life • Vuselela Ulwazi Lwakho (Vuselela)

22. Public-Private Partnerships • Direct AIDS Intervention (DAI) • Partnership with Alexander Forbes Health Management Services • Reaches over 32 corporate organisations in South Africa • Over 78,000 employees covered • (see program slides below) • Thusong Community Treatment Programme • Provides ART services via independent GP’s and GP networks • Active in 5 provinces, 14 participating GP’s

23. Partnerships with Foundations • Oprah Winfrey Foundation – Provision of home based testing and treatment to community members • Housing for HIV – provision of home-based HIV testing, treatment and management of treatment to low-income home owners. This program is linked to the Home Loan Guarantee Company to underwrite lender risk in low income populations

24. RTC Measured Performance • In-house monitoring evaluation team focused on site performance • Strong Public Health Evaluation and Epidemiology Research Group developing research agenda • Treatment outcomes • Interactions between HIV and TB • Social science agenda including loss to initiation, loss to follow-up • Economics research agenda – health cost economics and macro-economic impact of HIV on society

25. Q1 Monitoring Evaluation Results Period Dec 07

26. Q1 Monitoring Evaluation -Treatment target

27. Direct AIDS Intervention: A partnership with Alexander Forbes – Employer Funded Treatment Programs

28. HIV contracted Disease progressionmonitoring Patient not identified HIV related disease AIDS sick 7 year productive life extension due to HAART drugs  Cycle of demise excludes absenteeism costs It can be economically viable to treat a single HIV+ employee… Do-nothing costs Treated costs Delaying an employee’s termination by 7 years, and avoiding absenteeism costs saves R171kNPV for a R10’600/m employee 55 days additional sick leave over 2 yrs 3 months salary cost to recruit & train 25% productivity drop for 2 yrs

29. Direct AIDS Intervention (DAI) • Workplace programme in partnership with AFHMS • 300 Doctors supported by ETP • Programme covers over 130,000 employees of 38 companies • Many employers are moving to funding family members

30. RTC role in DAI program • Initial program design and negotiation with service delivery partners – Dr Ian Sanne, Chris Barker • Modeling of HIV risk and funding by company profile – Dr Ian Sanne and Chris Barker • Public and Boardroom presentations of the program – Dr Ian Sanne, presented to over 300 companies • Development of all clinical protocols and VCT protocols • On-site VCT for companies • Development of TherapyEdge-HIV™ • Development of case management division in RTC • Reporting of clinical outcomes • Rightmed Provision of ART in selected populations and programs • Since Dr Strydom left less interaction with Alexander Forbes

31. Pricing scenarios – uptake 20% Negotiable Essential Optional Essential Optional N/A Essential Negotiable Optional Optional Optional Optional Essential

32. Pricing scenarios – uptake 50% Negotiable Essential Optional Essential Optional N/A Essential Negotiable Optional Optional Optional Optional Essential