Aims of the talk

1. Development of a tool for assessing site-readiness for the provision of vaginal microbicides and oral PrEP in South Africa

2. Aims of the talk • Provide an overview of the project • Introduce proposed outline of the tool and planned approach to its implementation

3. THE PROJECT

4. Project objective The objective of this project is to develop tools for assessing site/provider readiness to provide vaginal microbicides and oral PrEP

5. Phase 1: Pre-project stakeholder meeting

6. Phase2: Development of piloting of the tool (Feb to Sept 2012) • Create implementation scenarios for populations in which interventions have demonstrated efficacy, as well as potential utility in additional populations following subsequent RCTs. • Further engage/interview experts as needed • Develop site-readiness assessment tool and guide

7. Tool development process • Literature • The intervention type and formulations • Implementation scenarios for various populations • Legal frameworks • Who will prescribe? • Success and implementation of other interventions • Develop implementation scenarios for populations. • Interview relevant experts, stakeholders and provincial staff. • Review of processes through interviews with relevant staff working at the 3 sites. • Site visits and observation (3 identified sites). • Development of draft assessment tool and guide. • Piloting of and feedback on tool and guide • Finalise draft of detailed guide/report summarizing process for tool development and instructions for use. • Present draft tool and guide to previously identified stakeholders, additional leaders, and CDC. • Finalise tool and guide

8. Phase 3: Post-project stakeholder meeting ( Sept 2011) • Update of on recent developments with respect to biomedical prevention in South Africa and internationally • Present the developed site-assessment tool and implementation guide for review by key stakeholders.

9. Tool outline Sections A to C

10. Tool section A- Background information Purpose of the tool The tool has been developed for the purposes of preparing service points for the introduction of vaginal microbicides and oral PrEP. South African clinical guidelines Reference to the relevant DOH guideline; which will provide a guide to the model for service delivery – how to bridge this gap in the meantime?

11. Tool section B- Clinic competency assessment Comparison of facility resources against the set standards, namely: • Staffing (staff, patient ratio by cadre) • Patient management requirements (space, package of services, monitoring, adverse event reporting, referrals) • Commodities (storage/refrigeration, stock, cost, procurement, dispensation) • Data management and data use • Facility (health facility vs. non-health facility based implementation) • External partners and relationships (government, AIDS councils, NGOs/CBOs)

12. Tool section C- Summary and recommendations • Primary recommendation – ready to provide vaginal microbicides and oral PrEP- yes or no? • Identification of improvement interventions and improvement implementation plans. • Set date for follow up visit by assessment team.

13. User guide This will outline: • By whom should the site- assessment tool be implemented? To whom should it be introduced – which are the key personnel? • Methodological principles for implementation: CPG & QI implementation principles. The supportive supervision approach? • Different models of introduction in health facilities based on various prevention models? Ideal versus pragmatic • Linked key documents • Link between readiness assessment and ‘package of care’ and ‘treatment guidelines’. • Costs?

14. Discussion