In South Africa, the name New Start and its rising sun logo, have become synonymous with no-cost, high quality HIV prevention services.
New Start is a PSI franchise that spans several countries, including Zimbabwe, Botswana, Lesotho, Mali, Namibia, Swaziland and Zambia.
SFH uses the franchising model within South Africa to establish a viable network of services. SFH has social franchising partnerships with the non-profit organizations like Mosamaria and the Training Institute for Primary Healthcare to provide HIV testing services and with Thathenda Healthcare and the Perinatal HIV Research Unit to provide MMC services. All franchise partners follow standard service guidelines and provide similar quality of service.
The New Start Programme launched in 2004 in three South African citiesas an HIV counselling and testing (HCT) programme designed to take testing out of the medical setting and encourage more South Africans especially men to undergo testing. Above all it was intended to communicate the idea that knowing your HIV status enables you to deal with your health and your future in a purposeful, empowered way.
New Start's services have expanded over the course of a decade. Presently HCT services as an entry point to combination prevention services that include CD4 count testing, sputum sample collection for TB, referrals to New Start's medical male circumcision service and to a range of health and social services, as required by the individual or family.
Within months of opening its doors in South Africa, New Start adopted the innovative approach of setting up mobile testing services in busy shopping areas and transport nodes. These mobile services operating from tents, became increasingly bold in their location. Far from being deterred by the visibility of the services, people flowed in steadily. It seemed that the more in your face we were, the better the testing service seemed to work,recalls New Start's first employee and Director of SFH, Scott Billy.
In the course of a decade, more than one million HIV tests have been administered by New Start, accompanied by quality counselling and additional services, as required by the individuals circumstances.
Over the years, the New Start HIV testing programme has evolved (in line with national strategies and policies) to incorporate TB screening and sputum sample collection, CD4 count testing for those who test HIV-positive, information on and referrals for medical male circumcision for men who test negative, and a wide range of other referrals to social and health services.
Home-based HCT involves teams of trained counsellors going door-to-door in residential areas offering members of households the convenience of taking a test in their own homes and incorporating the other service elements described above, as appropriate. Their approach is proactive they select an area and work systematically through it, road-by-road and then move on to the next patch and do the same. This method is known as the general population HCT model.
HCT teams also use the index client model, where they reach out to the families of individuals who have undergone testing at a local clinic and are HIV-positive. The main purpose of this service is to ensure that the individual's sexual partner and children, where appropriate, are tested and to assist couples to deal constructively with the results, whether both partners are positive or the partners are discordant in terms of HIV status.
Couples counselling and testing has become a strong feature of New Start's offering. This involves the joint counselling and testing of partners.Results are given to both partners in each other's presence. The counsellor is able to assist them deal with their reactions to the results, which is especially important when one or both partners test HIV-positive.
Currently, about 80% of HIV tests performed by New Start are done in homes while 20% take place in mobile testing sites in high-traffic areas of towns.
In March 2010 the first New Start medical male circumcision (MMC) clinic began operating in Pietermaritzburg and currently the national programme performs more than 35 000 procedures a year.
The Society for Family Health (SFH) had been involved in one of the ground-breaking studies that demonstrated that MMC could reduce the risk of HIV infection by some 60% - the Orange Farm study and was committed to translating this evidence into accessible MMC services in the communities it served.
Seed funding through PSI to fund the first site in Pietermaritzburg, then funding from the US President's Emergency Plan for AIDS Relief (PEPFAR) channelled through the Centers for Disease Control and Prevention (CDC) helped make this goal a reality.
New Start currently has fixed MMC facilities in Witbank in Mpumalanga; Soweto and Tsakane in Gauteng; Bloemfontein in the Free State; and Pietermaritzburg and Umlaziin KwaZulu-Natal. As part of their outreach approach, New Start MMC sites periodically set up surgical facilities and perform MMC at venues in the community, such as schools and community halls.
In March 2015 the first fully mobile New Start MMC service was launched in the Umgungundlovu District of KwaZulu-Natal.
Collectively, New Start MMC services have performed more than 100 000 MMC proceduresover a period of four years and, by so doing, have averted an estimated 20 000 HIV infections.
Besides it's direcly managed sites in Witbank, Pietermaritzburg and Tsakane, New Start works with its franchised partners, the Perinatal HIV Research Unit and Thathenda Healthcare, in Soweto, Bloemfontein and Umlazi. In several instances, provincial health departments have provided space in existing hospitals and health centres for New Start MMC sites. New Start also works with a network of GPs in Ekurhuleni , namely Bokamoso Health Care, to perform circumcisions.
Generating a demand in the community for MMC services is a major activity in any site. Not only is MMC a relatively new option in the HIV prevention field, but it is an irreversible measure that usually involves surgery and therefore requires careful consideration. In some areas where New Start works, there are established communities that conduct traditional male circumcision and young men (and, in some instances, their parents) are faced with a choice between traditional and medical circumcision.
New Start is sensitive to these complexities and invests considerable effort in the marketing of MMC services within communities through periodic campaigns, community dialogues andthrough dedicated teams responsible for interpersonal communication and education of potential MMC clients.
The Families Matter! Program seeks to promote positive parenting and effective parent-child communication on sexuality and sexual risk-reduction. It recognises that many parents may need support in order for them to assist their children deal with their sexuality and make choices that protect them from HIV infection, abusive relationships, and unwanted pregnancy.
The programme was developed by the US Centers for Disease Control and Prevention (CDC) and is delivered by a range of organisations in eight African countries. SFH began to offer this programme in the Mangaung District of the Free Stateand Enlanzeni District in Mpumalanga in 2013. In the first two years alone some 1 400 parents and caregivers completed the curriculum.
Families Matter! Program follows the same process and curriculum no matter where it is offered. The sessions are facilitated by a team of two certified facilitators, one male and one female. The complete programme comprises five weekly sessions of about three hours each.
It is aimed at parents and caregivers of children aged nine to 12 years and take them systematically through parenting skills:
The sessions are designed to get parents thinking, to equip them with important information, and to enable them to learn by discussion.