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Background: In 2008, South Africa''s National Department of Health (NDOH) established a new mid-level cadre called Clinical Associates (ClinAs) to fill critical human resource gaps at rural district hospitals, enable task sharing, and increase efficiency while maintaining a high standard of care. With support from the American International Health Alliance (AIHA), more than 600 ClinAs have completed a three-year bachelor''s level training course and are currently deployed in rural, under-resourced sites throughout South Africa. ClinAs are trained to provide a range of HIV prevention, care, and treatment services, including VMMC, which reduces the risk of female-to-male HIV transmission by up to 60%.
Description: The Centre for HIV and AIDS Prevention Studies (CHAPS) started recruiting ClinAs to perform VMMC services in 2013. CHAPS currently employs 15 ClinAs, who provide an average of 1,500 VMMCs per month at 16 sites in four provinces.
Lessons learned: A program evaluation conducted in 2015 assessed the applicability of ClinAs'' VMMC training and found that quality of care provided by ClinAs is comparable to that of doctors. Additional research revealed that when ClinAs work with doctors as part of a multi-disciplinary clinical team, health facilities enjoy cost savings of up to 60%. ClinAs also enable task-sharing, allowing doctors to rotate and provide supervision at multiple sites while ClinAs provide VMMC, counselling, and follow-up care.
Conclusions/Next steps: ClinA training and deployment has the potential to significantly reduce costs, increase efficiency through task sharing, and rapidly expand access to VMMC without compromising quality of care. Other countries should invest in and utilize similar mid-level cadres to support their efforts to address HIV prevention and the 90-90-90 goals.

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