STUDY SETTING Tholulwazi Uzivikele (TU)(4) is a non-profit organisation serving the communities surrounding Manguzi Hospital in northern KwaZulu-Natal. The area borders Mozambique and is extremely rural with poor access on sandy roads. Unemployment is estimated at 70% (5) and the antenatal HIV prevalence is 28%. TU was founded in 2002 by concerned staff members at Manguzi Hospital wanting to mitigate the effect of the HIV epidemic on the surrounding community. The organisation started with an emphasis on orphans and vulnerable children and home-based care, but has subsequently expanded to include programmes for poverty relief, HIV prevention, and access to medical care and social services. Antiretroviral treatment (ART) is available at Manguzi Hospital and all 10 local clinics. CD4 tests can be done and ART initiated at any of these sites. Patients can usually commence treatment within 2 weeks of a diagnosis, and most of the population lives within a 10 km radius of such a clinic.