Newsletter 71 - Positive Expansions to South Africa’s ART Programme-14 May 2010
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In April 2010, two major national health programmes were launched: the South African Antiretroviral Guidelines 2010, and the HIVCounselling and Testing (HCT) campaign. These programmes are seen as a gateway into HIV prevention, treatment, and care.
There has been much advocacy for the decentralisation of Antiretroviral Treatment (ART) to the Primary Health Care (PHC) level in order to increase access. The South African Antiretroviral Guidelines 2010, published on 1 April 2010 by the Department of Health and the South African National AIDS Council (SANAC), aim to extend the programme to the country’s 52 health districts. These include both district and metropolitan municipalities. So decentralisation appears to be on the cards.
In the South African Antiretroviral Guidelines 2010 the eligibility criteria have been amended to allow HIV-positive people to receive ART sooner. There is now increased access to treatment for vulnerable priority groups, who are:
- HIV-infected pregnant women with a CD4 count equal to or less than 350, who can now get treatment at that level instead of waiting for their CD4 count to be 200;
- HIV-infected infants, who also do not have to wait for a CD4 count of 200 and can now receive treatment regardless of their CD4 count;
- People with both tuberculosis (TB) and HIV infection; and
- People with multi-drug resistant (MDR) or extensively drug resistant (XDR) TB
The main objectives of the programme are to ensure timely initiation of treatment and prevention, minimise unnecessary drug toxicities, and strengthen the private and public health sectors’ capacity to deliver high-quality health and wellness services. To achieve this, the HIV Counselling and Testing (HTC) campaign has been initiated.
The main aim of the HCT is to have 15 million South Africans (that is almost one in every three people), voluntarily tested for HIV by June 2011. The HCT campaign also includes other health screenings, including for TB, diabetes, blood sugar, and blood pressure.
The campaign has four long-term objectives, which are:
- To mobilise people to know their HIV status;
- To support people with key prevention interventions in order to take proactive steps to a healthy lifestyle - irrespective of their HIV status;
- To increase the incidence of health-seeking behaviour; and
- To increase access to treatment, care, and support services.
The roll out of the campaign will start in nine districts, one per province. It will then move in succession to nine new districts every month until all of South Africa’s 52 health districts, which include both district and metropolitan municipalities, have been covered.
The guidelines and campaign are set to be decentralised to the PHC level. This means local health facilities will be more involved in the initiation of ART. More nurses will be trained on ART initiation. The number of nurses with ART initiation training is set to increase from a current 400 to about 4 000.
This will mean more people can obtain access to the drug at a local level. There will be increased access to treatment as there will be more ART sites. This will reduce the distance people have to travel to receive treatment. An increase in the number of ART sites will allow sites to be less congested and so will reduce ART waiting lists.
The very large scope of these programmes is ambitious. Whether they will succeed remains to be seen. Concerns have been raised about the cost. There is also concern about the human resource capacity, given that the country already has a chronic shortage of health care personnel. However, proper implementation could result in the most successful HIV testing and treatment campaign yet.
-Nachi Majoe
by
nkgafela
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last modified
2010-05-14 09:29
