SOUTH AFRICA: Challenges remain for MSF's ART programme
[This report does not necessarily reflect the views of the United Nations]
JOHANNESBURG, 30 April (PLUSNEWS) - Three years after its inception, the first project to provide free AIDS drugs to South Africans put the 1,000th patient on antiretroviral treatment (ART) this week.
In May 2001 the Medicins Sans Frontieres (MSF) and Western Cape Health Department project started providing people at an advanced stage of AIDS with ART at three HIV/AIDS clinics in Khayelitsha township, outside Cape Town.
Today the clinics offer about 2,000 consultations every month in the sprawling township. "We estimate that 5,000 people need treatment in Khayelitsha today," MSF campaign coordinator Marta Darder told PlusNews.
Although the programme was recognised in 2003 by the World Health Organisation as one of the models for an integrated HIV programme, Dr Erick Goemaere, Head of Mission for MSF South Africa, said he was still nervous about the challenges ahead.
"The programme has demonstrated that a well-run HIV programme can succeed in resource-limited areas, however, we will have to find new solutions and adapt to new challenges," he said.
New challenges emerging in Khayelitsha, and soon to be faced in other areas as South Africa's national ARV programmes roll out, form the basis of current research that includes developing approaches to identify and support patients not adherent to ART, and when to change therapy due to resistance and treatment failure. Scaling up to meet the year-end target of 1,700 people on ART is another.
The availability of dedicated and well-trained health staff appears to be the biggest constraint and the most difficult to overcome. "Many of the staff are burnt out and tired and have left," said Goemaere. "We have to find ways to motivate people and to attract new doctors, but there needs to be political will to do this."
The objective of the Khayelitsha programme was to show the feasibility of treating people infected with HIV in poor communities.
By the end of 2001, 100 patients were on ART. This increased to 300 by the end of 2002, just 17 months after the programme began. By the end of 2003, a total of 776 patients, including 84 children, were receiving treatment.
"Given that the effectiveness of the intervention is no longer in question, the research emphasis within this project will be more directly focused on the systems of service delivery, with further simplification and emphasis on nurse-based services," said Darder.
Lessons learned from the Khayelitsha programme, no longer a pilot study, will be integrated into the provincial scale-up. Over the next three years, the challenge will be to transfer responsibility for the Khayelitsha programme to the Western Cape Department of Health. An estimated 100,000 people in the province are infected with HIV or have AIDS-related diseases, and around 5.3 million people are living with HIV or AIDS in South Africa.
Another MSF project, supported by the Eastern Cape Department of Health and the Nelson Mandela Foundation, aims to demonstrate the feasibility of providing comprehensive HIV services, including ART, in a rural setting.
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