SOUTH AFRICA: Monitoring ARV patients like 'working in the dark'
[This report does not necessarily reflect the views of the United Nations]
JOHANNESBURG, 23 February (PLUSNEWS) - The South African government has just a month to reach its target of providing treatment to 53,000 HIV-positive people by the end of March, but only an estimated 30,000 are currently on anti-AIDS medication.
Activists have raised serious doubts about the government meeting the deadline, which was extended by a year from March 2004, and are calling for the state to accelerate its rollout.
But Health Minister Manto Tshabalala-Msimang has said her primary concern is her department's ability to monitor "how all the people who are using ARVs are doing, and why some of them stop the programme".
Tshabalala-Msimang admitted in parliament last week that her department did not have reliable figures on how many people had dropped out and their reasons for doing so.
"We are working in the dark, and you just give the medicine and hope God will be on your side," she told journalists during a media briefing.
Dr David Kalombo, project manager for the government's operational plan, told PlusNews it was crucial that facilities reported side effects and adverse reactions to ARVs, as healthcare workers would then be able to monitor drug compliance and follow up patients who had stopped taking the medication.
When patients start dropping out of the treatment programme, "the implications for adherence and the potential development of resistant strains" were huge, warned Health Systems Trust (HST) senior researcher Rob Stewart.
This type of data collection was, however, still "something new for everyone", and would take time to be implemented in all facilities. "We cannot run away from it - people need to report, but we are still putting these systems in place," he added.
In the meantime, government should have interim measures in place, like a "simple register" to prevent treatment interruptions. "Ultimately, they need to keep it very simple and not overburden [ARV sites'] ability to collect data," Stewart said.
Although there had been attempts by some provinces and facilities to create their own patient reporting forms, there was still a "mish-mash of different forms and data collection systems", with no clear standardised system in place, Stewart noted.
"The idea was to start treatment and build up [these] systems, but there are multiple stand- alone, ad hoc systems and none of them are coming together," he said.
According to Kalombo, things were slowly getting off the ground, with mechanisms being put in place to improve the current situation: there were now three pharmacovigilance centres in the country conducting adverse drug reaction monitoring.
But, for activists, the pace of implementation remains too slow. "Using the difficulty of data collection as an excuse for not rolling out on time is unacceptable," Deborah Ewing, editor of the 'Children First' journal and member of the Joint Civil Society Monitoring Forum, told PlusNews.
According to Ewing, civil society was not trying to use figures of people on treatment as an example of failure by the government, but rather to "help tell us where we are, and identify gaps and needs".
Nevertheless, Kalombo responded that for government the March 2005 target of 53,000 people on ARVs was not a number "set in stone", but a projection.