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SOUTH AFRICA: Slow start of ARV rollout

Photo: PlusNews
Recipient of free drugs roll out
johannesburg, 1 April 2004 (PlusNews) - Dr Blackburn was one of eight doctors, a team of pharmacists, nurses, and dieticians on duty at the new antiretroviral treatment (ART) clinic at Johannesburg Hospital on Thursday, awaiting the expected flood of patients on the first day of the anti-AIDS drugs rollout in South Africa's Gauteng Province.

Although not the rush anticipated, the ART clinic saw 35 patients and put five on antiretrovirals (ARV) over the course of the day as the government's long-awaited programme to provide free ARVs through the public health system began, albeit initially as a pilot scheme.

To qualify for ART, a patient must have a CD4 count (which measures the strength of the imune system) of 200 or below and be committed to following the regimen strictly.

Five hospitals - Johannesburg Hospital, Chris Hani-Baragwanath, Helen Joseph, Coronation and Kalafong - will provide the drugs to people living with HIV/AIDS in Gauteng, South Africa's economic heartland.

Dr Blackburn's second consultation of the morning revealed a situation that free access to ARVs should eliminate. She explained to PlusNews that her patient had been on ART but couldn't afford to continue.

"People manage to scrape together money for a month's supply and then the money runs out, and ART stops. The problem is that the treatment must be taken religiously, and for life. Once you stop, you start breeding resistance," Blackburn said.

Across the hall, hospital pharmacist Lara Cohen was explaining the course of treatment and possible side effects to the first patient in the province to be supplied with free ARVs.

"Inform someone who can help you to make sure that you take your medicine. Keep a diary or use your cell phone to ring, to remind you to take your medicine at certain times in the day. If the side effects are very, very bad, you need to inform your doctor, and don't leave it - but it doesn't mean that you shouldn't adhere to your medicines. Good luck," said Cohen.

Minette Botha, a dietician at the hospital, gave the patient a bag of Philani - a highly fortified cereal that the hospital provides some patients with each month's supply of ARVs.

"Provided the patient is malnourished and has a BMI [body mass index] of below 20, he or she qualifies to receive Philani," Botha told PlusNews.

While grateful for ART, one of the patients receiving their drugs said the rollout should have come sooner, so that more lives could have been saved.

"It should have been earlier. The government has announced it close to election time [on 14 April]," he said. "But I am excited, very excited about this. I feel like I have been given a second chance. I can now become healthy again and take care of my daughter."

Like the other four hospitals selected for the rollout, Johannesburg Hospital has run an HIV clinic for the past two years, where ART and follow-up have been available to paying patients.

"My department currently runs 44 clinics per week," Sagie Pillay, the CEO of Johannesburg Hospital told PlusNews. "With the addition of an ART clinic and a back-up HIV satellite clinic that will run five days a week to provide screening and back-up accessibility, we will be running 44 plus."

Pillay is eager for AIDS to be understood as another chronic illness. "I think the hype will go, and people will realise it is just another chronic illness that needs chronic monitoring and chronic treatments - you're not going to cure it, but we're going to control it."

He anticipates that roughly 30 new patients will be put onto ART per week. Another 18 sites in the province have been earmarked to provide services by next year and the provincial health department aims to reach 10,000 people by the end of March 2005.

According to a 2002 study commissioned by the Nelson Mandela Foundation and the Nelson Mandela Children's Fund, the HIV prevalence rate in Gauteng is 14.7 percent, second only to the the Free State at 14.9 percent. KwaZulu-Natal, where antenatal surveys had previously shown the highest infection, was ranked fourth at 11.7 percent.

The survey, conducted by the Human Sciences Research Council and the Centre for AIDS Development, Research and Evaluation, found that Gauteng and the Free State had the highest proportion of people living in informal settlements, a significant risk factor for HIV.

Since cabinet approval of the government's Operational Plan for Comprehensive HIV and AIDS Care in November last year, very little has happened countrywide to implement the programme, said the AIDS lobby group, Treatment Action Campaign. Six months after the go-ahead, many provincial health departments are still unable to provide concrete information on their rollouts.

At the beginning of March, the Mail & Guardian newspaper reported that only patients living in Gauteng, the Western Cape and "at a push" the Free State would be assured of access to free ARV treatment within the year.

At the time, only 13 sites had been accredited, all in the Western Cape Province.

Gauteng Province Premier Mbhazima Sholowa, touring the five hospitals providing free ARVs on Thursday, was quick to point out that a lot had to be done before an effective and sustainable rollout could occur.

"It is important to understand that there was a great deal of planning that had to happen," said Sholowa. "I know it is a beginning, and I know that we are in for the long haul."

Theme (s): Care/Treatment - PlusNews,

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