South Africa runs the world’s largest programme of antiretroviral (ARV) treatment for HIV.
Despite a tremendous increase in testing and treatment and improved prognosis for people with HIV, there are still many new infections and HIV-related deaths each year. Rates of co-infection with tuberculosis (TB) are also high. More needs to be done to reduce HIV transmission and initiate and keep people on ARV treatment, such as carrying out interventions tailored to children and adolescents, and for hard-to-reach communities.
Médecins Sans Frontières (MSF) continues to pilot new strategies to scale up testing and access to treatment for HIV and TB.
Khayelitsha, Cape Town
Each month some 1,000 people learn that they are HIV positive in Khayelitsha township, on the outskirts of Cape Town, where rates of HIV and TB co-infection have reached 70 per cent. MSF provides testing and treatment for HIV and TB, including drug-resistant TB, which requires a longer, more intensive, toxic and less effective drug regimen. Adherence clubs are a key element in the HIV programme: instead of monthly one-to-one appointments at the health centre, club members attend bi-monthly meetings where, as well as receiving a check-up and a drug refill, they can ask questions and offer mutual support.
The programme also addresses the needs of children and adolescents. A pilot project providing diagnosis and treatment for newborns began in 2014. Children are involved in family clubs and there are now nine clubs that are youth-focused, for those aged between 12 and 25 years. Overall the project supports 18 community adherence clubs.
An MSF-initiated pilot project at community ‘wellness hubs’, offering family planning and testing for pregnancy and sexually transmitted infections, significantly improved access to HIV screening for young women. More than 15,000 patients attended two wellness hubs before the facilities were handed over to the Western Cape Department of Health. MSF also supported two human papillomavirus vaccination campaigns in Khayelitsha, vaccinating more than 3,800 girls.
MSF continued an HIV–TB programme covering Mbongolwane Health Service Area and Eshowe municipality in KwaZulu-Natal. In 2014, more than 50,000 people underwent HIV testing, and three times as many viral load tests were carried out compared to 2013. This enabled staff to identify patients who could benefit from a change in their drug regimen. The programme also focuses on prevention activities such as promoting safe sex. A million condoms were distributed and more than 3,000 men underwent voluntary circumcision, which is shown to decrease the risk of HIV transmission.
Stop Stock Outs project
Drug stock outs cause a major bottleneck in South Africa’s HIV–TB programming and threaten the health of patients. MSF and several partners launched the Stop Stock Outs project in 2013, asking patients and healthcare workers to become ‘sentinel surveyors’: to anonymously gather reports on stock levels in the facilities they attend or work at, map reported cases and track specific issues. The overall goal is to understand the causes of shortages and stock outs and draw attention to a struggling health system.
No. staff in 2014: 198 | Expenditure: €6.7 million | Year MSF first worked in the country: 1999 | msf.org/southafrica
Thulile – 29 years old
I first heard about MSF early last year, and joined my first club towards the end of 2013. Before clubs, you would first have to queue to get your file, then queue to get your blood pressure and weight measured, and then queue to see your nurse to get your treatment. If the clinic was full, you could be there from 7am to 1pm. When your month’s supply of ARVs came to an end, you started dreading the clinic visit. You put it off. But with clubs, you actually look forward to the visit! It only takes an hour and we get two months' supply of ARVs.