Durban - Some of South Africa’s 2.4 million HIV patients will be able to get antiretroviral (ARV) treatment outside of health clinics in a move the Department of Health hopes will help address stocking problems.
This “good news” comes as millions of people in South Africa and around the world observed World Aids Day.
Many patients in the country queue monthly to pick up their ARVs, but as part of its latest funding application to the international financing mechanism, The Global Fund to Fight Aids, TB and Malaria, the country plans to move treatment out of clinics and into patients’ homes, local libraries and maybe even their local clothing chain stores in the next three years.
South Africa will be one of the first countries in the world to implement such a system.
According to the South African National Aids Council chief executive officer, Fareed Abdullah, the deputy director-general, Anban Pillay, is already overseeing work on potential models.
“The Department of Health is designing a mechanism to provide ARVs through courier services in the community,” said Abdullah.
“The good news is that we expect that service to become available to 300 000 patients.”
Department of Health spokesman Joe Malia said community treatment models were just one way the department wanted to tackle allegedly widespread stock shortfalls.
The department was likely to invite proposals for multiple community models but would also roll out community-adherence clubs nationwide, said Abdullah.
Piloted by Medicines Sans Frontieres (MSF), these clubs were first developed in Khayelitsha. As part of the clubs, stable, long-time ARV patients meet in the community - at someone’s house or a nearby library. A trained counsellor distributes a patient’s two-month ARV supply and does a quick check-up.
Unless counsellors pick up problems, patients see a clinician annually for a check-up and routine blood tests.
Dr Gilles van Cutsem is MSF’s medical co-ordinator for South Africa and Lesotho. He says the organisation has welcomed a national roll-out of the clubs - formally adopted by the Western Cape this year.
The Western Cape approved four-month supplies of ARVs for use in the clubs in the run-up to December, to accommodate those travelling home to the Eastern Cape during the festive season.
More than 20 percent of Cape Town ARV patients are now part of an ART adherence club, according to Van Cutsem.
Research had shown club members were more likely to stay in care and almost 70 percent less likely to see spikes in HIV blood levels. But he warned that community models of treatment might not be an answer to running out of stock.
“To run adherence clubs successfully, it’s essential to have a consistent supply of treatment,” he said. “The main challenge will be to fix ongoing drug supply chain problems.”
Moving ARVs into patients’ homes or communities will also depend on the government’s ability to roll out fixed-dose ARVs. Without these, the ARV stocks will probably remain too bulky for counsellors or couriers to carry multiple orders at a time.
In just days, world leaders will meet in Washington DC to decide the fate of one of the leading funders of HIV programmes worldwide, The Global Fund to Fight Aids, TB and Malaria.
South Africa historically has been one of only a handful of African countries that not only receives funding from the fund but also contributes to it.
While donors such as France, South Korea and the US have already signalled support, South Africa’s potential contribution has yet to be announced.
The Mercury