MSF Projects in South Africa
MSF has pioneered approaches to treat HIV in South Africa since 1999– both by being one of the first providers of antiretroviral treatment in the public sector, as well as by decentralizing HIV treatment strategies and by integrating tuberculosis (TB) treatment. In Khayelitsha, the largest township in the Western Cape, MSF put the first patient on ARV treatment in May 2001. Having helped scale up treatment to more than 20,000 people in Khayelitsha over the last 12 years, today MSF managed to handover almost all patients on first line ARV treatment to the national health system.
Pioneering Treatment Models in Khayelitsha
Today, MSF continues to provide support to clinics in Khayelitsha through mentoring and operational research on HIV and TB treatment, and pilots community-based treatment models to relieve the burden on the strained health care system and on people living with HIV (PLHIV). One of these models are adherence clubs in community sites outside health facilities and in patients’ homes. Instead of attending one-to-one appointments at the health centre, adherence club members go to meetings every two months for a check-up and drug refill, and to talk to other patients. MSF’s analysis found that 97 per cent of club members stayed in care, while the figure was 85 per cent for patients who qualified for club membership but remained in mainstream clinic care. By the end of 2012, there were 180 clubs, with more than 4,500 members, at nine health facilities in Khayelitsha. The Western Cape Department of Health has also set up more than 400 clubs.
Incidence of drug-resistant tuberculosis (DR-TB), a form of TB that demands two years of arduous treatment that can have painful side effects, is particularly high in Khayelitsha. Close to 200 patients, including those with multidrug-resistant TB and extensively drug-resistant TB, were started on treatment at their local clinic in 2012. This MSF pilot project has contributed to changing South African health policy towards decentralised management of DR-TB, which is critical to addressing the DR-TB epidemic.
Increasing access to testing and treatment in KwaZulu Natal
MSF’s programme in KwaZulu-Natal, the province has the highest HIV prevalence in the country, aims to radically increase testing and treatment coverage in order to significantly reduce incidence of HIV in the supported communities of Eshowe and Mbongolwane over the next five to seven years. As part of this strategy and in agreement with the Department of Health, MSF teams provide mobile testing units, door-to door testing teams and aims to implement the 2013 WHO guidelines for treating HIV, which include initiating PLHIV at an earlier stage of their disease, i.e. at a CD4 count of 500, offer advanced prevention of mother to child transmission treatment (PMTCT B+) and review needs of couples in which only one partner is HIV+ (sero-discordant couples)..
By end March 2013, the team had tested more than 36,500 people through its mobile one-stop shop, more than tripling the number for 2011. This was in part a result of work with community leaders and traditional healers to gain acceptance for testing and treatment. In 2012, 2,200 PLHIV were initiated on antiretroviral (ARV) treatment and access to CD4 counts more than doubled. The number of viral load tests done increased more than 10 fold from around 350 in 2011 to over 3,800 in 2012, facilitated by the teams’ training and mentoring of health staff, so that more people are having their treatment monitored.
Assisting mobile populations
The Musina project, near the Zimbabwe border, is in the process of handing over activities to the Department of Health and other organizations in October 2013. The project had began as an emergency intervention responding to xenophobic violence in 2007 but later evolved into an innovative approach involving mobile clinics for asylum seekers and survival migrants scattered across a vast agricultural region. Today, 500 farm workers have been put on HIV treatment, while thousands more receive primary health care which is otherwise largely inaccessible in the area. MSF hopes that the adapted model of care for mobile populations such as the farm workers, including a “health passport,” special counselling, drug supplies and a roadmap of ARV clinics, will be adopted and adapted in other regions of the world with high burdens of mobile populations.