South Africa and Lesotho reports

Khayelitsha

Comprehensive TB/HIV Services at Primary Health Care Level
Khayelitsha Annual Activity Report: 2007 - 2008

Report on the Integration of TB and HIV services in Site B Khayelitsha (November 2007)
Médecins sans Frontières, University of Cape Town

Surviving Rape: An Integrated Service for Rape in Khayelitsha, South Africa (August 2006)
Médecins sans Frontières
On August 4th 2005, the Simelela Centre, a centre which previously only offered follow up care to rape survivors, extended its services3 in the grounds of Khayelitsha Community Health Centre to include emergency medical treatment. Other service providers dealing with rape were also integrated into the Centre including the police, the justice system and the department of health. Today, rape survivors can get all the care they need in the one place 24 hours a day, every day of the year.
Although these extended services are still very new they demonstrate how proximate integrated care can greatly improve the treatment of rape. This report looks at the impact of rape in Khayelitsha, and the lessons learnt from providing an integrated service. It also highlights the urgent need for community action in the fight against rape.

Report on the Integration of TB and HIV services in Site B Khayelitsha (2005)
Médecins sans Frontières, University of Cape Town
This report presents the findings after one year of integration of TB and HIV services at Site B “Ubuntu” Clinic in Khayelitsha. The rationale for the project is explored, together with the progress that has been made to date.

Comprehensive HIV Service Development at Primary Care Clinics: The experience from Khayelitsha (Activity update 2005)
Western Cape Department of Health City of Cape Town Health Services Médecins Sans Frontières Infectious Disease Epidemiology Unit, University of Cape Town
By the end of 2004, the Khayelitsha programme had been integrated into the Provincial antiretroviral (ARV) roll-out plan following the announcement of a comprehensive National Treatment and Prevention Plan (approved on November 19th 2003). The national plan aims to provide universal coverage of ARV treatment in South Africa within five years. The three existing HIV clinics initially opened by MSF are now accredited as government sites. The provincial ARV medicines' depot has taken over the supply of ARV medicines as of the end of 2004.
This report describes service developments and clinical outcomes in Khayelitsha since inception until the end of 2004.

Exploring HIV Risk Perception in a Context of Antiretroviral Treatment: Results from a household survey in Khayletisha, Cape Town (September 2003 to March 2004)
University of Cape Town, Médecins Sans Frontières, Institute for Tropical Medicine (Antwerp)
In order to better understand people’s knowledge and attitudes towards HIV/AIDS in the setting where it is implementing HIV programmes, Médecins Sans Frontières and the Infectious Disease Unit of UCT carried out a household survey in Khayelitsha township, Western Cape, in 2003.

Providing HIV Services including Antiretroviral Therapy at Primary Health Care Clinics in Resource-Poor Settings: The experience from Khayelitsha (Activity report 2003)
Médecins sans Frontières, University of Cape Town
This report describes the epidemiology of HIV and development of services in Khayelitsha, including the ART programme, and reports on adherence , clinical response, survival and occurrence of adverse events in patients on ART until the end of June 2003.

Cost-Effectiveness of Antiretroviral Treatment For HIV-Positive Adults in a South African Township (Report to Health Systems Trust, November 2003)
University of Cape Town: Susan Cleary, Andrew Boulle, Di McIntyre and David Coetzee

Implementing Antiretroviral Therapy in Rural Communities: The Lusikisiki Model of Decentralized HIV/AIDS Care: (Journal of Infectious Disease 2007: 196 (Suppl 3))
Martha Bedelu, Nathan Ford, Katherine Hilderbrand and Hermann Reuter

Achieving and Sustaining Universal Access to antiretrovirals in Rural Areas: The primary health care approach to HIV services in Lusikisiki, Eastern Cape (October 2006)
Médecins sans Frontières, Nelson Mandela Foundation and Eastern Cape Department of Health (ECDOH)

Rural Conference: TB in the World of HIV (Report and recommendations, May 2005)
Médecins sans Frontières, Nelson Mandela Foundation and Eastern Cape Department of Health (ECDOH)
Port St Johns, a small coastal town in the middle of the rural Eastern Cape, is situated in the former homeland of Transkei, now the Nyandeni local service area. In May 2005 a workshop was held in Port St Johns to discuss the TB and HIV epidemics in two districts of the Eastern Cape (Nyandeni and Qaukeni) and to plan a strategy to tackle the problem. As in most provinces of South Africa, the Eastern Cape has been affected by both the TB and HIV epidemics. HIV sero-prevalence at ante natal units is 24% and TB incidence is 675 per 100000 people.

Implementing HIV/AIDS services including ART in a rural resource-poor setting: Siyaphila La Programme - Lusikisiki, Eastern Cape (Activity Report 2003-2004)
Médecins sans Frontières, Nelson Mandela Foundation
Lusikisiki has a provincial hospital – St. Elisabeth – and 12 primary care clinics which serve a population of about 150,000 people (figure 1). Clinics are between a 30 minute and one hour drive from the hospital. Antenatal HIV-prevalence is amongst the highest in rural areas of the country. Thirty-three percent of women testing during antenatal care are HIV-infected. It is estimated that today about 1,500 people are in need of ARV treatment in Lusikisiki. The first months of the Lusikisiki programme were devoted to the implementation of basic HIV/AIDS services, co-ordinating with district and provincial authorities and supporting the Treatment Action Campaign (TAC) in building the community response to HIV. In October 2003 the Department of Health of the Eastern Cape gave the go-ahead to MSF to start providing ARV therapy in Lusikisiki. The first patients were started on ARV therapy in late October 2003. In October 2004, the Lusikisiki programme was accredited as part of the national government ARV roll-out plan. The present report aims to review key outcomes, strategies and future challenges after two years of experience providing HIV/AIDS care – including ARVs - in Lusikisiki.

Decentralising free, nurse-based HIV/TB care & treatment at the primary health care level in rural Lesotho: 2007 mid-year progress report

Ensuring Access to Free HIV/AIDS Care and Treatment in Lesotho:
A Cost Analysis of the Decentralised HIV/AIDS Programme in Scott Hospital Health Service Area

Decentralising free HIV/AIDS care & treatment in rural Lesotho: A mid-year progress report (July 2006)

“Mount Elgon: Does anybody care?”
May 2008
Médecins sans Frontières


HELP WANTED! Confronting the health care worker crisis to expand access to HIV/AIDS treatment
(May 2006)
Médecins sans Frontières
A report shows how the dire lack of health care workers in southern Africa is threatening efforts to expand access to HIV/AIDS treatment. The report covers four southern African countries - Lesotho, Malawi, Mozambique and South Africa - where more than one million people still need life-saving antiretroviral treatment but do not have access to it. Lack of action will result in unnecessary illness and death.

Scientific publications

How can South Africa’s medical profession contribute to humanitarian action?
December 2008, Vol. 98, No. 12 SAMJ

Dispatch from the medical front: Somali symbiosis, part 2: what I saw
CMAJ • December 02, 2008; 179 (12)

Dispatch from the medical front: Somali symbiosis, part 1: what I saw
CMAJ • November 18, 2008; 179 (11)

Global health-care implications of substandard medicines
November 2008, Vol 8, The Lancet

Aid Groups Target “Silent” Malnutrition
November 5, 2008—Vol 300, No. 17, JAMA

Success with antiretroviral treatment for children in Kigali, Rwanda: Experience with health center/nurse-based care
October 2008, 8:39, BMC Pediatrics

TB in disasters
September 2008, 12(10):1104, The International Journal of Tuberculosis and Lung Disease

Antiretroviral Theraphy and Early Mortality in South Africa
September 2008, 89, Bulletin of the World Health Organisation

Dealing with drug-resistant tuberculosis in Africa
6 September 2008, Vol 372, The Lancet

Trail Blazer HIV clinician and 'temporary resident' honoured
South African Medical Journal, August 2008

The untold stories of the Sichuan earthquake
2 August 2008, Volume 372, The Lancet

Substandard medicines in resource-poor settings: a problem that can no longer be ignored
August 2008, volume 13 no 8 - Tropical Medicine and International Health
JM Caudron, N Ford, M Henkens, C Mace´, R Kiddle-Monroe and J Pinel

When Best Practice is Bad Medicine: A new approach to rationing tertiary health services in South Africa
(May 2008, Vol. 98, No. 5- South African Journal of HIV Medicine)
Chris Kenyon, Nathan Ford, Andrew Boulle

Tough choices: Tenofovir, Tenders and Treatment
(Summer 2008- South African Journal of HIV Medicine)
Nathan Ford, Andy Gray, W D Francois Venter

MSF FACT SHEET: Children and HIV/AIDS
(July 2007- MSF Campaign for Access to Essential Medicines )

MDR and XDR-TB in high-prevalence HIV settings
(November 2007 - Eric Goemaere)

Report on TB Diagnosis and Drug Sensitivity Testing
(October 2006 -Martine Guillerm, Martine Usdin, James Arkinstall)

Report on Development for New Drugs for TB Chemotherapy:
(October 2006 - Martina Casenghi)

Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries (The Lancet, Vol 367 March 11, 2006 )

Registration problems for antiretrovirals in Africa (The Lancet - Vol. 367, Issue 9513, 11 March 2006)
Ford N, Darder M

Regimen Durability and Tolerability to 36-months Duration on ART in Khayelitsha, South Africa (Presentation at the Conference on Retroviruses and Opportunistic Infections - February 2006)
Andrew Boulle

Antiretroviral roll-out, antifungal roll-back: access to treatment for cryptococcal meningitis (The Lancet Infectious Diseases - Vol. 5, Issue 9, September 2005)
Bicanic T, Wood R, Bekker LG, Darder M, Meintjes G, Harrison TS

Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa ( AIDS. 2004 Apr 9;18(6):887-95.)
David Coetzee Katherine Hildebrand, Andrew Boulle, Gary Maartens, Francoise Louis, Veliswa Labatala, Hermann Reuter, Nonthutuzelo Ntwana and Eric Goemaere
The aim of this analysis is to present the early clinical outcomes for adults in a public-sector ART programme in a primary care setting in a poor urban community in South Africa.

Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa (AIDS 2004, 18 (suppl 3):S27–S31)
David Coetzee, Andrew Boulle, Katherine Hildebrand, Valerie Asselman, Gilles Van Cutsem and Eric Goemaere
Approaches that optimize adherence to therapy are essential, and remain a key challenge, especially when considering the target of reaching the large numbers of individuals who are in need of ART. Methods used to enhance adherence in the primary care setting have not been well described. The objectives of this paper are to describe the approach used to promote adherence and to present the outcomes in the first primary care public sector ART project in South Africa.

Integrating tuberculosis and HIV care in the primary care setting in South Africa (Tropical Medicine and International Health, volume 9 no 6 pp a11–a15 suppl june 2004)
David Coetzee, Katherine Hilderbrand, Eric Goemaere, Francine Matthys and Marleen Boelaert
In 2000, a pilot project was launched in Khayelitsha, South Africa to provide a comprehensive continuum of care for HIV-infected persons, including ART. However it was soon realised that a comprehensive TB/HIV service may be more advantageous due to the large numbers of coinfected patients. The purpose of this paper is to present the initial findings from a review of the HIV and TB services in this primary care setting where ART is provided, in order to assess whether they should be integrated.

Case Study: Antiretroviral therapy in primary health care: experience of the khayelitsha programme in south Africa (WHO - Perspectives and practice in antiretroviral treatment – 2003) Médecins sans Frontières, the Department of Public Health at the University of Cape Town, and the Provincial Administration of the Western Cape.
The Khayelitsha ARV treatment project was initiated to demonstrate that treating HIV/AIDS with antiretroviral (ARV) drugs in a primary health care setting and in a resource-limited environment is feasible and replicable. In addition, it aimed to prove that developing countries can provide affordable HIV/AIDS care with low-cost ARV drugs.
After two years, the programme has produced invaluable lessons, which are outlined in this paper.

Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa (Bulletin of the World Health Organisation, 2005; 83; 489-494)
David Coetzee, Katherine Hilderbrand, Andrew Boulle, Beverley Draper, Fareed Abdullah, & Eric Goemaere
This study aimed to estimate the field efficacy of the PMTCT programme in Khayelitsha, and to provide details on the antiretroviral regimens received by mothers and children.

Demystifying antiretroviral therapy in resource-poor settings (Essential Drugs Monitor, Issue 32; 2003)
Toby Kasper, David Coetzee, Francoise Louis, Andrew Boulle, Katherine Hilderbrand
Few areas of public health have generated as much debate, controversy and protest in recent years as the drive to expand access to antiretroviral therapy – the drugs that have transformed AIDS from a death sentence to a chronic condition – in developing countries. Several years ago, it was a futile discussion: with a yearly cost of US$10,000 per patient, there was little possibility of widespread access in developing countries. But, largely as a result of a potent combination of generic competition and activism, prices have plummeted, with triple therapy now being available for as little as US$209 a year1, causing a huge shift in the debate about availability.

Guidelines

HIV Clinics Counselling Guidelines (Khayelitsha - August 2003)

Community education tools