An MSF vehicle in Rustenburg, on South Africa’s platinum mining belt. September 2019

South Africa

In South Africa, Doctors Without Borders (MSF) continues to develop innovative strategies to prevent and treat HIV and tuberculosis (TB) and provide comprehensive care for victims of sexual violence.

In 2019, our large-scale community HIV/ TB project in King Cetshwayo District, KwaZulu-Natal, run in collaboration with the Department of Health, became the first in South Africa to reach the UNAIDS 90-90-90 targets. A survey supported by Epicentre, MSF’s epidemiological research arm, revealed that 90 percent of people living with HIV knew their status, 94 percent of those were on antiretroviral treatment, and 95 percent of people on treatment had a suppressed viral load. In response to the growing phenomenon of disengagement from HIV care, we have developed services in the informal settlement of Khayelitsha to encourage patients, including those with advanced HIV, to restart treatment.

In Khayelitsha and rural Eshowe, where young people, particularly women, remain highly vulnerable to HIV, we offered preventive treatment to 204 patients. We also continued to develop different HIV screening strategies, including distributing over 30,000 oral self-testing kits. MSF supports two multinational, multi-site clinical trials: TB PRACTICAL and endTB, which aim to find shorter, less toxic, and more effective treatment regimens for multidrug-resistant TB. In 2019, the endTB trial enrolled its 48th patient at the Khayelitsha site, and two new sites, Durban and Johannesburg, were added to the TB PRACTICAL trial, with a total of 70 patients enrolled by the end of the year. We welcomed the registration of the newer TB drug delamanid, and we continue to push for improved treatment for the disease nationally.

Sexual violence

MSF works with the provincial health department to provide victims of sexual violence with essential medical and psychosocial care through community clinics known as Kgomotso Care Centres on South Africa’s platinum mining belt. In 2019, we handed over two of the four clinics to the department. We also launched initiatives to identify victims of sexual violence, for example through our school health program, which reached 26,000 students. Community-based initiatives accounted for at least 160 of the 1,294 new patients seen in 2019.

To meet the high demand for pregnancy termination, we trained 23 health providers in safe abortion care. In MSF-supported facilities, an average of 209 abortions were performed monthly in 2019.

Molefe Goodwill Motsilenyane, MSF Driver - from Rustenburg

MSF in South Africa in 2019

Since 2015, MSF has been working with the North West Department of Health to expand access to free, high quality and confidential care for survivors of sexual and gender-based violence in Rustenburg’s Bojanala district through four dedicated clinics, known as Kgomotso Care Centres.

Migration

In Tshwane, we opened a hub offering medical and psychosocial care to migrants, refugees, and asylum seekers, who struggle to access public health services under South Africa’s increasingly restrictive migration policies. In 2019, 668 people received medical and psychological support, and 456 attended group mental health sessions. In addition, our emergency teams responded to episodes of xenophobic violence against migrants in three provinces.

Access to medicines

We continue to call for wider availability of lifesaving drugs by addressing the patent, registration, and financial barriers that prevent their supply. Through a national access program set up by MSF, we donated 610 courses of flucytosine – an effective cryptococcal meningitis treatment not yet registered for use in South Africa – to 15 specialist facilities across the country. The program seeks to build evidence to support its registration as an essential medicine.

No. staff in 2019: 227 | Expenditure in 2019: €11.9 million | Year MSF first worked in the country: 1986

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