Putting the government’s HIV/Aids plan to the test

North West Province

The high prevalence rate (29,9%) in the province has led to the provincial health department speeding up its plans to deal with the pandemic and roll out anti-retrovirals (ARVs).

Provincial health spokesperson Barba Gaoganediwe says his department has allocated close to R50-million for voluntary counselling and testing (VCT) and prevention of mother-to-child-transmission and sexually transmitted infections.

Gaoganediwe says the province is on track with the implementation of the national government’s comprehensive plan for the management, care and treatment of HIV/Aids in three of the four accredited sites in the province.

“As of October more than 5 000 new patients have been to the three service points and approximately 1 124 patients are being treated at these points,” says Gaoganediwe.

“We want to treat at least 1 500 people by the end of December …”

He adds that they want to reach 15 000 people in the next five years.

Although Gaoganediwe is excited and encouraged by the number of people visiting the sites, he says the department is faced with huge challenges, such as the recruitment and retention of nurses and doctors in rural areas.

This year the department was allocated R70-million for the HIV/Aids programme, including R29-million for ARVs, which includes procurement of drugs, upgrading and staffing.

Gauteng

Although Gauteng has not, for the past 10 years, formally monitored the impact of Aids on the health-care system, 2002 records indicate that 64% of the people between 25 and 34 years of age admitted to state hospitals were infected with HIV.

According to Dr Nomonde Xundu, the director of HIV/Aids, STI and TB (HAST) in the health department, the province experienced a sharp rise in the prevalence of HIV among pregnant women between 1997 and 2001.

With regard to the roll-out of ARVs, Xundu says 19 hospitals in the province are providing the drugs, and the province plans to expand the programme to 80 facilities by 2009.

Meanwhile, “by November 5, a total of 49 268 people have been assessed, of whom 5 588 adult and 800 children received ARVs”, says Xundu.

The province has a total budget of R334 231-million for the year 2004/05.

Limpopo

On a national level Limpopo is rated the third lowest (17,5%) in terms of HIV-prevalence.

The provincial health department has put initiatives in place, including home-based care.

“There are currently 500 sites for home-based care, which assist in networking, training and the provision of kits,” says spokesperson Phuthi Seloba.

Since October more than 2 000 patients have been assessed. Three hundred adults and 40 children are on ARVs, which they receive from eight sites launched in August. From April next year the province intends to roll out the ARV programme in 30 district hospitals and 22 community health centres.

The province has R80-million for the Aids programme this year and R120-million for next year.

Northern Cape

The national comprehensive plan in the province has been running for about three months, and has already registered about 1 200 patients who qualify for ARV treatment. Of those, 250 patients have already signed on. About 500 patients with a CD4-count of more than 200 have also been assessed. One of the targets set by the department is to reduce the number of new HIV-positive cases by 50%. R31,8-million has been budgeted for this financial year.

Eastern Cape

The province is well on its way to reaching its target of treating 2 750 HIV-positive patients by early 2005. In May the Eastern Cape health department launched the national government’s comprehensive care and treatment plan. Targets on the rolling out of ARV treatment to patients were set at 2 750 and six months later the department has reached more than 90% of its goal.

About 2 000 patients, 135 of them children, have been registered and are receiving treatment at 11 sites. A budget of R40-million has been allocated and about R22,6-million has been spent in this financial year on ARV treatment.

A regional training centre has been established at the University of Transkei and provides HIV/Aids training to nurses, health workers, doctors and social workers. The centre is jointly funded by the Department of Health, Columbia University in the United States and Central Disease Control South Africa. So far, about 1 000 health professionals have received training at the centre.

Media liaison officer for the provincial health department, Sizwe Kupelo, says the department is negotiating the establishment of more sites.

Western Cape

The Western Cape health department is considered one of the more efficient as far as the roll-out of ARV treatment is concerned. It is estimated that about 12 000 people are in need of treatment and so far about 5 500 people, 1 000 of them children, are receiving ARVs.

The province has 31 treatment sites, including remote districts such as Beaufort West and Vredendal.

The Western Cape Aids programme has a total budget of R119-million, of which R29-million is a grant from the Global Fund.

The five-year plan aims to have about 40 000 people on treatment and to reduce the percentage of mother-to-child-transmission to less than one percent. Dr Faried Abdullah, deputy director general of district health service and programmes, says that by 2010 25% of health care visits will be HIV-related.

Free State

In October 260 ARV patients were treated at sites in the Free State — a long way short of the target of 2 127 by March 2005. However, the Free States ARV roll-out plan is on track as far as its aim to establish five ARV sites by March 20 is concerned. Currently the province is providing ARVs for patients at one regional hospital and four district hospitals that work with three related assessment clinics.

A budget of R30-million has been allocated for this year and R60-million for next year. The programme makes provision for one doctor per 500 ARV patients and 150 ARV patients per professional nurse. There is provision for 12 community counsellors per 150 patients. The roll-out plan is targeting 16 additional ARV sites at 16 hospitals.

Mpumalanga

Despite R67-million allocated for Aids programmes in Mpumalanga, the province is not likely to reach its target of 1 934 ARV patients by March 2005. Mpumalanga is currently only treating 378 people — a small increase from the 130 patients reported in July this year.

The province currently has eight ARV roll-out sites, though the national Department of Health declared in October this year that it already had 12 sites, which is the target for 2005.

Media liaison officer Dumisani Mlangeni said the major problems facing the Mpumalanga health department were the lack of both human and capital resources, having to combat the stigma attached to Aids and having to treat patients from neighbouring countries. Mlangeni also cited the high costs of long stays in wards and the prevalence of HIV/Aids amongst health care professionals in the province as other major obstacles.

KwaZulu-Natal

KwaZulu-Natal, with the highest HIV/Aids prevalence rate in the country at about 38%, is falling way short of its March 2005 ARV patient target of 20 000. The province is currently treating only 3 247 adults and 167 children at 31 sites — the highest number of roll-out sites in the country.

A further 16 sites have been recommended for accreditation by the national advisers. A conditional grant of R64-million has been made available for the roll-out of the ARV treatment programme.

Manager of the ARV unit, Dr Chris Jack, said the province’s five-year plan includes full coverage of ARV roll-out in KwaZulu-Natal and a general strengthening of staff, infrastructure and health information systems.

Jack said a group of skilled health care workers would be trained to provide high-level care for HIV/Aids patients. Education and prevention campaigns would be mobilised in communities. The health department is currently putting 160 medical officers through a year-long HIV/Aids course and a further 400 health care workers are being trained at clinics by the Reproductive Health Research Unit.

Treatment sites