Starting next month, South Africa plans to implement a massive expansion of HIV testing and treatment outlined by President Jacob Zuma last December on World AIDS Day.
Health Minister Dr. Aaron Motsoaledi insisted at a press conference Thursday that the nation’s health system is ready to tackle the challenge of testing 15 million people by 2011.
“The counseling and testing shall take place at all government hospitals and clinics, all universities and FET campuses and mobile units will be deployed to villages, rural areas and other remote areas of the country,” Motsoaledi said.
This aggressive approach to HIV marks a new era in South Africa’s response to the disease, but whether actions and a health system can back up the words is yet to be determined. People here remain skeptical, particularly given the recent controversy over the president’s decision to take a third wife after fathering a child out of wedlock.
Government leaders will test in public on April 15 to launch the campaign to test all South Africans. To increase capacity for voluntary testing and counseling the government has asked retired health care workers to undergo a one-day training and help out, and fourth-year medical students to volunteer during the campaign’s first week.
I am in South Africa now learning about loveLife, a youth HIV prevention organization. LoveLife focuses on youth development and empowerment. It works with government clinics to help them be youth friendly and has some clinics at its youth facilities, but does not focus on offering medical services. I’m not spending most of my time here visiting medical facilities and learning about the health system, but I am visiting some clinics and the largest government hospital in Soweto, Chris Hani Baragwanath Hospital.
At the first provincial clinic I went to last week in an informal community (SA’s euphamism for the ghettos blacks were contained to under Apartheid), hundreds of patients lined benches in the hallways, waiting up to four hours for care. That day, apparently, was worse than most because three of the six primary health nurses were away for training.
Chris Hani Baragwanath Hospital Soweto, the largest public hospital in South Africa
In the ARV ward of the clinic, no bench space was available. Under the HIV testing and treatment expansion plan President Zuma announced last December, patients are expected to increase because treatment will now start when patients have a CD4 count of 350 instead of 200.
“Young & full of like?” asks the sign at this health center for youth providing ARV treatment in an underserved community in South Africa
The World Health Organization released new guidelines in 2009, recommending that HIV treatment begin earlier to prevent more opportunistic infections and decrease mortality.
Other changes to HIV treatment include earlier treatment initiation for all pregnant women at 14 weeks, treating all positive infants younger than age 1 regardless of CD4 counts, treating all patients with TB & HIV under one roof. About 1 percent of South Africa’s population has TB and the prevalence of co-infection between TB and HIV is 73 percent.
Yet, it is estimated that only 4 percent of South Africans with HIV receive preventative TB treatment and only 1 percent are screened for TB.
I’m not in a position to judge whether the system has the capacity to meet these new goals, but they are ambitious. To reach the goals, Zuma said HIV services must be available at all health institutions and not siloed in separate ARV centers. The president said, “Any citizen should be able to move into any health centre and ask for counseling, testing and even treatment if needed.”
That means ARV provision will be have to expand from the current 400 facilities to more than 4,000 health centers. Beyond critical workforce implications that come with expanding ARV, what implications these new guidelines will have on patient adherence and retention remains to be seen.
