Slowly closing the treatment gap

South Africa is falling short of the AIDS treatment targets set by the World Health Organisation (WHO) '3 by 5' campaign, according to a new report. The report, which covered progress on the initiative to place three million HIV-positive people in the developing world on treatment by the end of 2005, found that between 10 percent and 14 percent of South Africans living with HIV/AIDS were being treated. In KwaZulu-Natal (KZN), one of the provinces hardest hit by the pandemic, nearly 12,200 patients have been receiving antiretrovirals (ARVs), but the province's rollout has been plagued by long waiting lists and too few health facilities distributing the medication. A new initiative by the provincial health department has now stepped in to shorten waiting lists at public hospitals prescribing ARVs. KwaZulu-Natal will soon become the first province to allow community healthcare centres to test patients for the HI virus and screen HIV-positive patients' viral loads and CD4-counts (which measure the strength of the immune system). Until now, these tests have been carried out at larger health facilities, due to the high cost of the equipment. The first clinics to be accredited are in Cato Manor, a poverty-stricken informal settlement on the outskirts of the port city of Durban, and Bothas Hill, which services the entire Valley of a Thousand Hills, a semi-rural area with little infrastructure and a population of more than half a million. People from the Valley have to travel either 40 km to Addington Hospital in Durban or about 30 km to the R.K. Khan Hospital in Chatsworth, the nearest rollout sites. Over the next few months the provincial health department plans to accredit a total of 14 clinics in KZN's 11 health districts, said Roger Phili, deputy director of the KZN health department's ARV programme, during the monthly AIDS forum of the South African Medical Research Council. According to World Health Organisation guidelines, patients with a CD4 count of below 200 are in stage IV of the illness; they qualify for ARV therapy and will be referred to the nearest rollout site for treatment. Phili noted that this move would "release pressure on hospitals" struggling with high patient intakes and staff shortages. Some of the rollout sites had "already reached capacity" and "cannot take more patients", he added. It took an average of six weeks "but sometimes months" for patients to receive their first drug supply after they had qualified for treatment, depending on which public hospital they went to, said Phili. Some community-based organisations have reported a waiting period of up to a year to have a CD4 count taken. Stressing that the government was still at the early stages of the treatment programme, Phili acknowledged that "we are aware that some patients die in the process" and added "that's why we are vigorously extending [the] screening [process] to clinics to shorten waiting lists". While over 11,000 of the people receiving treatment in KZN are adults, only 1,079 of the province's HIV-positive children are receiving ARVs. Phili noted that the number of children on ARVs was "still low" and there were "lots of problems" in the paediatric rollout because many were orphans without "stable caretakers" who could help them adhere to the strict drug regimen. He attributed the low figures of people - adults and children - receiving the medication to the high dropout rate of patients after the initial screening process. More than 65,500 CD4 counts had been taken in the province, but less than 22,000 patients attended the first of the three ARV literacy sessions required before starting therapy. About 18,700 patients came to the second session, while only 17,300 attended the third, and only 12,200 started lifelong therapy. Although no research had been conducted to determine why so many patients dropped out of the programme, Phili said some of the reasons could be difficult socioeconomic conditions and the long travelling distance to hospitals. The provincial department expected to provide the life-prolonging medication to an additional 18,000 adults and children by March 2006. ARV rollout targets for provinces are not publicly available, but with an estimated 50,000 people now being treated nationally, the country is close to reaching its target of treating 53,000 people by March 2005 - admittedly a few months past the deadline.