Closing the treatment gap

It's been over a year since the South African government launched its much-anticipated HIV/AIDS treatment programme, but there is growing frustration over the pace of implementation. In November 2003 the government committed itself to providing free antiretroviral (ARV) treatment to 53,000 patients by March 2004; by the end of 2004 the health department estimated the number of patients receiving the drugs at 19,500, and the target date was moved forward a year, to March 2005. The Uthukela district, along the key transport corridor between Johannesburg and the port city of Durban, is one of the worst-affected regions in KwaZulu-Natal province. "We have been very badly hit - the [HIV/AIDS pandemic] has exploded to such an extent that we are unable to cope. About 75 percent of the patients in the [Ladysmith] provincial hospital are positive," Dr Phillip Kotze, a local doctor in the main town of Ladysmith told PlusNews. Antiretroviral (ARV) drugs are not available in Ladysmith or any of the smaller towns in the district, and HIV-positive people have to travel over 150 km for treatment. But a project by the pharmaceutical company Bristol-Myers Squibb (BMS), offering not only treatment but also complementary services, has now stepped in to close that gap. Under the BMS 'Secure the Future' initiative, the Augmented HIV/AIDS Action (ACHIVA) programme provides voluntary counselling and testing (VCT), food and nutrition support, an income generation scheme and home-based care. The ARV element, which began in July 2004, follows the government's treatment guidelines and has already enrolled 160 people, achieving an adherence rate of 95 percent. Despite being on medication for just four months, 29-year-old Busi has seen significant changes in her life. According to her mother (who is also HIV positive), Busi was bed-ridden and unable to look after herself before commencing ARV therapy. "I couldn't leave the house because I had to be with her all the time. She couldn't even sit up, and putting her into a taxi to take her to the clinic was so difficult," said her mother. Busi eventually sought help from the Mpilonhle caregivers - a group of about 600 volunteers who make up the community component of the ACHIVA project. One of the caregivers assigned to Busi, Maureen Mayisela, said fear of the stigma made families reluctant to invite the Mpilonhle home-based carers into their houses. "Sometimes they won't allow us to help, and you will find the person sick and alone with no-one to help, because the family can't cope." Kotze, who also runs the project's ARV clinic, admitted there were still a number of challenges; denial and stigma were also causing people to enrol too late in the ARV clinic programme, when their immune system was badly compromised. Setting up such a clinic in a small town like Ladysmith, serving a rural population, had also presented "numerous logistical problems", he added. Although the hospital has the basic facilities for conducting HIV tests, and is accredited by the government as an ARV site, testing to establish the CD4 count (which measures the strength of the immune system) and viral load still has to be done in bigger cities. The distance patients have to travel from outlying villages into Ladysmith to get their monthly dose of ARVs is also problematic. ACHIVA is not only about the drugs: affected households and communities are encouraged to start vegetable gardens to improve nutrition and help with food security; food parcels are distributed to the most needy families. One of the concerns of staff members at the ARV clinic is that some patients, currently receiving disability grants, could default on their treatment once their CD4 count rises above the minimum required to access the grant. "Which is why ACHIVA places such a strong emphasis on looking after yourself: by being taught to grow their own vegetables and run their small chicken farming business, they won't need to rely on a grant," Kotze said. Orphans and vulnerable children are also assisted by 10 halfway houses in the district, which provide meals and assist the children with their schoolwork. Many of the volunteers have formed themselves into community-based organisations and have vowed to continue providing care, even after the BMS funding ends, and despite the risk of burnout. "We are giving them an incentive, in a way: we harness and provide a structure for existing community caregivers, and hope that they will be strengthened to attract more funding to do their work," Phangisile Mtshali, director of the BMS Secure the Future campaign in Southern Africa, told PlusNews. At some point, Mtshali noted, the provincial health department would take over the treatment programme. "We have just kick-started the process and are assisting them [government] by bringing ARVs closer to the people."