The Hlabisa HIV Treatment and Care Programme based in Hlabisa Health District in rural KwaZulu-Natal is a joint effort between the Department of Health and Africa Centre for Health and Population Studies. The programme began in October 2004 and aims to deliver safe, effective, efficient, equitable and sustainable ART to all who need it in Hlabisa district.
The Hlabisa sub-district provides health care to 220 000 people at the 300 bed hospital and 17 fixed primary health care clinics, with all these 17 clinics, including Philanjalo in the hospital, providing ART services. Six of these clinics are in the Africa Centre Surveillance area. Staff from both the Department of Health (DOH) and the Africa Centre are involved in implementing the programme and the partnership has been made official with the signing of a “Memorandum of Understanding”. Recently a similar MoU has been signed with the National Health Laboratory Services, which provide HIV testing and CD4 and Viral Load monitoring for the Department of Health programmes, which facilitates timely interface between the NHLS laboratory at Hlabisa hospital and the clinical programme.
The Africa Centre has provided 15 of the 17 clinics with park homes where HIV and TB services are provided. All the clinics are staffed with both AC and DOH counsellors and dedicated AC ART nurses. There are also 5 doctors that visit the clinics on a weekly or bi-weekly basis. The programme employs coordinators that are responsible for the implementation of different components of the comprehensive programme.
HIV infected people become eligible for treatment once their CD4 cell counts have decreased to a level of 200 cells per ml or less. The South African treatment eligibility criteria are due to change in 2010 to include initiation for pregnant women and TB patients at 350 CD5 cells or less and this will scale up treatment coverage for the community).
By end 2009, more than 11,000 patients on treatment with KwaMsane being the largest clinic with 2108 patients on treatment and Philanjalo at Hlabisa with 1258 patients. About 300 new individuals are initiated on treatment every month. Clinical data is recorded in ARTemis, a large operational database, which not only includes data from people on ART but also records summary information on people who are being monitored in the clinics for CD4 cell counts. The Home Based Care programme supports 24 organizations with 600 volunteers and more than 6000 patients catered for by these volunteers.
Voluntary Counselling and Testing (VCT) offered in the clinics has been improved with 10 of the 17 clinics implementing Provider Initiated Counselling and Testing (PITC). Home and Mobile VCT has been implemented to complement facility based VCT. Implementation of the two programmes has resulted in 35,200 people tested in 2009, a number of whom through VCT services that were offered during the Youth Engagement Soccer/Netball games that were taking place in the AC surveillance area. Plans are in place to implement Home and Mobile VCT services to cover the AC surveillance area and this will result in more people tested.
Using the data collected within the HIV surveillance to estimate the prevalence per primary health care clinic catchment area, we estimate that approximately 22% of all HIV infected people in the area were on ART treatment by end 2009. Most people access treatment at their nearest clinic, and access to care is facilitated by close proximity to the road and to the clinic. Dual Therapy as ARV prophylaxis for PMTCT has been implemented since 2008. Testing among pregnant women is high with 95.6% (6905 of 7267) of all women attending first ANC counseled and tested. HIV prevalence amongst pregnant women is 33%, higher than in the general population. A total of 1522 children born to HIV positive women were provided with ARV prophylaxis. Efforts to enroll more children in HIV care and treatment were eminent with much emphasis on PMTCT (PCR testing and referral for treatment). This has resulted in 1823 exposed children tested by PCR and those found positive initiated on treatment. The programme has as a result seen an increase in the number of children put on treatment (10% of the total on treatment).
TB and HIV/PMTCT services are well integrated with 80% of all TB patients tested for HIV and 100% of all HIV positive patients screened for TB. About 70% of TB patients test positive for HIV and this will result with an increase in the number of people eligible for treatment with the implementation of the revised South African treatment eligibility criteria that are due to change in 2010 to include initiation for TB patients at 350 CD5 cells or less.