Why are we there?
- Endemic/Epidemic disease
- Health care exclusion
This is an excerpt from MSF-USA's 2013 Annual Report:
South Africa remains at the center of the worldwide HIV/AIDS epidemic. More than six million people in the country live with HIV.
Innovative models of care have been introduced over the past decade and 90 percent of patients with HIV now receive treatment through the public sector. The projects run by MSF in 2013 continued to support the empowerment of people living with HIV, by giving them more flexibility in treatment approaches and enabling them to obtain drugs and support in their home communities.
Khayelitsha, a poor township on the outskirts of Cape Town, was the site of the first primary-level antiretroviral (ARV) treatment program in South Africa in 1999, and subsequent innovations include the ARV adherence clubs, introduced by MSF in 2011. One-to-one appointments at the health center are time consuming for patients who may not have the time to queue for hours to pick up their drugs, and are an added workload for health professionals in a country where medical facilities are chronically understaffed. As an alternative, MSF pioneered adherence clubs that offer people living with HIV the opportunity to combine peer support with check-ups and drug refills at bi-monthly meetings. The model quickly became popular and between January 2011 and September 2013, 231 ARV clubs were established at 10 health facilities in Khayelitsha, enrolling a total of 7,733 patients.
Research by MSF has found that 97 percent of adherence club members continued their treatment, compared with 85 percent for patients who qualified for membership but remained in mainstream clinic care. Club patients were also 67 percent less likely to experience treatment failure.
In September, the clubs were handed over to local health authorities and are being scaled up, thanks to a US$15 million Global Fund grant. Community-based clubs are currently undergoing trials.
KwaZulu-Natal has the highest tuberculosis (TB) incidence of all the provinces in South Africa and TB remains the leading cause of death for people with HIV. It is also the epicenter of the HIV epidemic in the country, with one in four adults infected. The Bending the Curves project that was introduced in 2013 seeks to implement multiple strategies to address the high co-incidence of HIV and TB, and reduce the number of incidences in line with the South Africa National Strategic plan. These strategies include: the rapid expansion of community-based testing, greater continuity of ARV and TB treatment, faster TB diagnosis and treatment, and the aggressive promotion of prevention methods, including voluntary male circumcision and earlier treatment of HIV.
Integral to these goals are mobile one-stop shops, where people get rapid HIV testing and treatment in a single location, at the heart of the community. In 2013, teams started an outreach program of testing and health promotion targeted at mobile populations on farms around Eshowe and Mbongolwane. A stronger focus was also placed on measuring patients’ HIV viral load to monitor the effectiveness of ARV treatment, nurse-initiated management of ARV, and the promotion of ARV adherence clubs.
Improving access to generic drugs
MSF is actively involved in the Fix the Patent Laws campaign in South Africa, which aims to tighten the law so that it only grants patents to drugs that are truly innovative. This in turn would facilitate the production and/or importation of generic drugs, thus making them more affordable to people seeking treatment.
At the end of 2012, MSF had 235 staff in South Africa. MSF has been working in the country since 1999.
“Not anyone can join the club. In order to join a club you must be taking your treatment and not miss any dates. So I was able to join the club because my card was clean, because I had been taking my pills regularly.
I wanted to join the club because in a club everything becomes easy. Everything goes quickly. It’s not like at the clinic where you have to wait: you arrive at seven in the morning and then go home at four.
But when you arrive at the club your treatment is always ready for you. You’re given your pills and the people we work with, the people who give us the pills, Sis Ntosh and Sis Fanelwa, are friendly. If you have a problem you can go to them. They’re approachable. And if we have a problem we can talk about it in the group.
If I’m not feeling well, I can ask the facilitator and they refer me to a doctor. After I joined the club I found it more comfortable because I don’t sit for hours and get bored. Neighbors don’t see that I go to the clinic. At the club they try and assist with the privacy of patients."