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MSF in South Africa, 2006/2007
Field Staff: 50
Reason for Intervention:
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An estimated 19 percent of the South African population, or approximately 5.5 million people, are infected with HIV . Yet only a quarter of the approximately one million people requiring treatment are receiving it. Since 1999, MSF has been providing HIV care in poor areas of the country with a high prevalence of HIV infection. The major challenges are an increase in tuberculosis-HIV co-infection and the lack of health workers to cope with the increasing number of patients.
At the end of 2006, MSF started providing comprehensive HIV care - including anti-retroviral (ARV) treatment - in two additional clinics in Khayelitsha, the largest township near Cape Town. MSF has handed over most elements of the program to provincial and local authorities, but continues facilitating the decentralization of care, addressing the challenges of long-term adherence to ARVs and facilitating integration of HIV and TB services. Since May 2001, MSF in partnership with the Western Cape Department of Health has been providing AIDS treatment at the primary care level.
Decentralization is a response to the high demand for services that has saturated existing clinics, and to the projected 15,000 people who will need to start treatment by 2010. Today, the Khayelitsha program provides ARV therapy to over 6,000 people. Whilst more than 200 patients are started on ARVs monthly, this rate is threatened by the lack of health staff. To cope with the increasing number of patients, intense efforts toward clinic organization, patient triage, re-definition of staff roles, and training are being implemented.
Integrating tuberculosis and HIV care
Given an extremely high incidence of tuberculosis (TB) in the township; a high level of TB-HIV co-infection (approximately 70 percent); and the different manifestations of TB in HIV positive patients; an integrated response to the TB-HIV epidemic has been in place since 2003. Ubuntu Clinic in Khayelitsha is the first in the country that provides integrated TB and HIV care. It has become the busiest primary care clinic in the province, indicating a good acceptance of the model by patients.
In October 2006, after four years of collaboration, MSF handed over all the components of an HIV program in Lusikisiki to the Provincial Government of the Eastern Cape. Since early 2003, MSF and its partner, the Nelson Mandela Foundation, were implementing a decentralized model for HIV care, including ARV therapy, in one of the most underresourced rural areas in the country. Because of intense efforts to promote voluntary counseling and testing for HIV and the implementation of medical services, over 40 percent of the adult population in Lusikisiki now know their HIV status. At handover, more than 80 percent of the people requiring ARVs were receiving the treatment they need.
Complete care for rape victims
MSF also continues to manage the Simelela rape survivors centre in Khayelitsha, a response to the high degree of sexual violence against women and children in the slum. Simelela provides medical care, psychosocial support, forensic examination, and police assistance to rape victims in a one-stop service.
MSF has worked in South Africa since 1999.