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South AfricaIn South Africa it is estimated by the UN that over 5.5 million people are HIV positive and about a million are in urgent need of anti-retroviral treatment (ART), half of whom are still waiting. Tuberculosis (TB), including drug-resistant TB, is the leading cause of illness and death among those living with HIV. At the same time, South Africa has become the leading destination in the region for migrants fleeing economic and political chaos in neighboring countries in search of jobs and safety. An estimated 2,000 - 6,000 people cross the border every day. Despite a constitution that guarantees healthcare for all, access to services for this group is far from assured. Providing HIV/TB treatment in a townshipSince May 2001, MSF has been providing primary care level HIV/AIDS treatment in the township of Khayelitsha, on the outskirts of Cape Town, in partnership with the Western Cape Province Department of Health. MSF has progressively handed elements of the program over to provincial and local health authorities but continues to support TB and HIV services. MSF introduced an integrated TB/HIV clinic in the country in 2003. The Khayelitsha program has the oldest group of patients on AIDS treatment in the public sector on the continent. A special priority has, therefore, been set together with partners, particularly the University of Cape Town, to monitor and evaluate treatment results. As of December 2007, nearly 9,000 people had been started on ART in clinics supported by MSF, including almost 3,000 who have been on treatment for more than two years. More than 200 new patients were started on ART monthly but this rate was threatened by complete saturation of existing sites and severe shortages of health workers. To cope with the ever increasing number of patients and with the goal of reaching 15,000 people by 2010, MSF focused on delivering HIV services in new decentralized health centers using a nurse-based model of care, improving clinic organization and triage of patients, re-defining staff roles and training. MSF also launched new strategies to address the challenges of long-term adherence to ART, including creating ‘adherence clubs’ for stable patients on ART for at least 18 months with no complications. Given the extremely high incidence of TB in the township and because 70% of TB patients are also HIV-positive, MSF introduced an integrated TB/HIV clinic in the country in 2003. Since then Ubuntu has become one of the busiest primary care clinics in the province. Efforts were made to improve diagnosis of drug resistant TB in Khayelitsha, strengthen TB infection control and develop a decentralized community-based model of care. MSF continues to coordinate the township’s Simelela Centre for Survivors of Sexual Violence, which provides medical care, psychosocial support, forensic examination and police assistance to rape victims in one setting open 24 hours a day, seven days a week. In 2007, nearly 1,000 survivors of sexual violence attended Simelela. Improving access to care for migrantsIn late 2007 and in response to an increasingly dire situation, MSF carried out an assessment and started providing essential healthcare to migrants, primarily from Zimbabwe. In the border town of Musina, Limpopo Province, MSF provides primary healthcare through mobile medical teams on farms and in townships. In Johannesburg, MSF opened a small clinic next to the Central Methodist Church where 1,500 migrants seek refuge every night. MSF provides basic care and enables access to public health services and more specialized care through a referral network. MSF has worked in South Africa since 1999. |
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