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MSF in South Africa, 2011
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In 2011, the Doctors Without Borders/Médecins Sans Frontières (MSF) program in Khayelitsha celebrated its 10th anniversary.
More than 20,000 people have started antiretroviral (ARV) treatment since 2001. The HIV treatment program in Khayelitsha, a township on the outskirts of Cape Town, was the first to provide ARV treatment in South Africa’s public sector. MSF is now focusing on new models of care, including decentralizing treatment for drug-resistant tuberculosis (DR-TB) to local clinics and bringing HIV treatment even closer to patients by offering services in community halls, libraries and private homes, in what are referred to as adherence clubs.
In 2011, the provincial government began piloting adherence groups – a concept initiated by MSF in 2007 – across the township, setting up 218 clubs in 16 facilities. Adherence clubs make living with HIV, and sticking to treatment, easier. Instead of a one-to-one appointment at the health center every month, club members go to ‘meetings’ every two months, where they are screened for symptoms and receive drug refills, and can also ask questions and share experiences, providing each other with mutual support. Club members are two-thirds less likely to experience treatment failure. More than 5,000 patients joined an adherence club in 2011.
Over the course of the year, some 50,000 people were tested for HIV, and more than 450 began ARV treatment each month, bringing the total on treatment in Khayelitsha to more than 21,800.
A new TB test
As HIV weakens the immune system, the body is more susceptible to opportunistic infections, including TB. South Africa has seen a 400 percent increase in TB cases over the past 15 years, and more than 70 percent of patients are co-infected with HIV.
In 2011, the South African government approved the use of a new automated test for TB, which can provide results far more rapidly, thus enabling people to start treatment earlier. The test can also detect TB much better than tests previously used and detect resistance to rifampicin, one of the most potent drugs used in the treatment of the disease.
Following the introduction of this test in MSF’s project in rural Eshowe, KwaZulu- Natal province, MSF has seen TB diagnoses increase from 13 to 40 patients a month. About 13 percent of the patients diagnosed with TB were resistant to rifampicin.
Treatment for DR-TB is far more complex, expensive and arduous than drug-sensitive TB. In 2010, there were 7,386 confirmed multidrug-resistant TB (MDR-TB) patients in South Africa. More than 700 patients had confirmed extensively drug-resistant TB (XDR-TB), which is even more difficult to treat.
Screening for HIV and TB in KwaZulu-Natal
The eastern province of KwaZulu-Natal has the highest prevalence of HIV in the country. At the end of 2011, MSF launched a mobile ‘one-stop-shop’, which travels around the province offering testing for TB and HIV. In its first month of operation, more than 1,000 people were tested for HIV, and 50 were screened for TB.
Future activities will include promoting prevention, such as through condom use and supporting male circumcision. The aim is to reduce HIV and TB incidence by 50 percent, in line with South Africa’s national strategic plan for 2011-2016.
Assisting migrants and asylum seekers
One-fifth of all applications for asylum worldwide are made in South Africa. The vast majority of people claiming asylum in South Africa come from Zimbabwe. In Musina, at the Zimbabwean border, MSF offered medical assistance to new arrivals outside the offices of the Department of Home Affairs and visited migrant workers on farms in the area during the day and at shelters in Musina town at night. Staff provided basic healthcare, treatment for HIV and TB – testing just under 1,900 people for HIV – and assistance for 120 victims of sexual violence, many of whom had been attacked on their journey to Musina.
Health screening in Johannesburg
Having observed that most patients attending MSF’s clinic near a church in Johannesburg came from nearby slums, in 2011 the team transferred activities from the clinic to mobile screening trucks, which visited some of the most deprived areas of the city. Before closing the clinic in August, staff conducted more than 1,100 consultations, mainly treating upper respiratory tract infections, skin diseases and sexually transmitted infections (STIs). Mobile activities began in May, and by the end of the year, some 11,100 people had been screened for conditions such as HIV, TB and STIs, and had either received treatment or been referred to public health facilities.
At the end of 2011, MSF had 149 field staff in South Africa. MSF has been working in the country since 1999.