South Africa is one of the countries in Sub-Saharan Africa with one of the greatest burdens of HIV/AIDS infections (5.7 million) and the second highest estimated TB incidence per capita worldwide. In 2009, the World Health Organisation estimated that there were 490,000 incident TB cases in SA, 60% of whom were co-infected with HIV. KwaZulu-Natal has the highest number of HIV positive people (estimated 1.2 million). Here TB notification rates are high with 1094 cases per 100,000 people, compared to a national incidence of 739.6 and an emerging epidemic of drug resistant TB. This poses a major threat to the success of the ARV roll out and where the HIV and TB prevalence is high, both require local solutions. So even though TB is fully treatable and curable, it is still the biggest killer of people living with HIV in the country. The National Minister of Health has called the dual epidemics of TB and HIV “the most important public health challenge of our time”.
Fortunately, South Africa has a health minister, Dr Aaron Motsoaledi, who cares, but whose task it is to turn around the deadly legacy of his predecessor, helped by the amazing TB/HIV Care Association, founded in 1929. The Sisonke district in rural KwaZulu-Natal has extreme levels of unemployment and poverty, combined with the worst dual epidemics of TB and HIV. The Franklin area of Sisonke has no clinic and centralized primary health care has become an imperative.
Local patients spend a large percentage of their limited funds on transport to the Kokstad Hospital, which is 30 km away, and the mobile clinic visits the area only twice a month. The round trip costs patients R80 and when TB and HIV services are not integrated, patients make several trips to the hospital to be diagnosed for TB or HIV or a duel infection. Due to the high rates of poverty and unemployment, these trips have become unaffordable.
In 1997, the TB/HIV Care Association (a national organisation) introduced Project Integrate to provide a patient-centred approach to health-care by strengthening the health systems, diagnosis and treatment of HIV and TB, and sexually transmitted infections (STIs). Recruited by TB/HIV Care Association, “Nurse Mentors”- experienced nurses with advanced clinical knowledge – were employed at a health post within walking distance of Franklin.
Patients could collect medication, meet with the doctor and have an HIV or TB test without spending any money. The Nurse Mentor also liaises with the Kokstad Hospital to ensure that patients that visit the hospital have the appropriate tests and can be initiated on ARVs if necessary. Two hundred and thirty TB/HIV Care Community Health Workers are also employed and they visit patients at home, perform HIV and TB tests and encourage patients to adhere to their treatment regimes. The integration of PMTCT, HIV, TB and STIs services cut down travel costs for the patient substantially.
Being sick is no longer a death sentence because the accessibility of integrated health services means that illness can now be managed. The results are magnificent: 89% of 1433 newly-registered TB patients were also tested for HIV. In the last quarter 15 323 patients were tested for HIV and 1571 were put on treatment. All HIV+ patients were tested for TB and those who tested positive were put on TB treatment. The cumulative number of patients on ARVs is now 19 277. The promotion of decentralized services allows patients with chronic diseases to access care near their homes and to save transport costs that can be highly significant to the patients and their families. Better health also means that people can seek employment, engage in self-employment or cultivate crops.
Published in The Citizen