South Africa

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Key medical figures:
• 26,500 patients on first-line ARV treatment
• 1,500 patients under treatment for TB

South Africa

South Africa remains at the centre 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 per cent of patients with HIV now receive treatment through the public sector. The projects run by Médecins Sans Frontières (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

Khayelitsha, a poor township on the outskirts of Cape Town, was the site of the first primary-level antiretroviral (ARV) treatment programme 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 centre 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 per cent of adherence club members continued their treatment, compared with 85 per cent for patients who qualified for membership but remained in mainstream clinic  care. Club patients were also 67 per cent 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

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 epicentre  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 programme 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.

Year MSF first worked in the country: 1999

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