Millions of South Africans are living with HIV so this week Siyayinqoba Beat It! looks at the government’s recent efforts to improve access to treatment. This means new and better drugs as well as earlier treatment for people co-infected with HIV and TB and for pregnant women living with HIV. One of the goals of the roll-out is to increase access to drugs like Tenofovir, so our CJs first visit Mpumalanga to find out why the drug is better and how available it is. Then in Gauteng we learn about the Department of Health’s program to train nurses to initiate anti-retroviral treatment which will ease the workload of doctors and enable more patients to access live-saving drugs faster.
In Mbombela, Susan Makhubela explains how she learned she is HIV positive in 2005 after suffering a miscarriage. She is now taking ARVs, including Tenofovir. Before she began her treatment she would quickly run out of energy but now she is getting back to her old self. At nearby Eziweni Clinic 300 out of 550 patients are on Tenofovir and it is available across the province following the roll-out in July 2010. Thembi Nkomo, an activist and patient, wants to be switched to Tenofovir because it is more accessible than other drugs, has fewer side effects and only needs to be taken once a day. First though she must take a blood test to check whether her kidneys can cope with the change of drug.
Reports from some provinces including the Eastern Cape and KwaZulu-Natal suggest that Tenofovir is not so readily available everywhere. Dr Trevor Majoro blames this on poor management at local level. The government has mandated the roll-out of the drug across South Africa so people must highlight cases where incompetency is denying them access to ARVs. The government has also announced that since the launch of the HCT campaign in April 2010, two million people have tested for HIV in South Africa. It is estimated that six million people are living with HIV in the country. These people will at some point require treatment but it is uncertain whether the health system can cope given the chronic shortage of doctors.
In response the Department of Health has begun training nurses to initiate ART. Previously only doctors could do this but in order to meet demands the department needs to utilize all of its available human resources. Training up nurses to conduct certain tasks is one way to do this and Sister Olivia Letsholo explains that she was eager to undergo more training having lost many people close to her to HIV and AIDS. She explains that the program involves knowing the treatments available as well as their side-effects, determining when to start treatment and what to prescribe a person according to their gender and condition.
To qualify, nurses must also shadow a clinical mentor until they are able to work independently. The advantages are enormous – from reducing the burden on doctors who can get on with other tasks to reaching more patients, much faster. At her clinic in Sasolburg, Olivia sees up to 300 patients a day while in total 1700 patients are on ARVs. The Department of Health meanwhile trained more than 5000 nurses between April and December last year and intends to eventually train all nurses in all health facilities in South Africa. The government has initiated the biggest ARV roll-out in the world and it will only get larger. It is a huge logistical challenge but the Health Department is planning ahead and training staff to meet it head on.