Adherence by a primary healthcare clinic in KwaZulu-Natal to the national HIV guidelines

Background: The decentralisation of antiretroviral therapy (ART) to primary health care (PHC) was rolled-out in South Africa in March 2010. PHC staff members are expected to initiate ART, monitor patients, and detect and refer patients with adverse events or virological failure to designated referral hospitals. The aim of this study was to assess the monitoring and referral of patients on ART who were being managed at a PHC clinic.Method: This was a cross-sectional, retrospective study on 488 adult patients attending a PHC ART clinic selected by systematic random sampling between June 2011 and June 2012. Data were extracted from the patient files using a standardised data collection sheet, based on the South African national HIV guidelines for 2010.Results: Pill count, CD4 count and viral load (VL) were all well assessed by June 2011. Thirty-one per cent of patients being followed-up at the clinic had developed virological failure, of whom 84% were referred. By June 2012, 49% of the patients had developed virological failure, of whom only 52% were referred for further management.Conclusion: The PHC nurses were excellent at monitoring pill count, CD4 count and VL, but were unable to detect and appropriately refer patients with virological failure. This is of great concern, and needs urgent intervention and further research