Ncayiyana, Daniel J

English

South African Medical Journal (SAMJ)

To the country’s collective sigh of relief, the South Africangovernment announced on 8 August 2003 that it would provideanti-AIDS drugs free of charge in the public sector, therebyputting an end to years of controversy marked by court battlesand other forms of confrontation with the Treatment ActionCampaign, the South African Medical Association and other civilsociety formations. And on 20 November 2003, the Cabinet approved the‘Operational Plan for the Comprehensive Treatment and Care forHIV and AIDS’ (the Plan) prepared by the Department ofHealth. In this well-considered plan, the provision ofantiretroviral (ARV) treatment in the public sector is but one of anumber of strategies to deal with the HIV and AIDS epidemic.The Plan proposes designated HIV and AIDS service pointsacross the country, and envisages that, within a year, there willbe at least one service point in every health district (there are 56health districts altogether) and within 5 years, one in everymunicipality. ‘Some areas will be able to start sooner than others,and the Department of Health will keep the public informed ofthe progress of the rollout’ according to Minister MantoTshabalala-Msimang.The government is quite rightly determined that the provisionof ARV treatment does not detract from the broader campaignagainst the HIV/AIDS pandemic.  Other elements of the plantherefore include ‘stepping up the prevention campaign so thatthe 40 million South Africans not infected stay that way;improved efforts in treating opportunistic infections for thosewho are infected but have not reached the stage at which theyrequire ARVs, and intensified support for families affected byHIV and AIDS’. A potentially controversial proposal is to‘expand programmes aimed at boosting the immune system andslowing down the effects of HIV infection, including the optionof traditional health treatments for those who use these services’.There is currently an unprecedented local and global focus onthe funding of ARV treatment to AIDS victims on the Africancontinent. The World Health Organisation’s ‘3 by 5 Initiative’seeks to get ARVs to 3 million AIDS sufferers in the developingworld by 2005, while the Clinton Foundation HIV/AIDSInitiative intends to provide treatment to as many as 2 millionpeople in Rwanda, South Africa, Mozambique, Tanzania and theCaribbean by the year 2008. The Canadian government and theUS Bush administration have both pledged significant resourcesin this regard. Here at home, SAMA has launched its owntreatment programme, called the Tshepang Campaign, and thegovernment plans ultimately to devote 11.5% of current publicsector health spending — an equivalent of US$687 — to theprogramme by 2007.One of a kindThe envisaged South African ARV treatment programme will bethe largest in the world, without precedent in its sheer size andscope. In no other country has a universal AIDS treatmentprogramme involving the sort of numbers we are talking aboutin the Plan been attempted.  In Zambia, only 7 000 people arecurrently receiving drug treatment, with plans to increase thisnumber to 10 000. Malawi recently unveiled plans to providetreatment for up to 50 000 people, using a grant from the GlobalFund.This column has previously underscored the mammothlogistical and human capacity challenges confronting theimplementation of an ARV treatment programme of themagnitude envisaged for South Africa. These include theprerequisite to train appropriate staff — counsellors, socialworkers, nurses and doctors; the need to ensure the reliablesupply and the secure local storage of specialised drugs; theneed for access to essential laboratory monitoring; the challengeof ensuring the reliable tracking of possibly millions of patientsunder treatment; the threat of non-compliance and treatmentinterruption leading to widespread drug resistance; and so forth.A news item on the Health Systems Trust website dated 19December 2003 observed that ‘despite the government’s decisionto roll out the provision of ARVs, a lack of planning has meanttemporary [drug] shortages — and could presage future crises ifproblems are not dealt with. An interruption in ARV treatmentcould have serious health consequences for people on aprogramme of treatment. Inconsistent supply of ARVs could kill[patients] sooner than the disease itself.’The Plan has anticipated these potential difficulties. The finaldraft drawn up by the department’s ARV task team has set asidea significant portion of funds for the training of thousands ofnurses, doctors, laboratory technicians, counsellors and otherhealth workers.The place of nutrition in the management of people livingwith AIDS has been the subject of some controversy in SouthAfrica, where some voices were understood to be advocating itas the sole remedy. There is general agreement, however, thatgood nutrition has an important role to play in the preventionand management of HIV and AIDS, as with any other seriousillness. In this regard, Lucy Steinitz of Namibia’s Catholic AIDSAction has expressed concern about the region’s drought andfood shortages affecting more than 6.5 million people that, shesays, will make the task of managing AIDS even more difficult. The controversies over the government’s position on thecausation of AIDS have served to obscure South Africa’s gains ofthe last few years in the fight against HIV, including thesuccessful campaign for affordableARV prices in the region. The implementation challengesnotwithstanding, and given theworldwide scorn we have had toendure over the last few years, thePlan represents a bold andimportant initiative whose timehas come.Daniel J NcayiyanaEditorSOUTH AFRICAN MEDICAL JOURNAL –FIRST PUBLISHED JANUARY 1884February 2004, Vol. 94, No. 2 SAMJAntiretroviral treatment roll-out policy is in place — nowfor the implementation challenges

Antiretroviral treatment roll-out policy is in place - now for the implementation challenges

http://samj.org.za/index.php/samj/article/download/2493/1755

Antiretroviral treatment roll-out policy is in place - now for the implementation challenges

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South African Medical Journal (SAMJ)