Aggressive programmes to treat HIV-positive people using highly active antiretroviral therapy could reduce the number of new HIV cases by as much as 60 percent, according to a study published on Tuesday in the Journal of Infectious Diseases, Toronto's Globe and Mail reports.
HIV/AIDS and Health Sector Responses in South Africa: Treatment Access and Equity - Balancing the Act
This paper is one of a series of papers commissioned by the Regional Network for Equity in Health in Southern Africa (EQUINET) for a programme of work with Oxfam GB on Equity issues in HIV/AIDS, Health Sector Responses and Treatment Access in Southern Africa. This programme of work seeks to inform the policy debates and advocacy that have grown around health sector responses to HIV/AIDS in the region. This paper reviews the equity challenges and concerns related to access to HIV/AIDS programmes in South Africa, with a focus on antiretrovirals. The information contained in the paper was gathered through a literature review of local and international publications, grey print and personal communication with key stakeholders.
It is clear that large-scale treatment for HIV will depend on re-thinking the use of human resources if it is to have public health benefits. Health care staff working in multi-disciplinary teams providing long-term HIV care may find their roles changing over time in ways that will need careful management. The role of nurses is of particular importance in many settings, and there is clearly scope for expanding that role with appropriate training and support. Nurse practitioners trained to prescribe a range of medicines and nurse-led clinics are among the options that need to be explored. Specialised pharmacists can also take on a major role in supporting people with HIV on treatment. A system that chooses first-line regimens that can be managed with limited direct involvement from doctors will be able to make more use of other health care staff in managing them. Human resource issues are therefore directly connected with the development of national treatment guidelines. Lay involvement, starting with peer support, may also be needed for a successful large-scale treatment programme. A variety of models for peer support and treatment education are available for use. Social stigma doesn't automatically disappear when services are established (though treatment certainly helps to overcome it). As well as training, resources are needed to prevent occupational exposure to HIV. Continuing professional support and development are needed by all staff involved in delivering HIV treatment, and not only in relation to ARVs.
Drugs programme at AngloGold has worked better than expected so far. At last, a success story about HIV/AIDS. It comes from AngloGold, whose initial provision of antiretroviral drugs (ARVs) to its miners has exceeded the expectations of management and silenced sceptical physicians who feared workers would not take the drugs in the prescribed manner. AngloGold estimates that 25%-30% of its workforce is HIV-positive. After much internal debate, the mining giant started its highly active antiretroviral therapy (HAART) trial programme in November 2002 with just over 100 miners at Western Deep Levels and the West Vaal Hospital. Results to the end of March this year are encouraging. Public affairs manager Alan Fine says AngloGold's three main concerns have proved unfounded: - That there would be many cases of serious side-effects; - That adherence to medical orders would be low; and - That workers on ARVs would not be able to return to productive work. Most significant are the high rates of compliance, with only sporadic reports of workers failing to take their ARVs. This has surprised AngloGold's physicians, who have typically experienced compliance rates of only 20%-50% among miners on long-term medication. Kruger attributes the high rate of compliance to a programme of intensive counselling that starts two weeks before an employee gets the first ARVs. AngloGold found 90% of all company miners accepted the HAART programme. Those who declined to participate did so because of denial of their HIV status or because they thought the drugs would not help, among other reasons. Five months into the programme , 93% of the 113 people enrolled were still taking their ARVs. Of these, 57 experienced mild, manageable side-effects; but three cases of severe side-effects were also reported, including hepatitis, anaemia and severe diarrhoea. Two patients stopped treatment because of the unwanted effects. Three patients who started treatment with very low CD-4 counts were on ARVs for only a short period before dying of tuberculosis. Though the initial phase of the programme has been successful, Kruger warns of difficulties that may lie ahead. She is particularly concerned about the possible emergence of serious side-effects associated with the long-term use of ARVs. The one likely to cause the most difficulty for miners working underground is peripheral neuropathy, which causes loss of sensation in the extremities. Kruger is also concerned that adherence rates will fall over time as workers become complacent about their health. And there is always the danger that those receiving treatment will revert to risky sexual behaviour. To counteract these dangers, AngloGold is placing a renewed emphasis on HIV workplace prevention this year. It is easy to become so focused on ARVs that you neglect the bigger picture, says Kruger. The company has learnt several lessons since initiating broad-based HIV/Aids workplace programmes in 1985. They include: - Avoiding the misconception that ARVs alone will stop the epidemic; - Focusing on intervention programmes that generate behaviour change. The importance of collaborating with labour. Even though this appears to slow the process of developing the programme, it is essential to inculcate the trust required to obtain high levels of behaviour change and programme acceptance. Also the need to spend less time on risk analysis, which can easily produce unreliable estimates, and more time taking action. Given the success of the trial, HAART is now made available to all employees who meet the medical eligibility criteria - roughly 25% of the company's HIV-infected workers. AngloGold hopes to conduct 4 000 voluntary testing and counselling sessions and enrol a further 820 employees in the HAART programme by the end of 2003. Fine says the company will continue to provide ARVs to workers through its own health care infrastructure even if the state introduces a national ARV programme (see Business June 13). But workers who leave the company will have to fall back on a government programme. AngloGold, like other large companies, offers ARVs to infected staff only while they remain in its employ. (Source: Financial Mail 4 July, 2003). http://free.financialmail.co.za/03/0704/currents/bcurrent.htm