An HIV/AIDS care facility in South Africa's KwaZulu-Natal province is not being fully utilised because people do not know it exists. Two-thirds of the 240 beds at the Dream Centre, a step-down-care facility, are standing empty - despite the fact that the institution is located in the province with the highest HIV prevalence rate in South Africa.
According to the centre's management, the low usage is because the concept of step-down-care, which functions as an intermediary between hospital and home-based care, is relatively new and has not been integrated into provincial hospitals' response to the HIV/AIDS pandemic.
Although the centre is funded by the South African Department of Health, there has been a lack of proper cooperation between provincial hospitals and the Dream Centre, said Dr. Henry Sunpath, the medical director. Most patients are still not aware of the existence of the Dream Centre - they are denied access because of ignorance.
The Dream Centre, located in Pinetown, a suburb north of the port city of Durban, is the only such facility in KZN, where the HIV/AIDS prevalence rate is 33 percent - much higher than the national rate of 25 percent. There are less than a handful of step-down-care institutions in the entire country, added Vincent Chitray, one of the Dream Centre's social workers. Most provinces operate drop-in-centres that provide immediate aid, rather than practical long-term assistance.
The Centre integrates palliative care and rehabilitation, which it provides to HIV/AIDS patients until they are ready to return to their homes, and offers terminal care to patients in the last stages of the disease. We provide care for those who need care the most and for whom no [customised] care system exists, Sunpath explained. After the Dream Centre opened in July 2002, Sunpath visited all provincial hospitals to introduce the concept of step-down-care to doctors, nurses and other healthcare workers.
It is difficult for patients to reach the Dream Centre. According to Sunpath, public hospitals do not make ambulances available to transport patients to the centre, as HIV does not count as an emergency, and most patients cannot afford private transport.
He said institutions like the Dream Centre were critically important in South Africa, where about 70 percent of public hospital beds were occupied by HIV patients, who are mostly long-term. This drained hospitals' resources, as it cost about R800 (US 121) per day to care for a patient.
Because wards [in public hospitals] are crowded with HIV-positive persons, other patients have difficulty getting admitted and are often turned away or discharged too early, explained Sunpath. Patients did not receive adequate support, as nursing staff were either overworked or the HIV/AIDS clinics lacked resources.
Daily expenditure per patient at the Dream Centre is just R170 (US 25) because it only offers basic services, such as nursing care, medication, psychosocial support and nutrition, provided by 65 doctors, nurses, paramedics and administrators. Expensive laboratory tests are outsourced to cooperative public hospitals, such as McCord Hospital in Durban, which also sends out social workers, psychologists, physiotherapists and counsellors to provide services at the Centre.
With beds remaining empty and public hospitals showing little initiative to collaborate, Sunpath and Dream Centre general manager Les Harris have asked the KZN department of health to intervene and organise a meeting with the province's hospital managers. A date for such a gathering is yet to be set.
We need a public awareness campaign to endorse step-down-care and remove the stigma associated with a facility specifically dedicated to HIV/AIDS, Sunpath said. The government should support this campaign.
Theoretically, such a facility should be filled to capacity, as it offers treatment free of charge, although it does accept patient donations. We are government-funded, but the provided budget covers only about 70 percent of our operational costs, said Chitray, adding that the centre urgently required further funding. Patients generally stay for a short period, until they are nursed to a level that allows them to return to their homes. During this time their families are trained in home-based care, including nutrition, social support, nursing and physical care.
Patients requiring antiretroviral (ARV) treatment are referred to public hospitals participating in the government's free ARV ro