By: Lunga Memela (Communications Engagement Lead)
63-year-old Community Caregiver, Mama Nelisiwe Mthabela, remembers how of the home delivery of antiretroviral therapy saved many lives in her community during COVID-19 Lockdown Level 5.
The fear, confusion and overall devastation that came with the COVID-19 pandemic, together with strict Level 5 lockdown regulations in South Africa, had many patients refusing to leave their homes, even when they needed to attend their nearest health facilities for check-ups and to collect their chronic medication, including HIV treatment, despite medical travel being permitted in the country at the time.
This raised serious concerns for dedicated healthcare professionals at Sigweje Clinic in the Alfred Duma Sub-district of KwaZulu-Natal's uThukela Health District – a renowned former Siyenza high-performing facility ‒ in response to this new challenge presented by the COVID-19 outbreak. Patients were missing clinic appointments, thereby risking treatment interruption, so an important strategy to deliver antiretroviral therapy (ART) to HIV-positive patients residing in nearby communities was introduced.
The U.S. Centers for Disease Control and Prevention (CDC) has supported care and treatment programmes in South Africa through a results-oriented initiative focused on scaling up proven public health interventions at the clinical level, especially identifying people living with HIV, initiating them on lifesaving treatment, and finding innovative ways to ensure their treatment continuity to achieve suppression of the virus.
Funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the CDC, the Health Systems Trust's (HST) SA SURE Project had long been supporting the Department of Health's TB and HIV programmes in uThukela when COVID-19 hit. The impact of the community-based ART delivery initiative was featured in a Spotlights Compendium launched in May 2022 by the University of California San Francisco's (UCSF) Optimizing Performance by Improving Quality (OPIQ) Project in efforts towards better management of TB and HIV in South Africa through shared best practices and innovative activities.
Taking ART into the community
HST's Acting District Co-ordinator, Mesuli Ntshalintshali (pictured above), explained that when patients started to miss their appointments due to COVID-19, facility staff had to make a plan to preserve the total number of patients remaining on ART (TROA) at 28 days. Clinic staff set out to decrease the number of patients on the Late Appointments list from 1.2% of the TROA in March 2020 to less than 1% by May 2020, using home medication delivery as an emergency response.
This was achieved by working closely with DoH-employed Community Caregivers (CCGs) such as Clinic Committee member Mama Nelisiwe Mthabela (pictured below), who, together with HST Campaign Agents (CAs), were allocated a set of patients grouped by location from the Late Appointments list. This emergency response was made possible by the collaboration of Community Health Workers (CHWs), as the intervention is labour-intensive and requires implementers to have excellent knowledge of the community context, as well as trust in them from the community. This work also strengthens a sustainable response for ongoing community-based support beyond the home deliveries that were necessitated by the lockdown conditions, through the establishment of outreach points.
Mama Mthabela started working as a Community Caregiver in 2007. Her testimonial on the reward she gets from promoting clinic services within the communities leaves any listener in awe of her passion for people, health and wellness. She said that the community really loves this particular clinic. "People come from far from wide to this one. The nurses here are caring and extremely dedicated." This is why she does what she does, and she wishes that the facility had even more nursing staff to lighten the workload.
Rolling out the project, Mama Mthabela and fellow CAs spent hours contacting patients telephonically to arrange a date and time for home delivery of their medication. The CAs would deliver ART to the patient's home and then report back to HST's Nurse Clinician after each home delivery. The information was documented in the patient's clinical chart and sent to the Data Capturer for recording on the DoH HIV Electronic Register, TIER.Net. "The best part about working with the CAs on this was that they themselves reside within the communities in which they operate, making it easy, accessible and comfortable for them to drop off medication within their geographical setting," says HST's Acting District Co-ordinator, Mesuli Ntshalintshali, who was working as a Quality Improvement Co-ordinator at the time.
"Another thing that contributed to the overall success of the intervention was the extension of clinic hours, which shifted from operating until 17h00, to instead closing at 19h00 daily. This helped in accommodating working patients who could not reach the clinic by 17h00," Ntshalintshali said.
Ntshalintshali said the community-based ART delivery initiative was definitely something that could be replicated in other communities and provinces as an emergency preparedness modality of care for patients on treatment. In this case, collaboration between HST and DoH staff was key. The main shortfall was that, because the CAs are not clinically trained, only patients who were stable on their HIV treatment could receive drop-offs of their medication.
Applauding the hard work of HST staff in supporting the Sigweje Clinic team was the DoH Alfred Duma Sub-district Primary Health Care (PHC) Manager, Yvonne Thembelihle Ndebele, popularly known as 'YT' (pictured above). She said the project was a great success and thanked HST staff for always wearing their epaulettes with pride at the clinic. "COVID-19 really highlighted our staff as unsung heroes. They were hands-on and always willing to go the extra mile."
She is planning to introduce staff recognition at the facility and beyond because she feels that with a little bit of extra motivation, much can be achieved collaboratively in the spirit of promoting health and saving lives.
Alfred Duma and St Chads Primary Health Care (PHC) Clinic Manager, Yvonne Thembelihle Ndebele; HST's SA SURE Project Operations Manager, Felicity Basson; and HST's uThukela Area Co-ordinator, Bathobile Mkhithi.