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Lesotho ARV programme excellent example for SA

By Claire Keeton | 17 November 2009

Lesotho is successfully doing nurse-initiated AIDS treatment at a primary health care level, a study in the current issue of the Journal of the International AIDS Society shows.

And Lesotho is doing better than South Africa despite having fewer resources.

Patients in Lesotho are starting treatment earlier than in South Africa – at CD4 counts of below 350 instead of below 200.

Their programme is using tenofovir in its first line regimen, which is better for patients.

Once again MSF – which initiated a programme in Lusikisiki in the Eastern Cape – is a major player in this rural care and treatment programme.

MSF, the Lesotho Health Ministry and the Christian Health Association of Lesotho rolled out the decentralized HIV/AIDS care programme in a rural area with 14 clinics and one district hospital.

“More than 13 243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level,” according to the study – and the results are encouraging.

“The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008.

“Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%).

“At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care.”

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Train, trust nurses to expand access to ARVs

By Claire Keeton | 3 September 2009

Nurses, clinical officers and physicians (doctors) mostly reached the same decisions on when to start antiretroviral treatment, a pilot study in rural Uganda shows.
The results, published in the latest issue of the journal Human Resources for Health, found that “nurses and clinical officers both showed moderate to perfect agreement with physicians in their final antiretroviral therapy recommendations”.
Lead author Ashwin Vasan and 8 co-authors said the results demonstrated that non-physician clinicians, particularly the clinical officers, had the “capacity to make corrrect clinical decisions to start ARV therapy” and this could benefit the scale-up of treatment and its decentralisation to rural areas in Uganda.
The researchers concluded: “Policy makers (should) more carefully explore task-shifting as a shorter-term response to addressing the human resources crisis in HIV care and treatment.”
But they added a multicountry investigation was needed to explore this preliminary data.
In South Africa, as in many developing countries, only doctors may initiate ARV therapy in HIV-positive patients and this severely limits access to treatment.
TAC, MSF, the HIV Clinicians Society of Southern Africa and RHRU from Wits are among those calling for “task shifting” in a way that would speed up access to treatment but not compromise care.
South Africa’s National Strategic Plan for HIV, AIDS and STIs 2007-2011 also recommends professional nurses initiate and manage ART for adults and children.
Why is it taking so long?