Buddies for life
It’s not the most expansive programme in the country, but if a pilot in Guguletu, Cape Town’s second oldest township, proves successful excuses for not treating people living with AIDS in the public sector could be wearing thin.
True to its name the Sizaphila project is ensuring the survival of many terminally ill AIDS patients who have been given the opportunity to access anti-retrovirals in the public health sector.
The first pilot of its kind, Sizaphila (We will survive) uses a novel buddy system that couples each person using the drugs with a trained therapeutic counselor who lives in the community. In many instances these counselors or ‘buddies’ are themselves on anti-retrovirals or HIV-positive.
Health workers believe that the buddy system has been responsible for compliance by the Guguletu patients well exceeding figures achieved in the developed world. Currently funded by Crusade, a United Kingdom charity, Sizaphila is able to treat 150 patients. Since the project started in September, 120 patients have enrolled.
‘We give priority to family units ‘ mothers, fathers, partners, children ‘ because otherwise we find that patients may share their tablets. Also, ethically, it is a practically good thing to do,’ says Professor Robin Wood, who heads up Sizaphila.
Wood, who has worked with Hiv/AIDS for many years, says the biggest challenge will be to meet the demand, but added that he was determined to secure more funding.
Professor Woods also believes the project’s early success is rooted in the buddy system. ‘These buddies are able to be there for the person when they deal with the trauma of being diagnosed or falling ill.
‘They are also able to support the person and pick on issues such as toxicity or side-effects once they start using the drugs,’ he said.
A buddy to six patients, Mthetheleli (asked for his surname not to be used) will soon partner up with 20 more as the programme expands.
Diagnosed HIV positive in 1998, Mthetheleli has firsthand experience of living with the virus and using the anti-retroviral drugs.
‘When I received my diagnosis I heard about a counseling course and I decided to attend. I realised that I couldn’t even distinguish between HIV and AIDS and neither could my community,’ says Mthetheleli.
He participated in the course and ‘came back to my community to educate people about the virus’.
Mthetheleli monitors the patients from the moment they are recommended to join the anti-retroviral programme.
He explains: ‘We go to their homes and talk to them. Here we screen them for the programme. Our duty is to educate them about the drugs, they must know everything. They must know what to expect and what the possible side effects are. It is also important for us to assess the situation at home, what the social situation is and whether they have disclosed to someone in the family.’
Mthetheleli says it is important for the patient to disclose to someone in the family or a friend.
‘That person has to remind the patient to take their drugs,’ he said.
He added that one of the most encouraging features of the programme was witnessing the recovery of those who were once so ill they could not work and who might have been a burden to their parents or caregivers.
‘It changes that bad situation at home with the family and neighbours,’ he says, alluding to the stigma and discrimination that is still very much prevalent in the community.
Mthetheleli said he found it ‘easy’ to use the anti-retrovirals.
‘When I started using the drugs my CD4 (immune cell) count was 213 and viral load (amount of HIV) 25 000. Now my viral load is undetectable and the CD4 count 448.
‘This is what I preach to people. That these drugs work if used as prescribed. It is now part of my life and I know if I stop using it, the virus will come back,’ he said.
To be considered for the programme patients have to live in Guguletu and be on an existing HIV treatment programme (for opportunistic infections) at one of the nine government clinics in the area.
Once health care workers at the clinics have identified potential patients they refer them to Sizaphila.
Health workers at Sizaphila use the World Health Organisation recommendations for treatment in resource poor settings when assessing if a person is ready to go onto anti-retrovirals.
Patients have to be symptomatic (have an AIDS defining illness) and have a CD4 count lower than 200. The CD4 count refers to the number of immune cells in the blood as opposed to the amount of HI-virus. A person who has an AIDS related illness will usually have a CD4 counts of less than 200 and a viral load reaching the hundreds of thousands.
After examining the patients and doing the relevant tests doctors make a recommendation and buddies conduct home visits and interview the prospective patients to determine whether they are ready for therapy.
Wood points out that it is crucial not to try and use anti-retrovirals in isolation. ‘You need an existing infrastructure or service,’ he says.
When quizzed on whether he thinks the success of Sizaphila could be repeated in other semi-urban, resource poor settings, Wood mentions several factors that would determine non-failure.
‘By the time patients reach Sizaphila they are very ill, so they want to go onto therapy. They want to get better. I think this is part of the reason why adherence is so high,’ says Wood.
Wood is clear that it is not good to start therapy at diagnosis.
‘It is a lifelong commitment and people first have some issues to work through before they are ready to make a decision.’
Wood compares the anti-retroviral pilot to a TB control programme where the drug regimens are as simple as possible, the buddy system (similar to the Directly Observed Treatment Shortcourse) is used to monitor the patient and high specialised staff are not required.
An added bonus to the introduction of anti-retrovirals, says Professor Wood, is the tangible improvement in staff morale.
‘Staff have been incredibly demoralised as patients die. It has been a joy to all of us to see patients return to health. It is very rewarding.’
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