How to get the roll-out rightLiving with AIDS #156


Duration 4min 10 sec

KHOPOTSO: Now that the Care and Treatment Plan for people living with HIV and AIDS has been approved, its implementation will be closely monitored to ensure that it does not run into the stumbling blocks and controversies which have dogged its predecessors ‘€“ the Prevention of Mother to Child HIV Transmission programme and the HIV prevention programme for survivors of rape. While some provinces like Gauteng and the Western Cape demonstrated the ability and the will to roll out the programmes, others such as Mpumalanga lagged behind. Dr Nono Simelela, Director of the TB, STIs and HIV/AIDS Directorate in the Department of Health is well aware of this trend and its potential threat to service delivery.  

Dr NONO SIMELELA: Yes, I think what’€™s different about how we approached this Plan is in the manner in which we interrogated provinces and had buy-in. The MECs have met several times on the content of this Plan. And when we did the provincial site visits we made sure that there’€™s full understanding of what has to be achieved.

It was not the route we followed with PMTCT, if you remember. They just selected sites and sites were announced and we had to actually do a fast-track process. And halfway through that process we had to go to court and then come back and review stuff. So, the lessons we learnt from that programme have really informed how we do this: that   provinces are the implementing agents and they have to have full buy-in. And with the PEP, yes. Remember that the PEP announcement was just made in the middle of nowhere by Cabinet. It took us by surprise. We didn’€™t even have a protocol at that stage that had been work-shopped with the provinces.

KB: The onus, it would seem, lies with the provincial health departments to make the Care and Treatment Plan a success. But the hands-on involvement of the national department cannot be over-emphasised.  

Dr SIMELELA: National can support with making sure the budgets are there, the training, everything. But we are focussing strongly on the weaker provinces even in terms of how the money is allocated to make sure that those provinces are up to speed because the issue of equity was raised sharply in the Cabinet debates. We don’€™t want people in Venda and the Eastern Cape not to benefit like other programmes where it just is in the urban areas.

KB: Some provinces, more than others, have already started preparing for the roll-out. Almost immediately after Cabinet’€™s announcement the Gauteng government said that it plans to make treatment available at 22 health facilities within a year, reaching an estimated 10 000 infected people in the province.

Public-private partnerships are also being formed to assist access to treatment.

Tomorrow (Friday December 12t), the Medecins Sans Frontieres in partnership with the Nelson Mandela Foundation is launching the first anti-retroviral treatment centre in Lusikisiki in the Eastern Cape. Last week, the Foundation together with the South African Medical Association launched the first Tshepang treatment programme ‘€“ named after one of the country’€™s youngest rape survivors, Baby Tshepang – at the G.F. Jooste Hospital in Cape Town. When introducing the initiative in Pretoria last year Mandela made this appeal.

NELSON MANDELA: The vast majority of people infected with the virus remains untreated. They are in desperate need of our help’€¦ We must help these people access treatment so they are able to live positive lives, contribute to their communities and remain amongst us as long as possible.

KHOPOTSO: The answer to that appeal has now been offered in the form of the Cabinet announcement on November 19. But others will remain sceptical until they see the treatment roll-out take shape. Dr David Spencer, an HIV clinician with a practice in Johannesburg, is one of the sceptics. Yet, he’€™s hopeful.

Dr DAVID SPENCER: HIV is an opportunity’€¦ to actually see where we’€™re going wrong and start righting it. The government’€™s saying it’€™s gonna roll out one of these days, hopefully when I’€™m still alive and not in the next millennium. We can have the drugs there, but that is the beginning of the road. And we’€™re going to need help.

E-mail Khopotso Bodibe


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