Fareed Abdullah has never been one to shy away from a challenge. In 2003, amid extreme tension between the national health department and Aids treatment activists, Abdullah, head of the Western Cape’€™s HIV/Aids programme, stood up at the Durban Aids conference in a bright yellow Treatment Action Campaign T-shirt and spoke passionately about the urgent need to expand access to anti-retroviral therapy.

Two years later, Abdullah has committed himself to making the life-extending drugs available to at least 85% of those needing treatment by the end of March next year.

Already the Western Cape is treating at least 8 000 people and the figure grows by 600 patients every month.

Currently, almost 50% of adults needing treatment are getting the drugs while 60 to 70 percent of children in need are accessing ARVs.

‘€œI think there were probably three factors that made it easier for the Western Cape to expand more rapidly than other provinces,’€ says Abdullah. ‘€œAt the outset, the Western Cape health department had a very good understanding of the role of ARVs. This hasn’€™t changed since we started giving AZT to pregnant women in Khayelitsha in 1998.

‘€œSecondly, we had a lot of know-how because we had started so early. We knew the drugs, we knew the side-effects, the suppliers, how to procure and so on. This gave us a head start when the time came to start triple therapy.

‘€œLastly, the Western Cape has better infrastructure and more medical and scientific expertise than most of the other provinces,’€ explains Abdullah.

He adds that while the Western Cape had in the past been (politically) shunned at national meetings, the province is now held up as a role model on how to implement government policy.

‘€œWe are now seen as part of the national initiative. It’€™s been a positive change,’€ he comments.

However, Abdullah can’€™t resist a dig at politicians. ‘€œThey (politicians) really had nothing to do with the success of this programme, the officials in the department did all the work.’€

Currently, ARVs are offered at 36 sites in the province with a further four in the pipeline.

Barriers to further expansion include a shortage or doctors and nurses which in turn leads to long patient waiting times.

‘€œWe probably have between 15 000 and 20 000 people who are in the system waiting to be put on treatment, but these factors are hampering us,’€ says Abdullah.

Should the Western Cape reach its target of having almost 85% of people on treatment by March, the province will be treating almost 14 000 people.

In terms of prevention of mother-to-child HIV transmission (PMTCT), the Western Cape’€™s programme is also showing the way. All ante-natal sites, labour wards and child follow-up clinics offer PMTCT services. This adds up to 344 clinics and 60 hospitals.

Of the women accessing maternity services, 85% consistently consent to be tested for HIV.

All women who test HIV positive receive a CD4 count test. Those with CD4 counts below 200 are referred to an ARV treatment site where they start triple therapy (three ARV drugs) in pregnancy.

Those with CD4 counts above 200 are put onto dual therapy that involves the woman receiving AZT from 34 weeks and Nevirapine while in labour. The baby receives a single dose of Nevirapine and seven days of AZT syrup.

‘€œThis is the optimal regimen for a developing country,’€ says Abdullah.

The mother-to-child transmission rate in the province is currently around 5% with the province aiming for a rate of between one and two percent by the time triple therapy is widely accessible.

‘€œWe want to see the elimination of paediatric Aids,’€ states Abdullah.

Some of the province’€™s outcome data that will be presented at the Durban Aids conference this week will reveal that 85% of patients were still on the treatment programme six to 12 months after starting.

Between one and two percent had serious side-effects of which most were picked up early and treated while 10% of patients reported minor side-effects that were easily managed.

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