HIV and AIDS HIV Prevention HIV Treatment Public Health & Health Systems

Top experts examine ARV access and health systems

Written by Health-e News

South Africa’€™s top researchers, policy makers, managers and providers have released the outcome of a roundtable discussion held last year, where they grappled with antiretroviral access and the health system’€™s capacity to cope with the increasing demand.

The  report, authored by Helen Schneider, Dingie van Rensburg and David Coetzee,  contains the key findings and policy recommendations fromt he meeting which they hope will feed into the country’s National Strategic Plan.

Some of the main insights and messages that came out of the meeting were that most of the existing programmes are still to a large extent doctor and pharmacy dependent.

Participants also felt strongly that integrating antiretroviral therapy (ART) with HIV-related primary health care services ‘€“ particularly with TB, the prevention of mother to child transmission and maternal and child health services within a district health system ‘€“ remains critical.

The shortage, distribution, management and supervision of skilled personnel in the public health sector posed serious impediments to efficient ART provision and expansion, the participants said.

There was also a strong feeling that prevention efforts in particular the prevention of mother to child transmission, have to be strengthened.

In summary, nine key overall lessons and recommendations for policy arose from evidence presented at the Round Table:

·                 Recommendation 1: Shift the focus of ART implementation from ART sites to district/subdistrict-based approaches.

·                 Recommendation 2: Mobilise and strengthen the existing PHC system by reviewing the composition, staffing and support systems of PHC teams.

·                 Recommendation 3: Integrate HIV and TB care, and provide both as one service within PHC settings.

·                 Recommendation 4: Focus on PMTCT, and integrate the programme into the treatment of children and pregnant women.

·                 Recommendation 5: Address loss to follow-up by introducing services more widely spread across the system and by strengthening systems for tracing dropouts.

·                 Recommendation 6: Build trust in the public health system by seeing the system from the household and patient’€™s perspective so as to better understand barriers to utilisation of services.

·                 Recommendation 7: Simplify and standardize approaches to implementation for patients, programme governors and local providers to promote better access and enhanced quality.

·                 Recommendation 8: Strengthen prevention and the health system response to other diseases and build the PHC and district health system.

·                 Recommendation 9: Improve dialogue among researchers, policy makers and service providers to promote the transfer of lessons, and to harmonise and simplify approaches.

Read the full report here.

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Health-e News

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