Currently, many patients in the country queue monthly to pick up their ARVs but as part of its latest funding application to the international financing mechanism, The Global Fund to Fight AIDS, TB and Malaria, the country is planning to move treatment out of clinics and into patients’ homes, local libraries and maybe even their local chain clothing store, like PEP, in the next three years.

South Africa will be one of the first countries in the world to implement such a system.

According to South African National AIDS Council CEO Dr Fareed Abdullah, Deputy-Director General Dr Anban Pillay is already overseeing work into possible models.

“The Department of Health is busy designing a mechanism for providing ARVs through courier services in the community,” Abdullah said. “The good news is that we expect that service could become available to about 300,000 patients.”

Department of Health Spokesperson Joe Maila said community treatment models are just one way the department is looking to tackle the allegedly widespread stock outs affecting the country.

The Department of Health is likely to put out a call to invite proposals for multiple community models but will also be rolling out community adherence clubs nationally, Abdullah added.

Piloted by the international medical humanitarian, Medicines Sans Frontieres (MSF), these clubs were first developed in Khayelitsha.

As part of these clubs, stable, long-time ARV patients meet in the community – at someone’s house or a nearby library. A trained counsellor distributes a patient’s two-month ARV supply and does a quick check up of the patient. Unless counsellors pick up problems, patients see a clinician annually for a check up as well as routine blood tests

Dr Gilles Van Cutsem is MSF’s Medical Coordinator for South Africa and Lesotho. Van Cutsem says the organisation has welcomed a national rollout of the clubs, which were formally adopted by the Western Cape this year.  The Western Cape also approved four-month supplies of ARVs for use in the clubs ahead of December, to accommodate those travelling home to the Eastern Cape during the festive season.

More than 20 percent of all Cape Metro ARV patients are currently part of an ART Adherence Club, according to Van Cutsem. Research has shown that club members were more likely to stay in care and were almost 70 percent less likely to see spikes in their HIV blood levels.

But he cautioned that community models of treatment may not be an answer to stock outs.

“To run adherence clubs successfully, it’s essential to have a consistent supply of treatment,” he said. “The main challenge will be to fix on-going drug supply chain problems.”

Moving ARVs into patients’ homes or communities will also depend on the ability of government to roll out fixed dose ARVs. Without these, the ARV stocks will likely remain too bulky for counsellors or couriers to carry multiple orders at one time.

In just days, world leaders will meet in the US capital, Washington, DC, to decide the fate of one of The Global Fund, one of the world’s leading funders of HIV programmes.

South Africa has historically been one of only a handful of African countries that not only receives funding from The Global Fund but also contributes to it. While donors like France, South Korea and the United States have already signalled their support, South Africa’s potential contribution has yet to be announced.  – Health-e News Service.