In South Africa, syphilis testing and treatment is a health priority. The current national policy is to test all pregnant women to detect maternal syphilis and prevent congenital syphilis. Routine syphilis testing however does not occur in all clinics, especially in rural areas. CDC has collaborated with the Eastern Cape and the DOH to conduct a study on the feasibility, acceptability, performance and cost-effectiveness of a new on-site syphilis test.
The study findings, released in September, indicate that the new on-site test prevents more cases of congenital syphilis, treats more cases of maternal syphilis, is quicker to perform, and is preferred by health care providers compared to the standard test that requires specimen collection and transportation to a laboratory.
Use of the new on-site test can facilitate improved syphilis treatment, especially in rural areas. CDC South Africa is not collaborating with the Eastern Cape and the DOH to develop a plan to expand the use of this test to other health facilities.
For more information, contact Dr. David Allen at Allend@sacdc.co.za
In 2001 a document was released by the Department of Health in collaboration with the Equity Project, to provide guidance on the establishment of district-based responses to HIV/AIDS.
In this document the authors suggest five reasons for a district-based approach. These are:
The district-based strategy document outlines a series of activities and sites or partners that can be established or mobilised to implement the national HIV/AIDS strategy in ways that make sense locally. The following example from the Paarl district in the Western Cape describes how this framework can be implemented.
Paarl is a peri- urban area 60km from Cape Town. Towns that used to be included in this District are Paarl, Wellington, Franschhoek. In terms of the new municipal demarcations Hermon, Saron and Gouda and now part of the district whilst Franschhoek is excluded. The population is estimated to be between 198 546 to 200 145 people.
While it is still difficult to monitor the actual prevalence of HIV/AIDS in the District, the trend of the epidemic can be described as follows. In the West Coast/Winelands region Paarl had the highest HIV seroprevalence rate 2000. In 2001, 167 new HIV positive cases were reported of which 83 were males and 84 females. A total number of 963 clients were treated as outpatients and 131 deaths were reported.
According to the district's annual PMTCT report, compiled in May 2002, the positivity rate of mothers attending the antenatal clinic is 8.3% - this is similar to the antenatal survey results released in June 2002 of 8.3%. According to these results the HIV prevalence amongst pregnant mothers has increased from 4.5% in 2000 to 8.3% in 2001. This rapid increase is of great concern and requires vigorous intervention.
The highest rates within the district are in Mbekweni (54%), and Farming areas (14%).
Referred to as the Drakenstein HIV/AIDS Co-ordination committee, this committee consists of various representatives from Government Departments, i.e. Education, Social Service, Health, South African Police, Correctional Services and Tourism. Also as part of this structure are NGOs, faith-based organizations, CBOs, traditional healers, the private sector and media.
This allows for intergovernmental intersectoral and multi disciplinary collaboration, to address issues of HIV/AIDS within the district. This platform services as a catalyst for promotion, advocacy and implementation of the different HIV/AIDS intervention strategies. Reasons for the establishment for this committee have primarily been:
Voluntary Confidential Counselling and Testing: The district has currently one non-medical site on the grounds of TC Newman Community Health Centre and is manned by an NGO - Agapè. This centre serves as a walk-in facility for clients wanting to know their HIV/AIDS status, they also test clients that have been referred from different departments in the hospital and doctors from the private sector. Over a period of one year the centre tested 1 500 people Important to highlight is the fact that with the introduction of Rapid Screening tests the request for Elisa testing through the lab has been reduced to 4-5 a day from the previous numbers of 40-50 a day before May 2001. Agapè also does outreach work on HIV/AIDS awareness, workshops and sometimes testing on farms they visit.
PMTCT: This programme commenced on 10 May 2001. TC Newman Community Health Centre currently renders 97% of antenatal care services in the district with an average of 210-381 new bookings per month. Partners who participate in the programme include Department of Social Service (placement of babies for adoption, child grant applications), Support Groups in the community, Agapé (support), World Vision (food parcels, trench door gardening) and Catholic Welfare Development (soup kitchen).
STI Treatment: One of the most important strategies in the fight against HIV/AIDS is the effective management of STIs. Currently it is estimated that private practitioners see 60% of patients, but manage them ineffectively, mostly being restricted by the cost of drugs. Accordingly to a survey conducted in October 2001 of 16 general practitioners in the district, they are treating about 574 STIs a month. In December 2001 a pilot programme involving 2 general practitioners was implemented. The service provided by the 2 GPs is regulated by a service agreement that assures compliance with the PFMA. This entails the free supply of drugs for STI treatment to the general practitioners. To date 343 clients have accessed STI treatment through their private practitioners as part of this project.
Home-Based Care: Provision of generic HBC in this District dates as far back as 1950, long before the current HBC initiative. HBC is rendered by various NGOs, FBOs and local authorities, with the assistance and guidance of Department of Health through the Regional office.
Caring Network: This organization falls under Catholic Welfare and Development and was established in 1992. The organization functions from a container based office on the grounds of the Roman Catholic Church at Mbekweni. Services provided include supervision of medications including DOTS, feeding, personal hygiene and the provision of HBC services to those with AIDS. In June 2002, the DOH contracted this NGO to provide Home Base Care services for the community of Mbekweni.
Hospice: Consist of a facility-based centre i.e. St. Lukes Hospice in Cape Town, and have various satellite offices in different places in Paarl and Franschhoek. They tend to terminally ill clients wishing to die at home.
Luthando Frail Care Centre: This is a 12-bed facility-based home care programme providing a compassionate, homely and caring environment for terminally ill patients suffering from HIV/AIDS and cancer. The centre has been established through negotiation of Agapè aids support group with Drakenstein Municipality for use of the building. The centre admits referrals from all the above-mentioned HBC organizations and Paarl Hospital. The Department of Health is also directly involved in management and funding of the centre. All efforts have been made to offer a holistic care through close interactions and integrated planning with the Department of Social Service in providing HBC. This effort has enabled a Paarl Welfare Organization the purchase of a "Dipper Machine" for the manufacturing of disposable napkins for Home Base Care.
"Luve u" and Friend Project: This project is run by two friends who are part of a bigger Women Support Group. They have identified the need to support women, men and children operating as sex workers in Paarl. The aim is to create awareness about HIV/AIDS for prevention of infection. This includes the promotion of safe sex practices, encouraging sex workers to know their status and addressing issues of child molestation and abuse. Whilst this project is still in its infancy stage it displays the high level of community involvement in the district.
KWV's Fight Against HIV/AIDS: KWV (a major employer in the district) recognised HIV/AIDS as a serious threat to its employees and the impact on the future business success of the company. Through the implementation of an integrated HIV/AIDS strategy, KWV strives to minimise the risk to and the impact on their business. This was done through the creation of a positive and supportive environment. Other programmatic interventions include a knowledge, behaviour and perception survey among personnel, training on HIV/AIDS in the workplace, training for Human Resource practitioners on the right of HIV positive employees, training of 30 peer educators, the development of a KWV HIV/AIDS policy, pre-test counselling, and anonymous voluntary testing of 80% of personnel. One of the successes is that the KWV peer educators reached beyond the staff to educate congregations, youth groups and schools about HIV/AIDS.
Thanks to Iris Cupido for providing information on the basis of which this short report has been drafted. For more information please contact her on 082399150
1 December 2002: World AIDS Day national event, Kimberley
www.health.gov.za
www.aidsinfo.co.za
www.aidsdirectory.co.za
www.dpp.org.za
www.hst.org.za
www.lovelife.org.za
www.childaidsservices.org
www.equityproject.co.za
www.unaids.org
You are also encouraged to share information on other useful websites. Feedback on the Department of Health website would be especially valuable.
Compiled by Celicia M Serenata
Project Manager: HIV/AIDS
Tel: (012) 312-0128
Fax: (012) 326-2891
e-mail: serenc@health.gov.za
For all requests of HIV/AIDS materials (posters etc.), please contact:
Tel: (011) 880-0405
Fax: (011) 880-8552
Fax: (012) 326-2891 or (012) 323-7323
Dr. Nono Simelela
Chief Director: HIV/AIDS and TB
Tel: (012) 312-0121
simeln@health.gov.za
Collen Bonnecwe
Director: HIV/AIDS (NGOs)
Tel: (012) 312-0137
bonnec@health.gov.za
Thami Skenjana
Director: GAAP
Tel: (012) 312-0133
Fax: (012) 325-0165
Dr. Refiloe Matji
Director: TB
Tel: (012) 312-0106
Fax: (012) 326-4365
matjir@health.gov.za
Dr. Rose Mulumba
Director: HIV/AIDS and STIs
mulumr@health.gov.za