KZN kicks off chronic care programme for HIV patients

Photo: PRI/Stephane de Sakutin

The number of people living with HIV who develop chronic conditions like cardiovascular and respiratory disease, cancer or diabetes is increasing.

High risk

“People living with HIV are at higher risk of developing common cancers, TB and other non-communicable diseases (NCDs). This is due to the HIV infection itself and antiretroviral therapy (ART) side-effects as well as lifestyle factors. Unaids reports that a third of the people screened at HIV testing sites are obese and have hypertension. Despite the clear links between HIV and chronic diseases or NCDs, the healthcare system’s prevention and treatment response remains fragmented. An integrated response that deals with overlapping problems and common risks has become a healthcare priority as ART is enabling people to live long enough to develop other diseases,” says Sibongile Ramotshela, cervical cancer coordinator at Right to Care).

The integrated chronic care initiative in UThukela is being funded by the Bristol Myers Squibb Foundation that has commited just over R15m for two-and-a-half years. Right to Care is the prime recipient, responsible for project management, training doctors and nurses and procuring equipment. Together with its partners, the Bhekhuzulu Self-Sustaining Project and the Mpilonhle Sanctuary Organization, Right to Care is working with the regional and district Departments of Health to scale up awareness, screening and treatment services. Communities, women’s groups and faith-based organisations are also being mobilised to help raise awareness.

“We aim to optimise the use of available resources and integrate screening and prevention. Ultimately, we are aiming for a single visit approach which allows patients to have all their chronic conditions reviewed at one appointment,” says Ramotshela.

Cervical cancer

Cervical cancer was once again highlighted as a preventable but highly prevalent cancer at the first milestone of the initiative, the cancer screening drive.

Ramotshela says, “The human papillomavirus (HPV) is the most common sexually transmitted infection and the most common cause of 70% of cervical cancers. The HPV vaccination of young girls is not well implemented in school health programmes in this area despite it being a primary prevention strategy for cervical and other HPV-related cancers. Furthermore, pap smear screening in this district are well below the levels required to effectively prevent these cancers.

“HIV-positive women are three to five times more likely to develop cervical cancer and its progression is far more rapid in HIV positive patients. The new integrated chronic care initiative aims to tackle this cancer as well, which affects young women the most,” says Ramotshela.

Treated HIV/Aids has become a chronic disease, and the healthcare needs of people on antiretroviral treatment resemble those of people with NCDs. There are also links between HIV and NCDs in terms of chronicity, risk of development and severity of progression of disease.

“The UThukela programme is being implemented together with the Department of Health as healthcare workers are required to take a far more coordinated approach. Furthermore, we are hoping to create more youth-friendly health services which have been identified as a vital element of prevention strategies.”

Roll out

The programme is being rolled out in three sub-districts of the UThukela district, the Alfred Duma local municipality, the UKhahlamba municipality and the iNkosilanga Libalele municipality. Implementation is taking place at 16 facilities – nine fixed clinics and seven mobile clinics.

The national HIV prevalence in SA is 29.7% and the highest HIV prevalence is in KZN, having reached 40.1%. HIV and other communicable and NCDs are on the increase in this province, exacerbated by poverty - more than a third of KZN's population live below the poverty line and 40% of the population is unemployed.