Company news: Crucial step taken in dealing with AIDS epidemic

Johannesburg, 26 February 2008—Right to Care, a non-profit organisation dedicated to combating the AIDS epidemic, has established its first HIV patient down-referral clinic. Right to Care and the Johannesburg City Council have concluded an agreement that will see the Crosby Clinic near Helen Joseph Hospital undertake the medical care of stable patients who are on antiretroviral treatment.

Two years ago, Right to Care began promoting the principle of “down-referral”, as it is termed in medical-speak. The signing of the memorandum of understanding sees down-referral formalised in a programme that may see three such clinics set up by the end of the year. The clinics will take on the management of patients who are on antiretroviral medicines.

This will bring welcome relief to overburdened government facilities, such as the Themba Lethu Clinic, part of the Helen Joseph Hospital in Westdene, Johannesburg. Themba Lethu is supported by Right to Care. It was one of the country's first facilities to administer antiretroviral medicines under the government's HIV treatment plan and is currently the largest ARV clinic in the country. Crosby Clinic is just 2km away from Themba Lethu.

“People outside of healthcare probably don't realise just how important this is. Down-referral is crucial to the country's management of the HIV epidemic,” says Dr Dennis Rubel, head of the down-referral programme at Right to Care. “The big hospitals simply cannot cope with influx of patients.

“Themba Lethu, for example, has over 10 000 patients on ARV treatment. This translates into an enormous daily load of patients, most of whom are now in very good health.”

The benefit of the Crosby clinic is not reduced travel to medical facilities. Many HIV patients do not want to be treated at a local clinic, for fear of having their HIV-positive status discovered by friends or family. Rather, the benefit is relieving the overburdened HIV treatment facilities at Themba Lethu.

A further benefit is reducing the level of medical care required to maintain in good health this segment of the HIV-infected population. All role players agree that it is not necessary for a highly trained specialist doctor to be involved in the maintenance treatment of patients who have reached a steady state in their antiretroviral regimen. In this light, Crosby will be managed and run by a small group of well-trained nurses.

This, the staff at Themba Lethu feel, may prove to be a practical model for the rest of the country. By this model, ill patients are treated initially at the treatment sites already in operation and then by the second year ‘graduate' to a nurse-run down-referal clinic.

Says Rubel, “This development is vital if we are going to reach the target of 2-million patients on treatment by 2011.”

Rubel's reference is to the government's strategic plan, announced in 2007, part of which was the 2-million enrolment target.