This program earned a Gold award.
Despite the government’s stated intention of rolling out HAART to all people who qualify for this treatment, there are still many people who are unable to access it. This is also true for Prevention of Mother-to-Child Transmission (PMTCT) treatment. This was partly due to the fact that many have to travel long distances to reach clinics where HAART is available; and also because many hospitals are heavily-burdened with patients suffering from TB, and in the last stages of AIDS. To try to address this, the Helderberg Hospital in the Eastern sub-district of Cape Town partnered with Institute for Healthcare Improvement (IHI) and Absolute Return for Kids (ARK) to establish an ARV clinic at the hospital in 2004. However, because there were no facilities for children, people were still having to travel long distances for paediatric treatment; and there were still no facilities for PTMCT provision. Thus, by 2008 the Hospital had stepped up its clinic to provide HAART to all who need it; strengthen the HIV referral network in the region (to ensure fewer patients are lost from care); to locate HIV services close to the communities who need it; to reduce the MTCT rates; decrease demand for acute medical services by providing treatment sooner in the HIV/AIDS continuum; strengthen the sub-District health system; and disseminate best practice to other parts of the health system. Many of the targets for the clinic were laid out in government’s the National Strategic Plan (NSP). The project has already met, and in some cases exceeded, the standards set in the NSP; and the project has already been rolled out to another clinic in a different sub-district.
Innovation: This project attempts to address a number of problems along the HIV/AIDS continuum – by making first-line treatment more easily accessible, it increases the quality of life for patients in the area, but also reduces the burden on the healthcare system. Thus, the quality of healthcare provided also improves.
Effectiveness: By the end of 2008, nearly 2000 patients were receiving HAART in 2 clinics. The average number of clients has increased to over 70/month (above the NSP target of 65/month). 2/3 of patients are now initiated at a community health clinic, rather than at a far-away hospital. The transmission of HIV to infants in the PMTCT has decreased to 5%; and the demand for acute medical services has decreased.
Poverty Impact: The project allows people to access treatment and medication more easily, improving their standard of health dramatically. This then allows them to earn a living, as they do not have to stay at home due to illness.
Sustainability: IHI’s involvement in the project ends in September 2009, and the focus of late has been consolidating the sustainability of the programme. Staff at the different hospitals and clinics have been trained to take over, and hopefully this means the project will continue in the future. The programme is covered by the hospital’s budget; while IHI covered the training costs for hospital staff.
Replication: The programme has already been replicated in a second hospital in Mitchell’s Plain sub-district – within 4 months, the hospital achieved the NSP target for HAART initiations; and has sustained this for 12 months. Thus, the programme is easily replicable in other hospitals and clinics. Similar systems-wide programmes are being run by IHI in Western Cape, KZN, North West, and Gauteng. There are also plans to work with government to design an Accelerated PMTCT Plan, which will use best practices from the current project.