10 years of ARVs in a small town called Lusikisiki

10 years of ARVs in a small town called Lusikisiki
30th November 2014 | lightspeed

A number of people have over the years played a role in the development of the TAC and our battle for antiretrovirals. There are too many to mention. In the following pages a small group of people who played a role in one way or another and represent various constituencies, share their recollections of the past and their dreams for the future.

Noloyiso Ntamenthlo (in orange) is the Eastern Cape TAC Co-ordinator and was a key member of the TAC and Médecins Sans Frontières (MSF) project in Lusikisiki that had been set up to debunk the widely-held belief at the time that antiretrovirals could not be administered in a rural setting.
Noloyiso Ntamenthlo (in orange) is the Eastern Cape TAC Co-ordinator and was a key member of the TAC and Médecins Sans Frontières (MSF) project in Lusikisiki that had been set up to debunk the widely-held belief at the time that antiretrovirals could not be administered in a rural setting.

In Lusikisiki, in the deep rural Eastern Cape, the TAC and Médecins Sans Frontières (MSF) developed and tested a successful model for HIV service delivery for poor rural communities. When the programme began, only 22 clinics had electricity and only one had running water or a phone. There was a shortage of doctors, only 40 percent of nursing posts were filled, and staff morale was very low. VCT (voluntary counselling and testing) was only available at St Elisabeth Hospital and there were frequent drug stock-outs. Through the MSF programme, VCT and ARVs were provided at primary healthcare level (clinics). By 2005 about 46 000 people had been tested and 95 percent of patients were receiving ART.

Task-shifting was the key to success. Doctors supervised clinics rather than dealing with individual patients. Nurses were trained to prescribe, initiate and manage ART and opportunistic infection (OIs) – normally “doctor’s work”. Pharmacy assistants dispensed medicines, checked and ordered stock – normally “pharmacists’ work”. Adherence counsellors linked to clinics took on “nurses’ work”. They were recruited from among community health workers and people with HIV/AIDS and trained through workshops and on-the-job mentoring. The counsellors provided VCT, took bloods for CD4 counts, prepared patients and treatment assistants on how to take ARVs, facilitated support groups, mentored community caregivers, and collected statistics for VCT, pre-ART, ART, TB and PMTCT. A very low rate of loss-to-follow-up in clinics was observed (two percent) and this was largely championed by the adherence counsellors. It was difficult for the clients who was co-infected with HIV and TB or other OIs to adhere, but still the success rate was high.

In 2006 there was a celebration in Lusikisiki of people who were on ARVs with a viral load that was undetectable; thousands of service users were adhering to treatment. There was also a high rate of disclosure, which leads to an increase of VCT in the facilities, and adherence improved even further.

It is very significant that the community managed to adhere to their ARV treatment even though they are illiterate. They were well-educated about their treatment and side-effects, and the dangers of defaulting on the treatment. Through being educated about HIV/AIDS they managed to meet the clinical criteria to be followed before starting ARVs.

Ten years after the rollout of ARVs, a number of factors have become easier or more efficient: compliance as a result of the FDC (fixed dose combination) and the initiation on ART through the nurse-driven system used at PHC level. I look forward to the next 10 years!