Angst as South Africa’s HIV & TB Healthcare Worker Hotline goes offline
South Africa's HIV & TB Healthcare Worker Hotline service provides information to all health care workers on aspects concerning the treatment of HIV and TB infection and related diseases. (Photo: Shutterstock)A crucial hotline run for nearly 20 years from the slopes of Devil’s Peak in Cape Town for healthcare workers anywhere in South Africa, from the country’s busiest urban hospitals to far flung resource strained rural clinics, has been suspended due to a lack of funding.
Around two decades ago when Dr Laurel Giddy first started working with people living with HIV, they were already very ill. She remembers five of her patients that she put on antiretroviral treatment dying. She says it was heartbreaking.
“I was just at sea. I felt like I was in the deep ocean, and it was very difficult to get help. There just wasn’t a lot of knowledge going around at the time,” she tells Spotlight. “Getting trapped in an environment where you’re not sure what you’re doing and where people die and you feel unsupported is just demoralising.”
This is the kind of high-stakes situation that the team at the South African National HIV & TB Healthcare Worker Hotline responded to when South Africa’s antiretroviral rollout started gathering steam after the end of state-sponsored AIDS denialism.
And with their help, the milestones at Giddy’s HIV treatment clinic that she help set up at the Knysna Provincial Hospital followed: first 100 people on HIV medicine and a couple of years later, 5 000.
“I’m getting quite emotional, but they helped our programme just fly,” says Giddy.
18 years of national support
The free hotline has to date answered more than 86 000 queries from doctors, nurses and pharmacists in public and private healthcare facilities in all corners of the country. The service is run by the University of Cape Town’s Medicines Information Centre.
“Over 18 years, the hotline has provided trusted, evidence-based clinical support to healthcare workers across South Africa, contributing significantly to patient care and strengthening health system capacity,” Annoesjka Swart, manager of the Medicines Information Centre, tells Spotlight.
But now the phone lines have fallen silent.
“Regrettably, we no longer have the financial resources required to sustain the service, having received no funding support for the hotline since April 2025,” she says. “Although we submitted a bid for a tender that was released on 1 April 2026, to our knowledge the bid has not yet been awarded.”
SA’s troubled twins
The suspension of a free hotline service dedicated to providing clinical advice for the management of HIV and TB is particularly worrying in South Africa where the two diseases remain deeply intertwined public health crises.
South Africa has one of the highest TB incidence rates in the world and the largest HIV epidemic in any single country. TB and HIV is among South Africa’s leading causes of death. Each is estimated to claim over 50 000 lives per year, although there is substantial overlap between the two since TB is the top killer of people with HIV.
The connection between HIV and TB is relatively straightforward. People with untreated HIV infection typically suffer severe damage to their immune systems, which dramatically increases the risk of falling ill with TB and dying of it.
One study showed how usage of the hotline by nurses increased dramatically in its first few years. Such support for nurses is particularly important in the context of the health department’s decision to authorise specially trained nurses to diagnose HIV and prescribe antiretroviral medicines in terms of its NIMART (nurse-initiated Management of Antiretroviral Therapy) programme. NIMART has been lauded as one of the reasons why South Africa’s HIV treatment programme could grow as fast as it did in the 2010s. Prior to NIMART, only medical doctors could prescribe antiretrovirals.
The team behind the hotline has also been involved with research – such as this study on healthcare workers’ knowledge of interactions between a widely used antiretroviral and other medicines.
How the hotline works
Swart explains that queries received by phone, e-mail, WhatsApp and ‘please call me’ go directly to one of the specially trained information pharmacists, who record all the details in a password-protected database. “Details recorded include caller demographics – profession, sector, facility, province – and relevant patient details – antiretroviral therapy history, medical history, laboratory results and other conditions/treatment and the question.”
The pharmacist then researches the query using up-to-date, evidence-based references and, where necessary, consults an expert clinician. “All references used and clinician input is recorded on the database. Most queries are answered on the same day,” says Swart.
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As the patient of a healthcare worker who calls the hotline, she says that patient can be assured that the best possible treatment has been discussed with a multi-disciplinary team, where needed, without having to leave their local clinic.
Swart adds that hotline pharmacists have access to many clinical experts, based at the University of Cape Town’s medical school, Groote Schuur Hospital, Red Cross Children’s Hospital and more.
“Up to the end of August 2026, the hotline had answered 86 672 queries,” she says. Over the last five years from 2020 to 2025, Swart says the hotline managed about 380 to 430 HIV/TB queries per month, around 18 to 20 healthcare worker consultations every working day, or an estimated 90 to 100 consultations every week.
Most queries are received from the Western Cape, Eastern Cape, Gauteng, and KwaZulu-Natal. “Over the past 5 years, we’ve seen a steady increase in calls from Mpumalanga – 347 in 2021 to 571 in 2025 – and Limpopo – from 90 in 2021 to 201 in 2025,” she says.
Practical resources
While the primary focus of the hotline is to provide clinical support to healthcare workers across South Africa, Swart says her team also develops and designs easy-to-use posters, booklets and tools based on national guidelines.
There is also an associated SA HIV/TB Hotline app available on Google Play and the Apple App Store. It includes a drug-drug interaction checker allowing healthcare workers to check multiple medicines against all HIV medicines, a step-by-step tool on how to manage skin, renal and liver adverse drug reactions to antiretrovirals and TB medicines, and a dosing tool for prescribing HIV medicines for children. “The app had over 6 000 active South African users between April and June 2026,” says Swart.
She adds that a Facebook page was created in 2016, which posts daily news and a weekly query of the week on Fridays to a following of over 12 500 people.
In one query posted on Facebook, a nurse from the Eastern Cape wanted to know if she should recall a patient earlier than the month she instructed. She initiated the 23-year-old male, who had been diagnosed with HIV three days earlier, onto the single-pill, once-a-day antiretroviral regimen of Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir. While he was clinically well, results for his CD4 count – the number of blood cells in a cubic millimetre of blood which gives an indication of the health of a person’s immune system – was 179 and he tested positive on a cryptococcal antigen test (CrAg).
The hotline’s experts advised the nurse to recall the client urgently, within 1 to 3 days and was pointed to the country’s guidelines which state that any client with a first or new CrAg-positive result should be called back for an urgent lumbar puncture and clinical assessment for meningitis, regardless of whether symptoms of meningitis are present. (Read our special briefing on cryptococcal meningitis, which is a serious fungal infection causing inflammation of the lining of the brain and one of the top killers of people living with HIV in South Africa.)
IN THE SPOTLIGHT | Cryptococcal meningitis is a serious fungal infection causing inflammation of the lining of the brain. In this special briefing, @elri-voigt.bsky.social dives into why it remains so deadly, and what we can do about it: www.spotlightnsp.co.za/2026/09/14/i…
— Spotlight (@spotlightnsp.bsky.social) September 14, 2026 at 10:04 AM
Swart says based on knowledge gaps that the pharmacists on the hotline pick up through the queries received, the hotline service has provided weekly WhatsApp-based microlearning sessions to three groups of healthcare workers. Since May 2025, 723 nurses, 915 pharmacists and doctors, and 375 community health workers joined these sessions on a wide spectrum of HIV and TB topics.
“The closure of the hotline will result in the unavailability of free clinical support for healthcare workers across the country managing people living with HIV and TB,” Swart says. “In addition, no posts will be added to the Facebook page, no new posters or tools will be designed, the weekly training has stopped, and the app will be maintained but not expanded.”
The funding conundrum
Swart explains that the hotline service has been funded throughout its existence, and most recently through a service level agreement with the National Department of Health from a Global Fund grant. “Our last Global Fund tranche finished in March 2025, and all documents to renew the contract were previously submitted in May 2024 for a new contract to start on 1 April 2025,” she says.
The Global Fund, established in 2002 to provide funding for HIV, TB and malaria programmes, announced in May last year that it was reducing funding to over 100 countries amidst shortfalls. It has indicated that it’s final grant to South Africa of around US$403 million will be for the period running from April 2031 to March 2034.
Swart says her team was informed in November 2024 that the team in charge of the Global Fund grant at the National Department of Health were planning to implement a tender process and was reassured that the hotline activities will still be supported.
“Several delays then ensued in combination with the global funding cuts across the board in February 2025. In April 2026, the service was put out on tender, and we successfully progressed through Phases 1 and 2 of the evaluation process. Following an invitation to present on 15 May 2026, we have unfortunately not received any further feedback, despite follow-up efforts made in a manner that respects the integrity and confidentiality of the procurement process. There has also been no information that another bidder was successful.”
A HUGE DEAL | We understand why Professor Glenda Gray found it so moving that the US National Institutes of Health lifted the block on funding for research in South Africa. Find out in our newsletter: tinyurl.com/y8wbf8xb
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Swart says the hotline’s activities came under strain in October 2025 when significant cuts in staff time were implemented and emergency funding was used to sustain the service.
“While we have always needed to seek and apply for funding, we have kept the service going and never had to face suspension before. Unfortunately, the massive budgetary constraints can no longer be overcome with emergency and cross funding endeavors,” she says. “It will remain suspended until alternative funding can be secured or the tender is awarded, so that we can reopen the hotline and continue all advisory activities.”
Spotlight sent questions to the National Department of Health, but had not received a response by time of publication.
What it means for healthcare workers
The news of the suspension of the National HIV and TB Healthcare Worker Hotline has prompted widespread concern.
Southern African HIV Clinicians Society CEO Dr Fiona Storie says it has promoted the use of the hotline to their extensive network of healthcare workers throughout the years.
“We believe the hotline provides an integral support service to clinicians in the country. The suspension of the hotline represents a significant loss of a valuable resource that enhances evidence-based HIV and TB management in South Africa.”
Noluthando Swartbooi, an occupational health nurse practitioner at Kwazakhele Clinic in Nelson Mandela Bay, tells Spotlight she has been using the hotline for about four years now. “HIV and TB management continues to require ongoing support, up to date knowledge and at times specialist guidance. Having access to experience through the hotline has been extremely helpful,” she says.
With chronic shortages of healthcare workers in the public sector among other challenges, she says she is worried about the suspension of the service. “The cases we deal with are not straight textbook examples so guidance from experts is beneficial. Suspending the hotline could place a strain on healthcare workers as they may have fewer options of teams that may assist in management of patient cases. This may affect the quality of care provided to patients,” she says.
As an information pharmacist at UCT, Briony Chisholm witnessed rural health workers missing out on crucial training that could make a real difference in their daily work.
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A clinical pharmacist in Mpumalanga, who has been using the hotline for around five years, says she is daunted because most practitioners she works with don’t keep updated with current national treatment guidelines. She says it falls on her with the help of the hotline to ensure that all patients are taking appropriate treatment and the right doses.
“I do not know who I’ll be seeking help from moving forward, especially for patients that need dose adjustments according to the liver and kidney function tests as well as paediatrics since there’s some TB medication that’s out of stock. Their absence will make my workload even heavier than it already is right now,” she says.
For her part, Swart seems committed to limiting the disruption and finding a way to getting the hotline up and running again.
“While the suspension of services represents a significant and regrettable setback, we remain fully committed to preserving the hotline and are actively exploring funding opportunities that may allow us to resume operations in the future,” she says. “Should funding become available, we will work diligently to restore the service as soon as possible.”
Giddy says she is devastated that the hotline service is on its knees. “They supported us in our sorrows, and they rejoiced in our triumphs with us for years,” she says.
