SOUTH AFRICA: Time running out for treatment targets

DURBAN, 2 April 2009 (PlusNews) – Task-shifting is urgently needed if South Africa is to meet its ambitious goal of reaching 80 percent of those in need of antiretroviral (ARV) treatment by 2011, delegates attending the fourth national AIDS conference heard this week. 
South Africa will have to double the number of people starting treatment annually to reach the target set by the National Strategic Plan for AIDS 2007–2011. 

Time is running out: South Africa is currently initiating 200,000 people on ARVs per year and when the conference this week there will be 999 days left to meet the NSP targets.

On Wednesday, the international charity organisation, Médecins Sans Frontières (MSF), the Reproductive Health and HIV Research Unit, the Treatment Action Campaign (TAC) and the Southern African HIV Clinicians Society called on government to issue a directive allowing task-shifting, and for regulatory professional councils to support the move.

In South Africa only doctors are permitted to initiate and manage ARV treatment for adults and children but the NSP has recommended that professional nurses be allowed to do this; only nurses are allowed to administer HIV rapid tests, and only pharmacists can dispense the medication because pharmacy assistants are prohibited from doing so.

Re-allocating tasks among the team of healthcare workers, or task-shifting, could improve access to treatment and adherence rates. According to existing evidence, quality would not be compromised, the organisations stated.

“Other countries have changed their regulations to allow nurses to start patients on ART [antiretroviral therapy], and lay counsellors to administer HIV tests. When will South Africa wake up?” said Dr Eric Goemaere, medical coordinator of MSF in South Africa and Lesotho.

Francois Venter, director of the Southern African HIV Clinicians Society, said nurse-led programmes in developed countries had produced better outcomes than those run by doctors, and attributed South Africa’s slow pace in introducing task-shifting to a “lack of leadership and urgency”.

“I would like to think that this is starting to change, but enough is enough … things can’t continue to be business as usual,” he told journalists. “SANAC [South African National AIDS Council] and the department of health need to get cracking.”