I-TECH Supports Implementation Of New South African ART Guidelines

South Africa is in the midst of an important and far reaching change in the country’s approach to HIV care and management. On 1 April 2010, health leaders put new antiretroviral treatment (ART) guidelines into effect, initiating a significant shift in the way HIV testing and treatment are managed by public facilities. Specifically, the new policies decentralize HIV care from a limited number of accredited sites, which are typically in larger towns and cities, to a much greater number of smaller, more widely located primary health facilities.

The guidelines also represent a new role for clinical nurses, who, under the mentorship of teams of physicians and pharmacists from previously accredited sites, will prescribe and manage antiretroviral therapy for the first time.

In Mpumalonga, a province with one of South Africa’s highest HIV prevalence rates, nurses and clinicians crowded into the training rooms at the Provincial Department of Health’s Regional Training Center as the guidelines were rolled out. The participants were anxious to learn how these changes will impact their facilities, their work, and their patients.

After opening the session, Thembe Mekoa, director of the training center, commented, “It’s been very busy as we train the nurses to be ready. Last week, we had 200 nurses here; and this week, the same. If we train just two nurses from each facility, that is still more than 500 nurses, because we have more than 280 facilities in the province.” 

I-TECH South Africa has also been actively working to prepare for the new rollout. The team has been involved in a collaborative plan to train health care workers in Mpumalanga province on the new guidelines, along with continuing provision of the I-TECH HAST (HIV, AIDS, STI, and TB) curriculum. “I-TECH is one of our partners who has been with us through thick and thin,” said Mrs. Mekoa. 

For several years, physician and nurse mentors from I-TECH, placed through the University of California San Diego (UCSD), have also mentored South African physicians and nurses in clinics and hospitals throughout Mpumalanga province. To support the new guidelines, I-TECH has placed another full-time mentor, Dr. Vivian Cox. Dr. Cox will provide support as antiretroviral treatment moves to the primary health facilities and ART eligibility expands.

As the crowded meeting in Mpumalanga drew to a close, Dr. Lesego Mawela, a medical officer who works in Barberton and is assisting the province with training and mentoring of health care providers, provided a summary of the guidelines.  After the session, surrounded by the energetic noise of participants, he expressed enthusiasm for the guidelines. “In the past five years,” he said, “we have seen many clinics initiating just three or four patients a week on antiretrovirals. We must be starting many more patients, and these changes will facilitate that. [The new guidelines] push antiretrovirals out to the primary care centers and integrate patients with HIV into the mainstream care at those centers.” 

South African health care workers, who face one of the highest HIV rates in the world, are witnessing a new leadership of the country and embracing a renewed ability to respond to HIV and AIDS. The new guidelines are an important part of this effort. Mrs. Mekoa, voicing the sentiment of many health care workers, echoed this renewed confidence. “These changes,” said Mrs. Mekoa, “are for the benefit of our communities and our society.”