Abstract
Tuberculosis (TB) and HIV care in Khayelitsha, and in South Africa as a whole, has overcome numerous obstacles in the past three decades. This article highlights what has been achieved in Khayelitsha, describes the key clinical programme and policy changes that have supported universal coverage for HIV and TB care over the last 10 years, and outlines the challenges for the next decade.
Highlights
Tuberculosis (TB) and HIV care in Khayelitsha, and in South Africa as a whole, has overcome numerous obstacles in the past three decades
The success in scaling up HIV/TB service provision in Khayelitsha is attributed to the collaborative efforts of service providers, policy makers, academics, civil society and the community at large
While the district is best known for its role in demonstrating the feasibility of antiretroviral therapy (ART) in resource-constrained settings, some of the most important lessons have come in more recent years, where the latent capacity of South Africa’s public health system has been demonstrated when subjected to energy, innovation and meaningful collaboration
Summary
Daniela Belen Garone[1,2], MD, PhD Katherine Hilderbrand[1,2], BSc, MSc Andrew M Boulle[2], MB ChB, MSc, FCPHM, PhD David Coetzee[2], MB ChB, MSc, FCPHM. The Khayelitsha programme, started in 1999, was the first in South Africa to provide antiretroviral therapy (ART) at primary care level in the public sector and one of two pilot projects in the country to provide decentralised care for drug-resistant tuberculosis.[12] Key strategies implemented include: ■prevention of mother to child transmission with ART and formula ■large-scale HIV counselling and testing, including out-of-facility testing, youth clinics,and male clinics ■mass community condom distribution ■decentralisation of ART to all clinics in the subdistrict ■‘one-stop-shop’ integration of ART and TB services ■nurse management of HIV and TB care, including nurse-initiated ART and TB treatment ■doctor support and mentorship, with a strong secondary care referral system ■district level planning and co-ordination ■three-tier monitoring and evaluation system (paper register, electronic register,and electronic medical record in selected sites) ■ongoing training and mentoring at clinic and district level. The successful decentralisation of paediatric care has led to positive health outcomes; 87% of children started on ART in primary care remained in care, and 98% remained alive after 5 years on ART
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