Piloting antiretroviral treatment in South Africa: the role of partnerships in the Western Cape's provincial roll-out

Abstract

In 1999, the government of the Western Cape Province, South Africa, entered into a partnership with Médecins Sans Frontières (MSF) to provide HIV treatment through public health clinics in the peri-urban settlement of Khayelitsha. From 2000 onwards, this partnership ran South Africa's first antiretroviral treatment (ART) programme. Due to the province's limited experience (as of 1999) in implementing and monitoring an ART programme, and the National Department of Health's opposition to the public provision of ART, this partnership was instrumental in piloting and later scaling-up the Western Cape's ART programme. Numerous studies have documented this pilot ART programme from a health system or clinical perspective. This study instead used qualitative methods to examine the factors that facilitated the public provision of ART in the Western Cape. With reference to the role of partnerships in piloting new health interventions, the article explores the partnership that was established between the provincial government, civil society organisations, research institutes, and service providers to support the public provision of ART in Khayelitsha. This partnership has demonstrated that ART programmes can be implemented successfully within resource-constrained settings, achieving high levels of treatment adherence, low rates of loss to follow-up and excellent health outcomes. Lessons from the partnership's components and strategies are therefore of vital significance to realising the roll-out of ART programmes in various contexts across the developing world, demonstrating the crucial role of collaboration and integration in the establishment and maintenance of these programmes.