The number of people living with HIV who develop chronic conditions like cardiovascular and respiratory disease, cancer or diabetes is increasing. Kwa-Zulu Natal, which has the highest HIV prevalence rate in South Africa, is the worst affected province.
Right to Care, together with the Bhekhuzulu Self-Sustaining Project and the Mpilonhle Sanctuary Organisation, has launched a new integrated chronic care initiative in KZN’s uThukela District to reduce the incidence of chronic diseases in HIV positive patients. This began with a common cancer screening drive at AE Haviland Clinic in Weenen.
Sibongile Ramotshela, cervical cancer coordinator at Right to Care, says: “People living with HIV are at higher risk of developing common cancers, TB and other non-communicable diseases (NCDs). This is due to the HIV infection itself and antiretroviral therapy (ART) side-effects as well as lifestyle factors. UNAIDS reports that one third of persons screened at HIV testing sites are obese and have hypertension.
Despite the clear links between HIV and chronic diseases or NCDs, the healthcare system’s prevention and treatment response remains fragmented. An integrated response that deals with overlapping problems and common risks has become a healthcare priority as ART is enabling people to live long enough to develop other diseases.”
The integrated chronic care initiative in uThukela is being funded by the Bristol Myers Squibb Foundation that has committed just over R15m for two and a half years. Right to Care is the prime recipient, responsible for project management, training doctors and nurses and procuring equipment. Together with its partners, the Bhekhuzulu Self-Sustaining Project and the Mpilonhle Sanctuary Organisation, Right to Care is working with the regional and district Departments of Health to scale up awareness, screening and treatment services. Communities, women’s groups and faith-based organisations are also being mobilised to help raise awareness.
“We aim to optimise the use of available resources and integrate screening and prevention. Ultimately, we are aiming for a single visit approach which allows patients to have all their chronic conditions reviewed at one appointment,” says Ramotshela.
Cervical cancer was once again highlighted as a preventable but highly prevalent cancer at the first milestone of the initiative, the cancer screening drive.
Ramotshela says, “The human papilloma virus (HPV) is the most common sexually transmitted infection and the most common cause of 70% of cervical cancers. The HPV vaccination of young girls is not well implemented in school health programmes in this area despite it being a primary prevention strategy for cervical and other HPV-related cancers. Furthermore, pap smear screening in this district are well below the levels required to effectively prevent these cancers.
“HIV positive women are three to five times more likely to develop cervical cancer and its progression is far more rapid in HIV positive patients. The new integrated chronic care initiative aims to tackle this cancer as well, which affects young women the most,” says Ramotshela.
Treated HIV/Aids has become a chronic disease, and the healthcare needs of people on antiretroviral treatment resemble those of people with NCDs. There are also links between HIV and NCDs in terms of chronicity, risk of development and severity of progression of disease. Ramotshela says, “The uThukela programme is being implemented together with the Department of Health as healthcare workers are required to take a far more coordinated approach. Furthermore, we are hoping to create more youth friendly health services which have been identified as a vital element of prevention strategies.”
The programme is being rolled out in three sub-districts of the uThukela District, the Alfred Duma Local Municipality, the uKhahlamba Municipality and the iNkosilanga Libalele Municipality. Implementation is taking place at 16 facilities – nine fixed clinics and seven mobile clinics.
The national HIV prevalence in South Africa is 29.7% and the highest HIV prevalence is in KZN, having reached 40.1%. HIV and other communicable and NCDs are on the increase in this province, exacerbated by poverty – more than a third of KZN’s population live below the poverty line and 40% of the population is unemployed.