Among other ambitious goals included in SA’s new five-year (2023-2028) action plan for HIV, TB and sexually transmitted infections (STIs), professional nurses could be trained to prescribe pills for mental health conditions like depression and anxiety (under a doctor’s supervision); sex work will be decriminalised; and the HPV jab campaign is to be rolled out to girls at non-government schools countrywide.
Although the South African National Aids Council (Sanac) launched the final plan in Rustenburg on World TB Day last Friday, Health Minister Joe Phaahla will still have to change the Nursing Act regulations to allow nurses to prescribe antidepressants, according to Andy Gray, a senior pharmacology lecturer at the University of KwaZulu-Natal.
Currently, only general practitioners and psychiatrists can prescribe psychiatric medication in South Africa, writes Joan van Dyk for Bhekisisa.
Nurses can get trained to prescribe some medicines, for instance, antibiotics, but not mental health medication like antidepressants because they’re classified as schedules five and six medicines.
About one in three people in South Africa will have depression, anxiety or a substance use disorder at least once, according to the 2009 South African Stress and Health Survey. But three-quarters of people will never be treated.
Depression, anxiety and substance abuse are much more common among people with HIV and TB than those not living with these illnesses, the plan says. Mental health conditions make it harder for people to keep taking their medication, and discrimination from health workers can result in people with mental health challenges not asking for help.
Anxiety and depression also increase the risk of contracting HIV or TB (anxious or depressed people often use coping mechanisms like substance abuse, that, in turn make them more vulnerable to contract HIV or TB), hence the need for it to be easier to get prescriptions for psychiatric medicine, the action plan says.
While professional nurses study for four years and receive a degree, community health workers will also be trained to identify the signs of mental distress and substance abuse early.
But the new plan, called the National Strategic Plan (NSP) for HIV, TB and STIs – which also aims to get more children vaccinated against the human papillomavirus (HPV) that causes cervical cancer – has a funding gap.
For the first year of implementation, there is R1.7m too little available to reach the plan's goals, and such shortfalls increase annually; by 2028, the last year of the plan, the cumulative deficit, as things stand now, will be R7.2bn.
What does the budget look like?
The government will fund the bulk (77%) of the NSP roll-out itself.
Another 20.5% of the money will come from international donors like The Global Fund to Fight Aids, Tuberculosis and Malaria (6%), the US Agency for International Development, and the US Government's Aids fund, the President’s Emergency Plan for Aids Relief, Pepfar (14.5%).
South Africa’s private sector will contribute just 2.5% of the total costs of the NSP until 2028.
International donors have increased their contributions in the past couple of years to help South Africa reach its 95-95-95 targets, but as the country inches closer to controlling its HIV, TB and STI epidemics, they will start to cut their funding, the plan says.
This is worrying, according to the NSP, because international partners invest a considerable amount into improving the country’s health system operations (for example, data collection). Donors also fund many community health worker programmes and projects that work with groups of people with high HIV, TB and STI infection rates, like sex workers and transgender people.
Other news from the fifth NSP:
• The plan aims to get more people with HIV and TB tested and treated for diabetes, hypertension and cancer.
• It also aims to start rolling out the HPV vaccine (that can prevent cervical cancer), to non-government schools. Currently, only girls in government schools qualify for the free jab.
• For the first time, the government will track HPV vaccinations the same way it tracks HIV & TB treatment in the NSP. It aims to vaccinate 95% of girls aged nine and older with the first anti-HPV vaccine by 2028: 85% of nine-year old girls should have received their second dose by 2028 as well.
• The Health Department will push to decriminalise possession and use of drugs (in personal use cases). Studies show people who inject drugs have much higher HIV infection rates than those who don’t (often of needle-sharing). The report says HIV and TB cases will decrease because when these drugs aren’t illegal there will be less stigma around drug use, making it easier for people to access health services. People are also at a higher risk of contracting TB if they’re imprisoned, or they might not have regular access to their HIV medicine.
• Sex work will be decriminalised. Studies show that when sex work is legal, sex workers are more likely to test for HIV and take up treatment if they test positive, leading to lower HIV infection rates. The government will also beef up screening, testing and treatment for viral hepatitis.
• The Health Department plans to start 260 000 close contacts of TB patients on preventive treatment by 2028.
• The government aims to vaccinate 90% of newborns against hepatitis B by 2028.
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