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Progress made with primary health care services for HIV/AIDS in Gauteng
Gauteng Provincial Government press release.
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Gauteng has developed its primary health care infrastructure to provide comprehensive HIV/AIDS care, according to an overall AIDS Care Strategy. This AIDS Care Strategy was reviewed and endorsed by outside experts in 2001 and 2002.
Primary care clinics were extended to reach all local areas of the province from 1995 to 1999. The TB service was strengthened as a top priority from 1996 and an HIV counseling and testing service added to the clinics. Home-based care services were developed from 1997.
A survey of clinics by Health Systems Trust (HST) showed that 80% of clinics had the infrastructure to provide HIV/AIDS care. This included clinicians (trained nurses and doctors), counsellors, medicines and laboratory tests for HIV and TB. However, the survey did not show how well these services were working.
The Gauteng Health Department therefore commissioned the study by the Centre for Health Policy (CHP) to assess the service, identify strengths and weaknesses and recommend improvements.
The study in mid-2001 confirmed the HST findings,with 90% of clinics having the necessary infrastructure. This compares very well with primary care services internationally.
The main gap identified was that nurse clinicians (primary health care nurses) do not have sufficient training on AIDS-defining conditions, which occur at the late stages of the illness, including oesophageal thrush. They also need more support to cope with the demands of caring for people with AIDS.
Nurses already have the skills to diagnose and treat common HIV-related infections such as TB, pneumonia, diarrhoea, ear and throat infections and sexually transmitted infections (STIs). Other areas for improvement were also identified by the study.
Clinical guidelines on HIV/AIDS adapted to the public health services were finalised a year ago and introduced to over 3000 clinicians in 2002. All doctors and nurses need to be familiar with these guidelines. While most doctors have the necessary clinical skills to implement the guidelines, many nurses need additional training. Over 90% of nurses are willing to provide this care.
Meanwhile, ongoing progress has been made with comprehensive services for HIV/AIDS at primary care level in Gauteng. This includes the TB programme, STI services, Home-based care services, prevention of mother-to-child-transmission (MTCT) and access to HIV testing with counselling.
* 26 000 people were treated for TB in Gauteng in 2001. TB cure rates are improving in the face of the AIDS epidemic and this progress has been recognised by the World Health Organisation.
* HIV tests became available in all clinics from 1997, with 1 000 counsellors trained in 2000.
* The service for sexually transmitted infections(STIs) has been provided in 90% of clinics from 1998, according to the syndromic approach. The rate of syphilis infection in pregnant women has dropped by 83% from 1998.
* 55 new Home-based care services run by NGOs were funded by the Gauteng Health Department. They provided care to 13 000 people with severe illness in 2001.
* Services to prevent MTCT were extended to 90% of hospitals and many clinics in 2002.
* Prophylaxis with anti-retroviral drugs following rape were introduced in all rape trauma centres in 2001 and the first services are now open.
Obviously, ongoing work is needed to strengthen services, improve quality of care and ensure local access. Local referral networks are also being developed. |
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