The Tygerberg Infectious Diseases (ID) Clinic, in affiliation with the University of Stellenbosch, provides HIV care ranging from basic primary healthcare to tertiary specialist care. The hospital’s primary drainage area is the Eastern Sub-district of the Cape Town metropole, with some 2 million residents. The ID clinic delivers an adult and a paediatric service.

ART - Adult

Adult Infectious Diseases Clinic

The adult clinic provides ARV services to all HIV patients above 16 years of age who need antiretroviral therapy (ART) or who experience complications. Primary community clinics supported by the Infectious Diseases Clinic regularly follow up the HIV-positive patients in their wellness programmes and then refer eligible patients to the hospital’s ID clinic for treatment as soon as they are eligible to start ART.

Upon arrival, the staff actively screen the HIV patients and seek to diagnose and treat all HIV-related conditions, as well as provide ART. These “roll-out” patients are followed-up monthly at the clinic with a holistic approach to care. There are counselling, social and religious services available to all clinic patients.

The number of patients at the clinic is steadily growing with a net increase of 18 patients per month over the past year. Until recently there where more than 1350 adults on treatment, attending the clinic or pharmacy on a monthly basis. This resulted in overburdened staff, crowded waiting rooms, longer waiting times and suboptimal clinical care.

The adult clinic currently has two full-time doctors, five part-time doctors, four nursing staff, two administrative staff, one full-time pharmacist, four counsellors and one socialworker. Due to the locally-growing HIV burden, it is expected that the clinic’s dual function as primary ARV clinic and referral centre for more complicated ARV/HIV-related cases to tertiary institutions will grow. Although new primary ARV clinics are to be opened in the Tygerberg vicinity as indicated by the National Department of Health, progress remains slow.

HIV Research Unit Tygerberg (HRUT)

The HIV Research Unit at Tygerberg (HRUT) was founded in 1993 in response to the tremendous challenges the ID Clinic faced in scaling up the national roll-out programme. Anova continues to support the unit through PEPFAR/USAID funding. HRUT’s mission is to strengthen the ID clinic’s capacity to deliver high-quality, cost-effective, comprehensive treatment, care and support to adults, children and families affected by and infected with HIV, within the Tygerberg catchment area. This is achieved by the development and implementation of several projects, focussing on improving data management, teaching and outreach, and expanding referral capacity, collated under the name of the Share Care Programme.

The Share Care Programme has eight staff members, representing all levels of care in the clinic, which increases the general workforce significantly. They form a motivated team, dedicating their time and energy to improvement and innovation in HIV care, providing technical assistance to the existing Department of Health structures, facilitating system strengthening and ensuring quality care. The Share Care Programme therefore is also co-operating closely with the department to achieve the goals set out in the National Strategic Plan 2007-2011.

The individual Share Care Programme components are:

• The Data Management Programme, which actively integrates information collection and capturing, as well as reporting and developing innovative systems for clinical management and data storage with the future in mind;
• The Down-Referral Programme, which supports the expansion of the National ARV programme by the creation of new nurse-driven satellite ARV centres based in the existing primary clinics;
• The COLPOS programme, which strengthens the care for vulnerable women by the close co-operation of the fields of reproductive health and gynaecology, i.e. with timely referral to family planning and cervical screening. Active involvement in the PMTCT programme at the antenatal clinic is also accomplished; and
• The Training and Outreach Programme, which builds up the care capacity of healthcare workers by active outreach and expanded training activities, bringing specialist care closer to the communities.

Down referral produces real results

In 2011 Anova is assisted the Western Cape’s health department in its endeavours to increase the number of ART sites in the province and to optimise its healthcare system through the Down Referral component of the Share Care programme.

The programme aims to transform sites that previously did not offer basic HIV services into sites that are equipped to dispense ART.

The programme achieves this by having a visiting nurse at the facility for a few days per week. The nurse brings pre-packaged ART from Tygerberg Hospital’s pharmacy for stable ART patients who have requested to be transferred to that clinic.

Project manager Dr Marije van Schalkwyk says the Share Care programme has made a significant difference in the lives of cash-strapped patients, who no longer have to travel great distances to collect their medication.

In 2011 the Share Care programme was operational in three Western Cape clinics. Bishop Lavis clinic was the first facility to host the programme in 2010 and the Elsiesrivier and Kasselsvlei clinics were added to the programme in September 2011.

Currently a total of 325 patients have been down referred via the programme. In November 2011 Bishop Lavis clinic was established as an official DOH ART site and all 200 patients previously followed up at Bishop Lavis Referral Programme have been officially transferred down with great success.

This has effectively brought down the number of Tygerberg adult patients on ART by 15%, to 1150. At the two remaining sites there are another 105 patients followed up in the Referral Programme and the number is growing steadily, bringing down the total of Tygerberg patients physically attending Tygerberg Hospital by another 9%. It is hoped that both Referral Programme Sites will soon become official DOH ART sites, making ART available closer to home for another 350 patients.

Paediatric Infectious Diseases Clinic

The paediatric HIV clinic at Tygerberg Children’s Hospital (TCH) was established in 1997 as part of the adult family ARV clinic in an attempt to give comprehensive care to families affected by HIV. Approximately 316 children receive HAART at the clinic (around a quarter of the total clinic population).

At the same time the clinic serves as a referral centre for those children with HIV who require secondary and tertiary care, and it is actively expanding paediatric care to community-based sites in order to facilitate the down-referral of stable children from tertiary care to community-based care. At these sites staff are trained and mentored. The clinic also oversees the initiation of treatment in nine community sites up to 70km away from the hospital.

A multidisciplinary meeting takes place every week to discuss ARV treatment and the impact of social issues on adherence. The programme refers many families to the socialworker in the hospital for social issues, including: exploring grant applications, violence or when a child is particularly vulnerable. Support groups for parents, mothers and caregivers run weekly while the children attend the adolescent group. As a result of strengthening community-based care, patient numbers at TCH remain stable while many infants and young children now access care in the community, rather than tertiary hospitals.

The project has also partnered with an occupational therapist who assists in the assessment and treatment of children with developmental delay, and also trains parents how to assist their children.

Community health workers (CHWs) play a crucial role in broadening access to health services. Therefore, ongoing training, support and recognition are especially important parts of the project because previously no CHWs in the area were trained on either paediatric assessment or care.  The project has trained 30 CHWs from four organisations. Weekly workshops are held around child health topics and are structured around South Africa’s integrated management of childhood illness protocols for CHWs.  The CHWs are encouraged to take part in health days organised by the project and spread the different messages to members of the community.

Tygerberg ART sites (Adult)

Tygerberg ART sites (Paediatric)