In the West Coast and Winelands health districts of the Western Cape, Anova is working in partnership with the Western Cape Department of Health to support and expand access to HIV-services. Apart from providing additional staff to support ART programmes in public health clinics, the project focuses on the scale-up of services and long-term care of patients on ARVs.

The main objective is, in the face of having fewer staff members, to improve the efficiency of the clinics in order to maximise patient numbers, as well as to develop a clinical management system that will facilitate easy follow-up of patients in care.

Anova’s team has devised a number of ways of partnering with local public healthcare facilities and surrounding communities in a way that recognises everyone as joint stakeholders who can share not only the responsibility of HIV care but also the successes and achievements. Anova’s West Coast and Cape Winelands team works closely with the local health department’s district managers and staff supporting the development of district plans and identifying gaps.

The patient development initiative is run in support of this objective. Patients are encouraged to count their own tablets in order to assist with adherence. In this way, patients are given a physical role in the ART team to create a sense of belonging and responsibility in the clinic, and at the same time improving their knowledge of their own ART.

The “Green Patient” concept uses positive reinforcement to reward patients who adhere to their treatment programme. If patients adhere to their treatment more than 95 percent of the time, keep appointments, and have a viral load of less than 400 copies per millilitre, then at a single visit they are given medication to last two months or longer (thus eliminating the need for more regular bi-weekly visits). The implementation of the Green Patient Programme has resulted in a significant decongestion of the current ARV sites.

Another of the successes of the programme has been the implementation of a clinical management (Adult ARV) system that was programmed and developed at the Ida’s Valley and TC Newman clinics by Anova staff. Currently, the programme does not require data capturers because most of the data is captured by the adherence counsellors, clerks and/or doctors during patient consultations. Pharmacists and patient advocates are also being trained to use the clinical management system. The data is used to enhance the management of the clinics. This method of capturing data also assists in the ability to track missed appointments and contact patients, either telephonically or through home visits. At Ida’s Valley this programme has proved very successful in limiting patients who are otherwise lost to follow-up.

Training

Training was highlighted as a particular area of need in 2011 and the Anova team responded by arranging training for healthcare staff in the districts. This included HIV and TB,  NIMART, and other training for all levels of staff including those in the pharmacy , counsellors and community workers.

One of the most successful training initiatives was the basic  HIV science training course. This is designed to ease nurses into this technically dense topic. The course also takes into consideration and therefore complements the NIMART training that nurses receive in order to equip them to monitor and dispense HIV treatment. The training sessions were attended by 132 nurses.

The West Coast and Cape Winelands Anova Conferences were attended by well over 180 delegates, served as another opportunity to focus on training. Training held at the conferences included: training clinic staff in paediatric care, training administrative staff in ARV reporting through the new tier.net monitoring and evaluation system and training in counselling for lay counsellors and positive life planners.

Accurate data and trained practitioners in the healthcare system provide an environment for a campaign the team calls “Know your epidemic, know your response”. District programme manager, Nelis Grobbelaar, explains that this involves understanding the complexity of appropriate responses. Each clinic services a set of behaviours in the community that influences the rise and fall of the epidemic. Understanding these factors can help staff combine their prevention and treatment strategies. As Grobbelaar says,  “There’s a magic day when a patient gets it. And when one patient gets it, there’s often a knock-on effect. ‘I’m on treatment ... Me too’ ... type of idea.”

The Anova team has devised innovative ways of forging closer relationships between the provincial Department of Health and the research and medical community at large. This takes shape in an annual meeting the team has christened “Rural Research Day”. Medical researchers are invited to present the work they are doing in the area. The district managers are given an opportunity to meet the researchers and better understand the value of the work that is being conducted within their districts. Knowing how the research might benefit their own work helps promote cooperation and a sense of partnership between the district managers and the researchers.

West Coast and Winelands ART Sites