Highly Active Antiretroviral Treatment ( HAART ) and Prevention of Mother-to-Child Transmission (PMTCT) projects

Objectives:

•  Provide comprehensive HIV/Aids care, monitoring and treatment to patients

•  Build capacity and promote partnerships between other NGO's in the sector, as well as government institutions

•  Become a role-model for HIV/Aids care in resource-poor settings through the ATC concept

In 2003 a project was set up in which HIV-positive patients are treated with Anti Retroviral (ARV) medicines (triple therapy). The project now aims to have 2500 people on treatment by 2005. By treating patients with ARVs, their immune system improves, making them less vulnerable to opportunistic infections that will lead to death when no medication is taken. Although ARVs are not a cure for AIDS, they improve life expectation and quality of life.

Since there are not enough funds available to treat all HIV-positive patients in the area, the project focuses on

HIV-positive pregnant women attending the antenatal clinic and their neonates

• TB patients attending the TB programme , who have tested HIV-positive
• children in the NNU programme who are HIV-positive, and their HIV-positive parents and siblings
• patients who have tested HIV-positive and are compliant on treatment for their opportunistic infections
• employees of NMC and related projects.

Patients belonging to one of the target groups have to meet clinical, biological, adherence and social criteria. A selection committee verifies whether all selection criteria have been met before a patient is allowed to enter the free programme.

The PMTCT programme focuses on preventing HIV transmission from mother to child by informing the women about the risks, encouraging them to test to find out their status, treating the women before and during the delivery to reduce the chances of transmission, and treating the neonate for four weeks after delivery. To prevent HIV transmission through breastfeeding, the women are given formula feed to feed their babies.

The HAART project serves as a model to make treatment with Anti Retrovirals (ARV's) accessible to people in rural areas, and is based on the concept of an autonomous treatment centre (ATC). An ATC is a primary health-care unit with extended services, such as a pharmacy, X-ray facilities, an ultrasound facility and a 15-bed admission ward that can be used for both primary health care and the care of AIDS patients. One ATC can assist up to four clinics with their ARV roll-out, therefore only one out of five units needs to be equipped with a laboratory, in which all HIV/Aids tests can be done. This testing is necessary to control the proper implementation and monitoring of HAART . A conglomerate of one ATC with its four clinics and laboratory, will be able to serve 5 000 – 7 500 HIV-positive patients on HAART , and monitor approximately 25 000 – 40 000 HIV-positive people who do not qualify yet for treatment. If one escalates this to an HIV prevalence of 26,9% of the population, it means that a population of approximately 100 000 – 160.000 can be served through such a system. PharmAccess International, an initiative taken by Professor Joep Lange of the Amsterdam Medical University , the Netherlands , developed the principle of an ATC. Ndlovu Medical Centre modified the principle in order to facilitate fast and well-managed ARV roll-out in South Africa . The Ndlovu ATC is an integrated service for Primary Health/ Tuberculosis and HIV/AIDS Care

NMC is equipped with these extended services. Its own laboratory has been fully operational since February 2004. All testing related to the monitoring of HIV-positive patients can be done at this laboratory. NMC therefore qualifies and functions as an ATC.

The construction of a second treatment centre will be considered once the principle has proven itself.