The Implications of ART for Local AIDS Care and Support Programmes

Introduction and Method

“With national-level obstacles to the provision of antiretroviral therapy (ART) cleared, and provincial roll-out programmes being implemented in a limited way, there is need and opportunity to reflect on the challenges of delivery at local level.

Whereas public sector ART programmes are planned and implemented at provincial health facilities, they require the co-operation of all those organisations working locally providing treatment, care and support to people with HIV and AIDS. This requires a marked scaling up of efforts to co-ordinate and integrate the activities of local AIDS support organisations and services, that have until now not needed to be closely linked operationally on a case-by-case basis. The objective of this study is to map out some of the manifold challenges faced in this respect.

More particularly, we present the findings of a case study aimed at understanding the implications of ART programmes for local programmes of support and care for people with HIV and AIDS, with a focus on the involvement of a local Hospice which provides homebased care (HBC) services.

Information for this analysis was collected through: a focus group conducted with home-based carers working at primary health care clinics and a local Hospice association; a focus group with HIV-positive people, some of whom are on treatment programmes; reflections on the experience of a Hospice staff member designated as a psychosocial worker (one of the coauthors); an interview with the Hospice Director; an interview with a member of the antiretroviral therapy (ART) programme task team; and, attendance at a task team meeting.

A thematic analysis was conducted to identify the key issues which need to be resolved in the development of an integrated local ART programme.”

This analysis of the needs of the Grahamstown, South Africa, Hospice ART programme describes the readiness assessment of potential patients; the local coordination and integration of programmes and services, including training; the challenges of health care provision and psycho-social support to patients; the needs for mental treatment for depression or alcohol abuse; problems of disclosure and stigma; assistance in applying for social service grants for patients; and the resources needed to serve the scale of patients.


Among the document's conclusions are the following:
1. "The development of systems, models and local guidelines should also be regarded as a resource problem. National treatment guidelines need to be complemented by guidelines for developing local systems of care and support. Far too much has been left in the hands of local task teams. Whereas each focal point presents particular challenges, some of which may be unique, there is much being faced in this focal point which is in all likelihood shared with others."

2. "Infrastructure and procedure development needs to be strongly led by a team with experience in health systems development in a multi-agency context.... Whereas ad hoc arrangements and funding have sufficed to date, it is all too clear that servicing of the need is going to require systematisation of local functions far beyond what currently exists. Informal systems of cooperation between organisations which have previously sufficed are inadequate at ever increasing scale and these need to be formalised and resourced."


3. "National treatment guidelines and provincial support programmes, to the extent that these are developed, need to be supplemented by a robust programme of support for local systems development. There is a need for a provincially co-ordinated strategy for operations research and formative evaluation, with a focus on how to develop, resource and maintain integrated and holistic local systems of ARV treatment."