Comprehensive HIV and AIDS Care Clinic programme
Provision of Antiretroviral Care project
This project was started in February 2005 in response to the dire need for antiretroviral therapy (ART or ARV therapy) to be made available to the rural communities served by Topsy. In most of these communities, there has been little access to ARV therapy, because the state-sponsored ARV campaign has been slow to reach rural areas. No formal comprehensive HIV and AIDS programmes have been implemented in any of the communities in which Topsy operates.
Topsy has since established its Comprehensive HIV and AIDS Care Clinic (CHACC) at the Topsy Sanctuary, a specially refurbished building at Grootvlei, which provides care and treatment specifically involving antiretroviral therapy to patients on the Antiretroviral Community Programme. The clinic team consists of two medical doctors, and a number of nursing staff and social workers, all of whom have received appropriate, specialised training.
The Topsy Foundation has secured support from Right to Care (a South-African based NGO supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) for the direct costs for patients on ART.
Once a patient has been selected, the following tests are done as part of the screening, together with any necessary additional tests:
- Clinical examination, including height and weight of the child;
- HIV ELISA – ‘enzyme-linked immunosorbent assay’, to detect HIV antibodies;
- PCR (if ELISA undetermined) – ‘polymerase chain reaction’ test, which can detect HIV infection earlier than the ELISA test;
- CD4 count, a test for the levels of a particular lymphocyte that normally plays an important part in the immune system and declines with the onset of AIDS infection;
- Viral Load – a test measuring the concentration of the virus in a given volume of body fluid;FBC (Full blood count) – a diagnostic check on the concentrations of white and red corpuscles and platelets in the patient’s blood.
On the patient’s first visit to the clinic after these tests, the medical professional will make sure all relevant results are available and ‘stage’ the client according to the World Health Organisation (WHO) ‘staging’, which defines four clinical stages in the development of HIV infection. The patient will be referred to the social worker to start ‘readiness counselling’. After at least three sessions, the social worker will determine when the patient is ready to begin ART. During this time, Topsy provides prophylaxis for opportunistic infections, as well as treatment for any acute infections.
Over the next three months, the patient will be seen fortnightly or monthly by a medical professional and a social worker. Checks including a pill count and monitoring of medical charts are undertaken to make sure the patient is adhering to the regime. The social worker gives ‘adherence counselling’ – encouragement to the patient to stick with the therapy and its requirements. All of this is documented.
If the patient has stuck with the therapy, is clinically stable, and the viral load has dropped to below 400 copies of the virus per millilitre of blood, he or she will receive treatment for three months. Children have to come to the Comprehensive HIV and AIDS Care Clinic every month to collect their treatment, since the dose they need changes according to their weight.
All staff members concerned undergo training, which covers HIV and AIDS, counselling, laboratory testing, ARV treatment, their own role in the community, and the expectations, fears and opinions they are likely to encounter.
Families caring for children are visited daily for at least one month after starting treatment, during which time trained fieldworkers ensure that they administer the drugs correctly. Each dose given must be charted. They then receive regular follow-up visits. This enables the Topsy Foundation to identify and deal with any social or medical problems as soon as they arise.
Follow-up blood tests are carried out every three months , together with urine tests and ‘rapid’ finger prick tests for glucose, cholesterol and lactate.. Additional tests are done if the clinical picture raises any suspicion of side-effects developing. This permits the efficacy of the drugs to be monitored, as well as any suspected development of side effects or resistance.
Voluntary counselling and treatment project
Topsy offers free voluntary HIV testing and counselling to any member of the communities it serves. This can be done in the community or in the clinic.
Prevention of mother-to-child transmission project
A study by the South African Department of Health estimated in 2006 that 29.1 per cent of pregnant women were living with HIV, and the provinces that recorded the highest rate of infection included Mpumalanga and Free State. Since the start of the CHACC Topsy has helped women who are pregnant and it formalised its programme for preventing mother-to child transmission of the virus in 2007, since when only one case of such transmission has occurred in the communities Topsy serves.
Post-exposure prophylaxis project
Pre- and post-test counselling, medication and aftercare are offered to staff and members of the community who may have been exposed to HIV infection through needle stick injury or other exposure.
General care for HIV and AIDS patients project
Topsy offers general care and assistance to patients who are infected by HIV in the form of medical treatment, or referral to a local clinic for treatment of opportunistic infections, and nutrition – since a person who has not eaten cannot be given medication.
Cervical cancer screening project
Topsy offers counselling and pap smear tests to screen for cervical cancer. Patients on ARV treatment are tested once treatment has started, or when there is a clinical indication. If results then require any further intervention, the patient would then be referred for treatment.