Establishing a workplace antiretroviral therapy programme in South Africa

Abstract

Ways to expand access to antiretroviral treatment (ART) in low income settings are being sought. We describe an HIV care programme including ART in an industrial setting in South Africa. The programme uses guidelines derived from local and international best practice. The training component aims to build capacity among health care staff. Nurses and doctors are supported by experienced HIV clinicians through telephone consultation and site visits. Patients undergo a three-stage counselling procedure prior to starting ART. Drug regimens and monitoring are standardised and prophylaxis against opportunistic infections (isoniazid and cotrimoxazole) is offered routinely. Laboratory and pharmacy services, using named-patient dispensing, are centralized. The programme is designed to ensure that data on clinical and economic outcomes will be available for programme evaluation. Between November 2002–December 2004, ART delivery has been established at 70 ART workplace ART sites. The sites range from 200 to 12000 employees, and from small occupational health clinics and general practitioner rooms to larger hospital clinics. During this period, 2456 patients began ART. Of those on treatment for at least three months, 1728 (78%) have been retained on the programme and only 38 (1.7%) patients have failed the first-line ART regimen. This model for delivery of ART is feasible and successful in an industrial setting. The model may be generalizable to other employment health services in settings of high HIV prevalence, and as a model for implementing ART in other types of health-care settings.

Acknowledgments

We would like to take this opportunity to acknowledge the contribution of all the company leaders that were instrumental in ensuring the programme was successful. Thank you to the doctors, nurses and counsellors at all the ART delivery sites for their dedication to the programme. To all the members of the Aurum ART consortium, we thank you for your continued dedication in the project. We would like to acknowledge the rest of the Aurum ART team for their contributions to this programme. We would especially like to thank Sister Thobeka Dwadwa, Sister Bulelwa Magadla, Dr Surita Roux, Mr Clement Sefuthi, Mr Themba Moyake, Mr Michael Eisenstein, Mr Tsohane Puso, Mr Pule Seatlanyane, Mr Simone Senoge, Miss Debbie Muirhead and Mr Lehlohonololo Khotle for their efforts in setting up this programme.