Photo: People waiting on vaccinations at Thelle Mogoerane Hospital. (Photo: Denvor de Wee/Spotlight)
This World Aids Day we need to find opportunities for public health improvements in this decade
This World Aids Day, South Africans are carrying the greatest HIV/Aids burden in the world, our country’s original pandemic. Yet, to combat COVID-19, our country has been able to move millions of people through vaccination sites each month. So, how do we utilise COVID-19 learnings and vaccination sites to bridge this gap for all our people living with HIV/Aids?
Imagine if we turned each large community-based vaccination site into an opportunity where individuals could not only be vaccinated but also get screening and counselling for other critical health concerns? A large number community-based outside facilities have the option to become multifunctional centres, we just need to figure out how to balance our resources.
I run part of one of the world’s largest HIV Care and Treatment programmes, which is funded by the USA’s PEPFAR (President’s Emergency Plan for AIDS Relief) fund and USAID and is operated by BroadReach, global public health implementation specialists, in partnership with the SA Department of Health (DoH). The five-year programme is known in HIV circles as APACE (Accelerating Programme Achievement to Control the Epidemic). As we move into the fourth year of the programme this quarter, we are thinking of creative ways to reach the ‘lost generation’ of HIV patients that have stayed away from facilities during COVID-19.
The facility headcount data for geographies supported by BroadReach is still about 15% lower than pre-COVID-19 times. We must take opportunities to utilise the COVID-19 vaccine sites as springboards to provide multiple essential health interventions in one place, thereby moving health from vertical, single-issue processes to more holistic care that puts the patient’s needs first.
The situation right now
I recently read a social listening report on the DoH COVID-19 Information Centre and it got me thinking: are we at risk of repeating the same mistakes as the initial response to HIV by consolidating all COVID-19 efforts into one ‘vertical programme’? By doing this, do other health priorities suffer? From what we’ve seen at the clinics that BroadReach supports, the answer is yes. Since March 2020, when national lockdowns commenced, foot traffic in clinics dropped substantially by about 20%. It is slowly recovering, but it’s still only at 85% of the headcount we saw in 2019.
That means that fewer people are coming forward, accessing services and getting tested and initiated on treatment for HIV across the country, making the UNAIDS 95-95-95 targets for 2025 that much harder to reach. Rather than rely on foot traffic alone, our programme initiated extensive, creative programmes within the confines of the different levels of lockdown to ramp up testing to find new cases and to ensure patients continued to have access to treatment. Some of the activities our teams focused on was increasing ‘index testing’ (testing contacts of those who tested HIV positive), offering extended hours services for clients to access treatment, offering patients who were eligible to be enrolled on to Central Chronic Medicines Dispensing and Distribution (CCMDD) programme or DABLAP (slang for ‘shortcut’) medicine collection as it is known these days. The good news is that, for the most part, we didn’t see many people drop off treatment in the geographies that we support.
The importance of staying on ARV treatment came into renewed focus when a recent study proposed that Africa’s large HIV+ population of immunocompromised people may be the reason for the emergence of COVID-19 variants on the continent. Prolonged infection allows the virus to mutate multiple times as individuals struggle to recover from the disease. That’s why it is essential we are testing and treating for HIV to keep people’s immune systems high while the country rolls out vaccinations.
It is not just HIV programmes that have struggled to attract patients during COVID-19. CANSA reports similar statistics for breast cancer screenings. It saw a countrywide drop in client bookings at its screening clinics, especially during the crest of the ‘waves’. If screening and testing numbers don’t normalise, we may be heading for other health crises in five years as slow-growing, undetected cancers claim lives.
A silver lining of COVID-19
The triple pandemics of HIV, TB and COVID-19 have had a big impact on how we as healthcare providers continue to offer services. We remain committed to our partnership with the DoH to save more lives. Partnerships, generally, need to be top of mind, however, currently, we should all be asking how we as health partners can better collaborate.
Almost 200 000 people are going into COVID-19 vaccination facilities every day in South Africa. Some sites are already conducting blood pressure, glucose monitoring and TB screening, but there’s so much more we could be doing. We need to partner with public health entities to offer their ‘captive audiences’ other crucial health services, like diabetes screening, HIV testing and counselling, mental health help and more, without stigma or discrimination and while providing a safe and secure environment for clients.
When people take 15 minutes to sit in the waiting area post-vaccination, could we find a way that they can access their antiretroviral medication from on-site pop-up ‘pharmacies’ at the same time? Or could that time be used to provide health education messaging or videos, or engage patients with an opportunity for Q&A? Multiple topics could be covered on breast cancer awareness and how to self-check, and we could share content on HIV prevention.
Community members and businesses are coming to the party to incentivise COVID-19 vaccinations, but could we get even more creative, and extend these offers of ‘free coffees’ and other rewards for Pap smears, TB testing and HIV screening as well? Could we share the importance of annual ‘mole checks’ and how sunscreen can minimise the risk of melanomas as South Africa’s summer season sets in?
We have an unprecedented opportunity to reach people we may not otherwise have access to. Rather than treating each health concern separately, imagine what we could achieve if we collaborate holistically. Creating a ‘one stop shop’ of vital health check-ups could be the silver lining to this situation. We need to step out of our silos, so we can see each individual as a whole person and offer everything they need to have the best chance of health. Our window is closing. Let’s act now.