End of an era of free Aids treatments as focus shifts
Mccord Hospital’s Sinikithemba HIV clinic will be continuing its good work, but with limitations, writes Kerry Cullinan
ALTHOUGH Mccord Hospital’s Sinikithemba Clinic, one of the oldest HIV/ Aids treatment centres in SA, will be closed to non-paying patients next month, the hospital hopes to be able to continue to treat children and patients with complications.
“We fully support the government’s approach that the treatment and care of stable adult HIV patients needs to take place at a primary healthcare level, not at hospitals, in order for treatment for all who need it to be sustainable,” said hospital CEO Dr Helga Holst.
“With treatment, HIV has become a chronic disease that can be managed at clinic level, with medical back-up at hospitals where needed.”
But, added Holst, her hospital and staff have built up a wealth of expertise in dealing with HIV that they hope they can put to use caring for children with HIV and complicated cases.
“We have about 800 children and their caregivers on antiretroviral (ARV) treatment. Many institutions are reluctant to deal with children, while we have a solid team of people comfortable with treating children,” said Holst.
“Some of these children have been with us from birth and we have support groups for them, including teenagers who have to come to terms with adolescence and all its issues as well as HIV.”
She said her staff had also worked with some of the best medical researchers in the world, including those from Harvard and Oxford universities, in an attempt to understand the virus, and they were able to deal with patients who developed complications that clinic staff could not deal with.
The hospital has treated more than 16 000 people with HIV, including starting 9 000 patients on ARV medication. It receives less than 40 percent of its operating costs from a government subsidy and hopes the health authorities will support Mccord treating children and complicated cases.
Without more government funding, the hospital will be able to treat only adults requiring ARVS who can pay for treatment, Hiv-positive children and Hiv-positive pregnant women.
However, the provincial Health Department’s general manager for strategic health programmes, Dr Siphiwe Mndaweni, said all patients would need to be “transitioned” to government clinics.
“As much as I appreciate the existence of expert knowledge on the complicated HIV cases in Mccord, these patients should also be transitioned, as there are teams of doctors who discuss difficult cases in the facilities,” he said.
Mccord Hospital started its first patients on ARVS in 1998, when it hosted a small clinical study involving 30 patients.
For those it could not enrol on treatment, the hospital started support groups and income-generating projects, including its world-renowned choir, which sang with Elton John in London and went to the US five times.
By 2003, the hospital was treating about 300 patients with ARVS – most of them self-funded and a few through a clinical trial.
In February 2004, the hospital became the recipient of a large grant from the US President’s Emergency Plan for Aids Relief (Pepfar) and it was able to offer ARVS to many patients.
Dr Janet Giddy, head of the programme at the time, said that the effect of ARVS on patients was “miraculous”.
“There is life where there was death. My patients, who would not be here without the drugs, are now getting pregnant, having Hiv-negative babies and carrying on with life,” she said at the time.
However, the hospital’s Pepfar grant ends in June and the US government has made it clear that SA’S government now needs to cover the cost of HIV treatment as Pepfar moves its focus to strengthening the government’s health systems.
Since March, more than 3 000 Mccord patients have been redistributed to 50 government clinics identified by the Kwazulu-natal Health Department.
Holst describes the process as sad.
“It is painful to let go of people you have nurtured and cared for, from death back to life. But we are proud that we have done our work well. It is rather like a parent watching a child grow up and leave home.
“Sinikithemba would like to continue providing care and treatment, through department of health funding and in support of the department, to children on ARVS as they grow into the difficult adolescent years and to pregnant women. It would also like to be a referral centre for patients on ARVS with co-morbidities and complications, stabilise them and refer them for ongoing care to primary health care clinics.” – Health-e News Service