Masiphumelele ART and Wellness

The Desmond Tutu HIV Foundation (DTHF) began a partnership with Masiphumelele clinic in 2000 in supporting their HIV care. From 2004 the DTHF provided clinicians and staff to introduce antiretroviral therapy (ART) and manage patients in need of therapy. The CIPRA-SA study comparing nurse management of people on ART with that of doctors was completed at Masiphumelele clinic and 1 other site from 2005 to 2009 [Sanne et al, 2010].

Clinical care of people on ART was gradually handed over to a City of Cape Town team during 2009. The DTHF retains critical staff at Masiphumelele including a medical officer, data staff and counseling staff to maintain the monitoring and evaluation of the ART service and to initiate new HIV care services. Since late 2009, the DTHF has been working with City of Cape Town staff toward a sustainable nurse-driven, doctor-supported integrated HIV-Wellness, ART and tuberculosis (TB) service. The project followed from the results of the CIPRA-SA study which showed that nurses were not inferior to doctors in managing patients that had initiated ART. This study is ground-breaking in that it allows a safe expansion of the ART service in settings where there is a shortage of doctors and a high burden of HIV. Until recently there was no specific service for HIV-positive individuals who do not need ART or TB treatment at Masiphumelele. The Wellness service is exploring and encouraging linkage of VCT testing to HIV-care, an area neglected in many communities to date. Key components of this integrated HIV-wellness system include: a clinical nurse practitioner-led, doctor-supported ART and TB service at the clinic level with a focus on linkage from VCT to the Wellness service. CD4 point of care testing is completed on HIV-positive diagnosis and clinical assessment, staging and a plan for future care are competed the same day. Retention in care programmes have been put in place for all HIV-positive patients – from diagnosis to ART initiation and beyond. A database has been developed that allows early notification of missed visits for people in the service, patients missing visits are traced in the community. The DTHF partners with community-based NGO’s (TB HIV Care and Living Hope) to create multi-disciplinary community health workers (CHWs) who both assist in home visits and in patient education (HIV/ART/TB) in order to ensure that patients are retained in care and to enhance clinic access and service delivery.

Projectleader: Dr. Catherine Orrel