Testing, treatment and prevention
As part of Right to Care’s direct service delivery to departments of health across South Africa and other parts of the world, our focus is on delivering quality care and treatment to people living with HIV and associated diseases.
We have over 20 years experience in:
With an overarching goal to improve health systems delivery, our approach to HIV and TB programmes encompasses:
We have pioneered strategies such as multi-month dispensing to empower patients to manage their health so that they adhere to their treatment. To support these strategies we have introduced:
Our work is informed by the South African National Strategic Plan for sustainability of HIV and TB programs (2018-2023).
Our treatment strategies
Our approach to increase the number of HIV-positive clients on antiretroviral treatment (ART) focuses on:
increasing HIV testing by scaling-up counselling and testing in facilities
100% linkage to care by linking every HIV-positive patient to care,
rapid treatment initiation by focusing on ‘same-day’ and ‘same-site’
retaining patients in care
improved data collection and use
maximising ART initiation especially in high volume facilities
To help us test and link HIV positive people to care in communities:
we use mobile services
we employ linkage to care officers
we deploy roving teams who work with skilled ‘mop-up’ implementers
These tactics help us to:
Find and test people
Link them to their nearest facility if they test positive
Start them on ART
We also support private general practitioners (GPs) in initiating their patients on treatment.
Antiretroviral therapy – living positively
Antiretroviral therapy (ART) is a combination of drugs used to treat HIV. The drugs do not kill or cure the virus. Right to Care’s goal is to keep a patient on ART to reduce the viral load of HIV in their body. Once the viral load is undetectable, HIV cannot be passed on to someone else during sexual intercourse.
This treatment as prevention approach leads to an winning scenario: a patient’s viral load is undetectable and therefore untransmissable.
Right to Care works according to the ‘test and start’ principle. As soon as a patient tests positive for HIV, they are:
Right to Care currently supports 1 000 000+ patients living with HIV on ART.
UNAIDS 90-90-90 targets
Our treatment programmes go hand-in-hand with:
Our work was thus informed by UNAIDS 90-90-90 targets:
We are now working toward UNAIDS 95-95-95 targets.
Dolutegravir
The new breakthrough antiretroviral (ARV) drug Dolutegravir is now being rolled out in South Africa.
Dolutegravir:
This new ARV will become the gold standard of HIV treatment in South Africa once it is implemented across the public healthcare system. It is also being rolled out in some of Right to Care International’s territories.
To date Right to Care has trained over one thousand healthcare workers including doctors, nurses, pharmacists and pharmacy assistants on the new drug and how to use it.
HIV in children
Right to Care has been an integral player in South Africa’s successful prevention of mother-to-child transmission programme. The incidence of mother-to-child HIV transmission has decreased significantly.
The majority of HIV infection in children under 15 years old are passed from mother to child during:
Our team at Right to Care has helped develop guidelines on antiretroviral treatment (ART) for the special needs of children and their growing bodies.
Tuberculosis
To reduce the burden of TB in South Africa, Right to Care has focused on:
We spearheaded the use of GeneXpert ™ technology in both the public sector and laboratory services in South Africa. The GeneXpert test is a molecular test for TB. The Genexpert diagnoses TB by detecting the presence of TB bacteria, as well as testing for resistance to the drug Rifampicin.
Right to Care’s mobile x-ray trucks have reached patients who would otherwise not have accesses to services.
Patient-centred care
People living with HIV (PLHIV) require a range of health services beyond just HIV care. These include:
To keep a patient in care, they must be connected to a clinic or healthcare facility.
A personalised approach is required and healthcare workers need to be actively engaged in a patient’s care.
There are different reasons why patients don’t attend their follow up appointments or collect their medicine:
- they don’t feel well enough,
- they feel well and don’t prioritise getting their treatment or attending appointments,
- they forget appointments,
- they fear being discriminated at facilities,
- they don’t have money for transport, and
- they work full time and can’t attend during working hours.
We try and address these barriers by:
- Holding information sharing sessions in waiting rooms to help people better understand their illness,
- Sending SMS’s to patients to remind them about their appointments,
- Calling patients who have missed appointments to reschedule,
- Conducting sensitivity training sessions with healthcare workers,
- Making sure the patients know there are friendly healthcare workers that await them,
- Taking the antiretroviral treatment (ART) to patients who live in outlying areas such as farms, and
- Working with facilities to extend hours until 6pm in the evenings and offer services on weekends.
These interventions are playing an important role in retaining patients in care.
Addressing challenges
Barriers that impede HIV and TB control are also addressed.
Right to Care experts participate in:
Right to Care’s contribution to controlling the HIV epidemic
We also contribute to implementation science output, collaborating with academic partners. This allows Right to Care to:
Our prevention strategies
Right to Care has implemented a number of dedicated prevention programmes. These have involved cohorts of well-trained and equipped social mobilisers who:
work in communities to address barriers
encourage patients to take up HIV and TB-related prevention and treatment services.
Design of Right to Care’s community mobilisation and demand creation strategies is informed by people’s behaviour. Tailor-made interventions address an individual’s particular situation while considering their social, economic, political and environmental circumstances.
Public awareness campaigns support the work of our social mobilisers. Right to Care’s prevention programmes are aligned to South Africa’s national comprehensive prevention strategy.
Targeting those most at risk for HIV and AIDS (key populations) is also a key focus:
In South Africa, there is a high incidence of HIV amongst young girls and women aged 15 to 24.
Men who are hard to reach in a healthcare context
Men who have sex with men (MSM) and people who inject drugs (PWID) are also at high risk of contracting HIV. PWID are also at risk of contracting Hepatitis C (HCV). Right to Care International has done excellent work in treating HCV, and making the treatment affordable in Ukraine and Myanmar.
Voluntary medical male circumcision
Prevention strategies like voluntary medical male circumcision are being expanded because circumcision has been shown to bring about a 60% reduction in the risk of HIV acquisition.
Right to Care has delivered over one million circumcisions with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria and USAID, and this effort is continuing through a grant with the Centers for Disease Control and Prevention (CDC).
Right to Care has targeted men aged 15 to 34, given that HIV incidence in men was peaking at around 27. Our focus was on areas with:
A study on the cost and impact of a large-scale circumcision programme in SA revealed that if eight in ten men are circumcised, around R225-billion in HIV care and treatment costs would be saved.
Ideally all sexually active men should be safely circumcised. Our Voluntary Medical Male Circumcision (VMMC) programme is focused on achieving 1.225 million circumcisions in the next five years.
Reducing risky behaviour
A reduction in risky behaviour is central to ending HIV and AIDS so education is crucial. Risk reduction can include:
Adolescent girls and men
In South Africa, there are two groups of great concern:
Young adolescent girls
Young adolescent girls are becoming HIV-infected five years earlier than boys, on average. Right to Care focuses on preventing HIV infection in girls to prevent:
Men are hard to reach
Men of all ages, but particularly young men, present a worrying challenge to the healthcare system. Unlike women, men do not enter a healthcare facility during pregnancy and for childbirth. Men therefore have no connection to healthcare services unless they become very sick.
Because many men work, Right to Care has explored ways to:
PrEP and PEP
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) work to reduce the risk of becoming infected with HIV. Studies have shown that the standard antiretroviral (ART) drug can be used in PrEP as a pill you take before the risk occurs. Adherence is critical – the treatment must be taken at the same time every day for it to be effective.
For key populations PrEP and PEP are proven interventions. Key populations include:
Men who have sex with men (MSM)
Transgender people, especially transgender women
Sex workers
People who inject drugs
These key populations tend to be:
stigmatised
victims of violence
discriminated against when they present at healthcare facilities
Through a Right to Care programme funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, we have been involved with sensitising healthcare workers about the rights and needs of key populations which include MSM.
Young women
PrEP and PEP are far less effective when it comes to young women. Work is currently underway to better understand which young women are more at risk and why.
Our helplines
Right to Care runs two HIV helplines for all healthcare workers such as doctors, nurses or counsellors to call with any query about managing their patients:
Paediatric HIV helpline
082 352 6642
Adult HIV helpline
082 957 6698
