This World AIDS Day it is time to come together and refocus on ending the HIV epidemic. As South Africa works to get back on track to meet its UNAIDS HIV prevention and care targets, healthcare organisations like the BroadReach Health Development are partnering with the United States Agency For International Development (USAID) and local government to find creative solutions to overcome the colliding epidemics of HIV, TB and COVID-19 – a “triple threat” that has had a significant impact on HIV programmes reaching their targets in 2021.
“The COVID-era has presented additional challenges in our collective fight to control HIV as many people stayed away from facilities therefore were unable accessing treatment,” says Dhirisha Naidoo, BroadReach Chief of Party for the United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded USAID HIV treatment and care programme. The programme is called APACE (Accelerating Programme Achievements to Control the Epidemic) and serves a population of about 4.3 million in rural areas of Southern Africa. “We are committed to collaborating to find positive solutions that put patients first and save more lives,” says Naidoo.
Andy Karas, USAID Southern Africa Mission Director says, “Through our and other PEPFAR implementing agencies’ support of HIV and TB treatment and care programmes in South Africa, the country was on the brink of reaching the 90-90-90 epidemic control targets, however the COVID-19 pandemic hindered progress. We must now redouble our efforts to get back on track and tackle HIV, TB and COVID-19 together so that we can support the South African people to build healthy and prosperous futures.”
The National Department of Health, together with USAID, funded by PEPFAR, and partners like BroadReach are focusing on key areas to get back on track to meet their HIV targets, including:
Multisectoral service delivery for communities, particularly on testing for HIV and COVID-19, vaccination and adherence to treatment.
Focusing on areas of concern in the country’s AIDS response, including:
Men’s reluctance to seek help in health services until a disease has progressed
Increased vulnerability of Adolescent Girls and Young Women (aged 15-24) – contributing to 30% of all new infections
The need for delivery of adequate and quality HIV counselling and testing services for children
Key populations, such as sex workers and transgender individuals who remain disproportionately affected by HIV.
BroadReach Health Development – part of the BroadReach Group, a social impact health organisation which has been involved supporting the care of nearly 10% of the global HIV+ populations over the past four years – is working with PEPFAR and USAID, the South Africa Department of Health and other healthcare organisations to get the country to meet the UNAIDS 90-90-90 HIV targets in the next year, and reach the revised 95-95-95 HIV targets by 2025.
The UNAIDS 95-95-95 targets refer to 95% of those with HIV knowing their status, 95% receiving their antiretroviral (ARV) treatments and, if they are on ARVs, 95% achieving viral suppression. In South Africa, many gains of the past few years were lost during the COVID-19 pandemic. According to the SA National Department of Health, HIV testing came down by an estimated 46%, and new patients starting on ARVs dipped by an estimated 35%.
One of the greatest setbacks in the fight against HIV/AIDS and TB in the COVID-era in South Africa – and the reason why the 90-90-90 gains were lost in many districts – is that the COVID pandemic caused the public to stay away from health facilities. The recent National Income Dynamics Study (NIDS) Coronavirus Rapid Mobile Survey (CRAM) study found that there was a marked reduction in primary healthcare utilisation during the pandemic, especially in HIV testing irrespective of COVID-19 levels, across almost all districts in the country. Within BroadReach supported facilities, foot traffic dropped by 55% when lockdown started in March 2020 and as of November 2021 foot traffic is at just 70% of pre-pandemic levels.
Naidoo and her team have been proactive in getting patients back to clinics. “Rather than rely on foot traffic to find newly infected HIV+ patients, our programme initiated extensive, creative programmes to ramp up testing to find new cases as well as to ensure patients continued to have access to treatment. For instance, our teams focused on increasing ‘index testing’ (testing the contacts of HIV+ people), offering extended hours services for clients to access treatment, and enrolling eligible patients onto specific medicine collection programmes.”
Before the pandemic BroadReach helped the KwaZulu-Natal Department of Health to turn around the rural Ugu district, from being the district in South Africa with the highest HIV prevalence, to becoming the first district in the country to meet the 90-90-90 targets in 2019.
Naidoo is also advocating for creative measures to tackle the “colliding triple threat of HIV/AIDS, tuberculosis and COVID-19 simultaneously”. One proposed measure is to turn the country’s vaccination sites into multipurpose “health expo” venues where patients can be screened and educated on a variety of illnesses. Naidoo says vaccination sites could offer pop-up pharmacies and video content on HIV, TB and cancer prevention, incentives like free coffees and other rewards for Pap Smears, TB testing and HIV screening. “We need to think laterally about how we can combine efforts to achieve greater public health outcomes in a shorter time,” concludes Naidoo.