Antiretroviral (ARV) Clinics

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ARV Therapy (ART) is used to manage HIV and its use has been shown to drastically reduce mortality from AIDS as well as transmission of the virus to other people. HOPE Cape Town was one of the first organisations to sponsor ARVs for children in South Africa before it was publicly available through the government clinics. Now South Africa has an extensive ART programme for both adults and children. HOPE Cape Town supports these public sector ARV clinics by providing Community Health Workers to staff the clinic, HOPE doctors that offer clinical outreach and training of clinic staff, and extra resources where needed.

History

HOPE Cape Town was one of the first organisations in South Africa to initiate antiretroviral therapy for HIV positive children and caregivers. Families, primarily from Germany, sponsored the treatment of a child. HOPE Cape Town also employed a part-time doctor to treat the patients.

In the beginning, ART was very expensive and HOPE Cape Town had to use strict selection criteria to ensure that those children who would benefit the most would receive the sponsored ART. Due to the difficulty and delay in acquiring ART, many children were too weak to survive the complications associated with starting ART. Some parents also struggled with being able to give treatment in a time when the stigma of HIV was debilitating. The selection of patients was a very difficult decision to make! However, those patients who received ART generally did very well. HOPE Cape Town provided care for them until such time as the governmental public rollout of ART was available. In total 38 patients received sponsored ART between 2003 - 2007. The last patients were transferred into the care of the provincial authorities in December 2007.

From the beginning there was careful scientific documentation of the response to treatment. This data has been given to the Children’s Infectious Diseases Clinical Research Unit (KID-CRU – which is now called FAMCRU) based at Tygerberg Hospital. The results from KID-CRU research were instrumental in the development of the government antiretroviral treatment programmes.

ART Therapy – Current and future Hope

ART is now widely available in the Western Cape through the public sector Community Health Clinics (CHCs). There has been an impressive uptake of ART services and currently ART access in eligible children nationally has increased from 17% in 2009 to 63% in 2018 (UNAIDS data).

Children and teenagers on ART are more complicated to manage than adults and thus their consultations require longer time. The increasing numbers of patients has increased the demand on the CHC’s. HOPE Cape Town aims to assist the CHC’s to provide good quality HIV care through HCHW services and paediatric ARV doctor outreach. HCHW’s assist in educating, counselling and encouraging patients, and by offering HIV tests and adherence advice.

Clinical Outreach

The HOPE doctors are involved in the paediatric HIV clinic in the Delft community.

On a Friday one of the HOPE doctors and a doctor from Tygerberg Hospital, runs the paediatric ART clinic at Delft CHC .This clinic cares for approximately 220 HIV positive children younger than 15 years old. Together, the 2 doctors see 25 -30 children per clinic morning.

Doctor responsibilities include:

  • Confirming the HIV diagnosis in referred children, and assessing eligibility for ARVs
  • Starting children on ARVs.
  • Educating caregivers and children about HIV and ARVs, and ensuring caregivers are competent to manage lifelong therapy, and potential side-effects
  • Starting children on ARVs
  • Routine follow-up of infected children. This involves careful clinical follow-up, anthropometry, developmental assessments, social circumstances assessment, adherence to ARV’s, monitoring for side effects, adjusting ARV dosages – and monitoring efficacy through blood investigations
  • Assessing children who are failing treatment, and changing regimens where necessary<./li>
  • Liaising with the HOPE Occupational Therapist for developmental assessment and assistance with schooling recommendations where necessary
  • Managing resistance testing where necessary. The results of the resistance testing are used to assist doctors in choosing the appropriate treatment
  • Disclosure of HIV status to children, using picture tools and age appropriate explanations
  • Training of community health workers working at the site, so that they can assist with tracking children lost to follow-up
  • Managing the patient tracking system, and ensuring that patients who miss appointments are phoned or visited, and brought back into care
  • Conducting grass-roots level research at the clinic facility. The latest project looked at reasons why children fail HIV treatment, and involved interviews with various staff members, caregivers and children on treatment

Adolescent Services

HOPE Cape Town believes in the importance of Adolescent and Youth Friendly Services. Being an HIV + adolescent brings with it a number of unique psycho-social challenges that can affect adherence to ARV’s, mental health and long term physical health.

Hope Cape Town, together with the local clinic staff, runs Teen Clubs at Delft Clinic and a Youth Clinic at Delft and Symphony Way clinics.

The Teen Club is a “fast track” way of doing clinic that prioritises peer support and minimises time waiting in queues. It is for teenagers that are clinically stable. It’s run on a Friday afternoon which also ensures that the teenagers do not need to miss school.

Youth Clinic is a youth friendly, dedicated clinic time for youth aged 15 – 24 years old. It is run on at a quieter time on a Thursday afternoon which helps to minimise the waiting time. One principle of the Youth Clinic is the importance of a consistent clinician who sees the patient – thus ensuring the development of trust and understanding between doctor and patient. This is particularly important with youth who may feel difficulty in sharing their struggles in a rushed consultation. The Hope Doctor will see between 6 – 10 youth per afternoon.