HOPE to Home

One of the biggest challenges in paediatric HIV today is the retention of care of patients who have started anti-retroviral treatment (ART). Consistent adherence to treatment is essential in order to avoid the development of drug resistant HIV. In conjunction with this, the rates of TB co-infection have increased significantly with an increased burden on the health care system. HOPE to Home is a project at Tygerberg Hospital that aims to help children and their caregivers in making the transition between treatment as an inpatient in Tygerberg Hospital’s ward and being treated as an outpatient in the community health setting. This is done through relationship building, support, education and ongoing telephonic follow up. HOPE to Home has over time adapted the project to include other children who are classed as vulnerable children into their care and support.

The face of HIV/AIDS in South Africa is changing. The success of the ART rollout has led to many people having access to ARVs and initiating therapy. Therefore, the focus has now shifted to retaining these patients in care and empowering them to lead full, happy and healthy lives. WHO and UNAIDS have initiated the 90:90:90 campaign, which was adopted by the Western Cape Department of Health. UNAIDS envisions that by 2020, 90% of people living with HIV should know their status, 90% of people who require ART should be on ART, 90% of those on ART should have an undetectable viral load. These goals are only possible if patients are adherent to ARV therapy. 90:90:90 further extends to TB which aims to ensure 90% of vulnerable groups should have been screened for TB, 90% of people with TB should be diagnosed and started on treatment, and 90% of those treated for TB should successfully complete treatment.

The biggest emerging threat to HIV positive patients receiving ARVs and TB positive patients is resistance to available drugs, often resulting from a lack of adherence to a treatment regimen. At HOPE Cape Town we recognize the importance of addressing the obstacles to adherence.

Retaining patients in care after they have been discharged from the hospital remains a challenge. Initial integration of patients into their community health care facilities plays a major role in retention. HOPE to Home programme aims to facilitate a smooth transition between Tygerberg Hospital and local community facilities. We do this by preparing patients for discharge, confirming appointments, providing telephonic support after discharge and liaising with a Hope Community Health Worker to trace the patient at a local clinic.

We provide services to the following HIV positive and TB diagnosed paediatric patients:

Newly diagnosed HIV positive children
Recently initiated ARV or TB treatment
Defaulted ARV/TB treatment
Adherence issues

We offer the following services to vulnerable children admitted to Tygerberg Hospital:

Psychosocial support of patients and their families
Practical support of patients and their families
Appointment confirmation system (at local community Infectious Diseases Clinics) for HIV positive children
Patient follow up from discharge to community by phone calls
Facilitating first contact with local health facility after discharge

We find that at least 80 - 100 children require these services per month.

Other services offered include:

Playroom facility in conjunction with volunteers and the Hope Cape Town Occupational Therapist
Receiving donations from various donors and distribution of donations
Cooking sessions once a week using donated food, distributed to mothers of children in the wards
Skills building craft facilities offered by an external facilitator to mothers of children admitted to the ward