This is an archive of the Treatment Action Campaign's public documents from December 1998 until October 2008. I created this website because the TAC's website appears unmaintained and people were concerned that it
was becoming increasingly hard to find important documents.

The menu items have been slightly edited and a new stylesheet applied to the site. But none of the documents have been edited, not even for minor errors. The text appears on this site as obtained from the Internet Archive.

The period covered by the archive encompassed the campaign for HIV medicines, the civil disobedience campaigns, the Competition Commission complaints, the 2008 xenophobic violence and the PMTCT, Khayelitsha health workers and Matthias Rath court cases.

The TAC Treatment Project

 
   
   
   
   
You can save a life! > Reports > January 2004 > Service delivery

Service delivery

Selection process and wellness programme (TAC members)

Only 25 TAC treatment slots were allocated for 2003 (50 total). In order to select patients for these slots, an audit of CD4 counts has been conducted in three provinces so far to identify candidates in greatest need. About 360 CD4 counts were conducted at the expense of the TAC TP, which enabled the establishment of a waiting list of 132 patients. Of these, 26 are receiving treatment. The CD4 counts are performed not merely to identify candidates for ART, but provides an opportunity for TAC members to learn their health status and is accompanied by interventions (counselling and workshops) designed to enable members to protect and improve their health (even in the absence of treatment).

All TAC districts in the three provinces in which the selection process is well underway (WC, GP and KZN) have now been covered. However, there are still many members who did not get the chance to have a CD4 count in the first round (e.g. they might not have been available on the day on which CD4 counts were done in their area). Also, budgetary constraints were severe, as CD4 counts had to be performed in the public sector at a cost of R188.10 per test. The TAC TP plans to launch a major CD4 count drive employing public facilities (CD4 counts are becoming increasingly available in public hospitals in preparation for the roll-out of ART) early in 2004 which will cover many hundreds of patients.

Candidates for treatment are selected on the basis of social and clinical criteria (and a record of activism) by provincial selection committees using anonymous reports that provide them with the relevant information. Selection of patients for the initial treatment slots in each of the three provinces has been completed. Provincial selection committees compiled waiting lists comprising all (or most) candidates who have CD4 counts below 200.

Summary of CD4 counts conducted in Wellness Programme

 

WC

GP

KZN

Total

n

106

146

108

360

average

380

302

300

 

median

325

261

264

 

under 200

34 (32%)

54 (37%)

44 (40%)

132 (37%)

 

All candidates for whom CD4 counts were conducted received at least one workshop focusing on staying healthy (esp. OIs, OI prophylaxis, nutrition and early treatment seeking behaviour). In addition, all candidates received their results during individual counselling sessions. However, so far capacity and resource constraints have prevented systematic follow-up of candidates – i.e. tracking of OIs, treatment for OIs, weight and other health indicators or assistance with joining support groups and accessing health services.

A new protocol for the wellness programme will be implemented in 2004, comprising at least:

·         patient-held medical records;

·         a branch member with responsibility for wellness of branch members (these volunteers will be trained by the TAC TP);

·         optimal use of existing support group infrastructure;

·         health days for follow-up and advice;

·         systematic accessing of health services (e.g. branch members attending a local clinic and insisting upon CD4 counts or other essential services for people living with HIV/AIDS);

·         coordination with first-phase roll-out of the public sector treatment programme (the TAC TP coordinator will ensure that all members within the catchment-area of roll-out sites know that ART is available there and access those services as early as possible);

·         treatment readiness workshops not only conducted for those starting treatment, but everyone in order to prepare patients for the public sector programme (this will be integrated with treatment literacy work).

Antiretroviral therapy: TAC members

The target established by the board is 25 TAC members on ART by the end of 2003. We have reached this target.

As can be seen from the table below, two problems that have plagued the TAC TP are (1) selected patients unable to start treatment (do not yet meet clinical criteria, cannot tolerate ARVs, etc.) and (2) patients dying while on treatment. This can be seen from the discrepancy between the number of patients inducted (41) and the number of patients currently receiving treatment (26). The number of patient deaths (4 due to AIDS-related illnesses and 2 owing to serious adverse events) probably reflect the fact that many patients start treatment when their CD4 counts are very low. The secretariat has resolved to convene the clinical committee to re-examine the clinical criteria in the light of these deaths.

Summary of TAC patients

Province

National

WC

GP

KZN

Total

Slots allocated

5

5

10

10

30

Inducted

4

11

12

14

41

Induction underway

1

0

1

0

2

Currently on treatment

2

5

9

10

26

Stopped

 

 

 

 

 

Could not tolerate drugs

 

1 (waiting)

 

2 (waiting)

3

Clinical criteria (too late)