Fighting HIV and TB in KZN
The KwaZulu-Natal (KZN) Department of Health is making strides in the fight against HIV and tuberculosis (TB).
Although the province has the highest HIV prevalence in South Africa, with over a quarter of its population living with the disease, Health MEC Sibongiseni Dhlomo said the department has made health services more accessible to residents and the impact is evident.
MEC Dhlomo spoke to PSM about the province’s strategy to combat diseases and improve service delivery in the health sector.
Of the estimated 7.9 million people who are living with HIV in South Africa, more than 4.2 million are receiving treatment and 1.3 million of these are from KZN.
MEC Dhlomo added that about 1 300 HIV-positive people have been placed on antiretroviral treatment (ART) in the province this year.
The MEC said the department has reduced the rate of mother-to-child transmissions.
“In 2008, 20 percent of women who were pregnant would give birth to an HIV-positive baby. This has been reduced to 1.2 percent. It’s a wonderful achievement,” he noted.
In 2018, the department also reached its goal of circumcising one million men. “This will go a long way in helping us fight HIV,” said the MEC.
Decline in TB
With regard to TB, MEC Dhlomo said KZN has recorded the highest decline in its TB incidence rate, from 511.3 per 100 000 in the previous financial year to 481 currently.
In addition, TB treatment outcomes have substantially improved over the years. The treatment success rate in 2009 was 65 percent and, by 2017, this had increased to 88.7 percent.
He added that there has also been improved access to multi-drug-resistant TB (MDR-TB) services.
“In 2008, we only had four treatment initiation sites in the province. Now we have about 26,” explained the MEC.
“This has led to the improvement of the MDR-TB treatment rate from 49 percent in 2008 to 60 percent in 2016. As a result, we have also seen a decline in the death rate caused by MDR-TB from 35 percent in 2008 to 18 percent in 2017.”
The MEC said South Africa has the most GeneXpert machines in the world, which have greatly assisted in the early diagnosis of TB and MDR-TB to allow for the initiation of TB treatment within 24–48 hours.
Of the 289 GeneXpert machines in the country, about 90 are in KZN and are distributed across the districts in the province.
Over and above ensuring that residents receive healthcare services for HIV and TB, the MEC said his department always encourages all healthcare users to get screened and tested for these ailments.
Some of the department’s interventions to fight HIV and TB include:
4 A community outreach programme called Operation Sukuma Sakhe, which is led by the KZN Office of the Premier.
4 Establishing a partnership with hardware brand Build It, which is helping the department to drive a vigorous TB awareness campaign through distributing information material at their stores throughout the province.
4 Targeting high-transmission areas like schools, correctional facilities, churches, taxi ranks and informal settlements to provide services.
4 Training nurses to initiate patients’ HIV and MDR-TB treatment.
4 Setting up TB and HIV tracing teams to visit households to provide directly observed treatment support.
Following reports that the provincial department did not have sufficient staff and machinery to treat cancer patients, the MEC said the situation is gradually being turned around.
He said the department recently employed new staff and it also has a team of radiotherapists.
The MEC also addressed issues related to cancer treatment and, in particular, the shortage of chemotherapy drugs.
“It is a countrywide problem that is being attended to. Chemotherapy has not been stopped at any KZN public hospital. All the hospitals that render chemotherapy are providing the treatment,” the MEC explained.
He said the only challenge that exists concerns the chemotherapy medication Paclitaxel, explaining that the contracted supplier is not able to supply the drug.
“There is no alternative supplier. Not many suppliers are involved in the manufacturing of chemotherapy or cytotoxic agents. However, the National Department of Health is working on finding alternative suppliers for importing via a Section 21 permit,” he explained.
MEC Dhlomo added that the department’s campaign to encourage the public to visit health facilities the minute they become aware of worrying symptoms is bearing fruit, with 80 percent of cancer cases detected early.
“Already this year, we’ve broken a record with almost 2 000 women who underwent pap smears in April. We also had about 2 231 women and 458 men who were screened and tested for cancer at Edendale Hospital and at Caluza in Pietermaritzburg in October,” he added.
Reduced waiting periods
The department acquired 15 large loop excision of the transformation zone (LLETZ) machines earlier this year. LLETZ procedures remove cervical tissue for examination and treat some precancerous changes of the cervix. Another 15 were distributed across the province as part of Health Minister Aaron Motsoaledi’s National Cancer Campaign launched in KZN in October.
The MEC said the province also has seven fully functional linear accelerators, which is more than any other province. These devices are most commonly used for external beam radiation treatments for cancer patients.
“The seventh machine is used as part of a public–private partnership at the Queen Nandi and Ngwelezana Hospital complex. Currently, there is no (extended) waiting time to see an oncologist at this complex,” he added.
MEC Dhlomo said the department has contracted three oncologists from the Wits Health Consortium, who are based at Inkosi Albert Luthuli Central Hospital, and has two oncologists at Addington Hospital.
As a result of these measures, the waiting period to see an oncologist for the first time at Inkosi Albert Luthuli Central Hospital and Addington Hospital ranges from three to eight weeks, depending on the type of service required.
He added that there are no waiting times for children who need to see an oncologist.
Before these interventions, the waiting time was between five to six months.
Taking medication to the people
One of the programmes the MEC is most proud of is the Central Chronic Medicine Dispensing and Distribution system which has made it possible for 1.7 million people in KZN to collect their chronic medication closer to their homes. This means they no longer need to spend money on transport or wake up very early to stand in long queues at congested healthcare facilities. Collection points include libraries, community halls, tribal courts and other local amenities.
The medication is pre-packaged and all look the same, which helps eliminate stigma because no one can tell what the medication is for.
He said this has encouraged more KZN citizens to adhere to their chronic medication and has helped alleviate congestion at hospitals and clinics.
“The progress of this programme is very pleasing; it means that our fellow compatriots who are hypertensive, diabetic or have arthritis, HIV and other ailments only have to come to a health facility once every three months.”
The MEC said he is happy with the progress that the department is making on different fronts and is hopeful that greater strides will be made in the new year.