The role of the different health care professionals in the antiretroviral therapy and follow up of HIV patients in Grahamstown's public sector

Abstract South Africa is greatly affected by the Human Immunodeficiency Virus (HIV), and the prevalence rate was estimated to be 29.5% by testing of pregnant women in December 2005. “Roll out” of the HIV treatment programme started in 2004. By the end of 2005 there were between 980 000 and 985 000 people estimated in need of Antiretroviral Therapy (ART) in South Africa, while less than 235 000 people received this treatment. By conducting observational studies in health care facilities, semi structured interviews with 55 Health Care Professionals (HCPs), and two group discussions, the present study analysed the follow up and care of HIV patients benefiting from the roll out of ART in Grahamstown’s public sector. Recruitment of respondents and data collection were carried out between February and August 2006. Since roll out of ART in Grahamstown in May 2004 until September 2006, 687 HIV-positive patients have been enrolled on the programme. As the number of patients receiving treatment is still very low compared to the need, the programme is growing continually. Observational studies showed that though the number of patients receiving ART in local clinics was small, HIV patients required special care and attention, and therefore this required more time and focus in the clinics. This lead to a great challenge for HCPs who were already coping with stretched limits with regard to workload and the opportunity to provide each individual with sufficient health care. Results from observational studies and semi structured interviews showed that there were few pharmacists and physicians involved in this work, whereas nurses and support staff played an important role with major responsibilities in the treatment. HIV patients represented a diverse group with different needs with regard to social and medical support. When newly diagnosed, many patients were afraid of stigmatisation from other people, and also often believed that ARVs were dangerous. This provided a challenge for HCPs involved in this work, to ensure that the patients returned for follow up after being diagnosed as HIV-positive, and that they were well enough educated, especially with regard to adherence, to manage the ARV regimen. All interviewees pointed out that work with HIV patients required specific training, though sufficient training had not been provided for all HCPs. The majority of the interviewees acknowledged the need for prioritising in their work with HIV patients, with time constraints being one of the limiting factors