South Africa: Nurses Should Be Backbone of ARV Treatment

At the recent Fourth South African AIDS Conference in Durban, doctors, researchers, and activists said the Department of Health must decentralize its antiretroviral (ARV) program if it is to be successful in scaling up treatment access.

Since the government began providing ARV treatment in 2004, services have been predominantly hospital-based and doctor-led. Providing nurse-led ARV management in primary health care clinics in addition to hospitals would boost people's access to treatment, said Winnie Moleko, director of the Reproductive Health and HIV Research Unit Inner City Program. Under this model, once a patient has been started on ARVs by a doctor, nurses take over and manage the patient's care going forward.

"Nurses are the backbone of our health system and therefore need to take full charge of ARV services, like any other chronic disease managed at primary-care level," said Moleko.

The centralized system now in place has led to a backlog of patients waiting many months to get treatment, said Victor Lackay, national community health advocacy coordinator for Treatment Action Campaign. In 2007, only 34 percent of those in need of ARVs were able to access them, said TAC.

"Without clear leadership from the national Department of Health and expedited cooperation of regulatory professional councils, we will continue to be stuck," said Lackay. "There is still no directive from the health department clarifying that trained professional nurses can initiate ARV treatment."

"Other countries have changed their regulations to allow nurses to start patients on ARV treatment and lay counselors to administer HIV tests," said Dr. Eric Goemaere, medical coordinator of Doctors Without Borders in South Africa and Lesotho. "When will South Africa wake up?"

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