South Africa runs the biggest HIV treatment programme in the world, with the number of patients on treatment climbing to over 3.4 million today. Yet, as Minister of Health Dr Aaron Motsoaledi told delegates at the AIDS conference yesterday “the number of healthcare workers has not kept up with this increase, often leading to frustrated patients and lack of treatment adherence”.
“The biggest challenge with not adhering to treatment is that it poses a real risk of the emergence of drug-resistant HIV, in the same way drug-resistant TB came about,” he said. “It is thus imperative that we embrace all available measures to make it easy for people to continue with their treatment.”
When we visited some AHP doctors in rural KwaZulu-Natal recently, they discussed how prevalent HIV and AIDS is in their everyday work.
“I think I didn’t really have an appreciation of large the HIV endemic was,” one of our UK doctors explained. “It’s something you’re told, but until you’ve actually seen it so often that it becomes something associated with most, if not all of your patients, you don’t understand.”
Another doctor echoed the sentiments of South Africa’s Health Minister: “Often, we only find out someone is HIV positive when the illness presents, and then we have a slim chance to make a difference. People here can’t afford to travel far or miss work for too long, they start on one of two drug regimes, but there is the fear of stock outs or that they are not reliable in their drug-taking, which means there is only one alternative drug if we need to start again.”
“The life-saving impact of treatment relies on adherence,” explained Jenny Ottenhoff, global health policy director of the One Campaign. “We know that when a patient is on medication and taking it correctly, the chance of passing the virus on to a partner is virtually zero. This preventative effect is a game-changer and can help make the end of the Aids epidemic a reality by 2030, but only if we ensure that every person accessing treatment has the support needed to take it correctly every day without fail.”
So we were excited yesterday as Dr Motsoaledi unveiled news of the Pharmacy Dispensing Unit (PDU) currently being piloted at Thembalethu Clinic at Helen Joseph Hospital in Johannesburg. It’s a self-service machine where patients can obtain their medication in the similar way people withdraw money at an ATM.
After registering for the service, a patient receives a card similar to a bank card. To ‘withdraw’ their medication, patients insert their card into the PDU machine, enter their PIN and select the medication they require from their prescription list. The machine immediately dispenses the selected medication, eliminating the need for the patient to wait in queues, and the data is electronically updated. The PDU also allows patients to communicate directly with a trained pharmacist from the machine using a built-in video conferencing function, but also means that a patient could fetch medicine after hours. The machine will dispense ARVS, but also medication for diseases such as diabetes and TB – as such, it will not be possible to identify patients as HIV positive and expose them to stigma.
The unit has been designed by Right to Care, an NGO that funds AHP’s recruitment activities, amongst other work.