About Kheth’Impilo POSTER 274

1. About Kheth’Impilo POSTER 274 • South African Non Governmental Organisation • Kheth’Impilo works in close partnership with the South African • Department of Health • 88 sites in 8 districts throughout four provinces: • Western Cape • Eastern Cape • KwaZulu-Natal • Mpumalanga • Provides a comprehensive HIV management & PMTCT service in • primary health care facilities in tandem with community-based • adherence support.

2. Our Mission and Objective Mission:  • To support the South African Department of Health in achieving its goals for the scale up of quality services for the management of HIV/AIDS in the Primary Health Care sector as outlined in the National Strategic Plan, which aims to: • Reach 80% of people living with HIV/AIDS • Reduce new infections by 50% Programme Context • Optimum adherence to ART is critical for effective HIV/AIDS management • Poor adherence is a major predictor of treatment failure, progression to AIDS and death • High levels of virologic failures (>40%) noted in many ART programmes in resource-poor settings

3. Our Achievements and Results CSS HSC • Patients in care – a total of 98,665 patients were in the care of the Kheth’Impilo staff throughout the four provinces • Children account for 5.7% of the new initiates. In summary

4. Adherence support • To pre-empt poor adherence: • A community based adherence support programme was established for patients through community workers • Ongoing treatment, counselling and psycho-social support at the community level is provided • Special attention paid to very important patients (VIPs), 40% of workload ;i.e. patients who are ill, pregnant, TB infected, children & adolescents, those who have not disclosed & those showing early signs of defaulting • Patients are encouraged to contract with themselves & get a treatment buddy to facilitate adherence to positive lifestyle changes that include the taking of treatment & keeping appointments.

5. Doctor • Nurse • Pharmacist • Quality Mentor • Social Worker • Data Quality Manager NATIONAL OFFICE DISTRICT OFFICE (Provincial) ROVING TEAM • CSC District Coordinator • CSC Trainer PA COMMUNITY HEALTH CENTRE PA Site Facilitator PA PRIMARY HEALTH CARE CENTRE (Clinics) PRIMARY HEALTH CARE CENTRE (Clinics) Site Facilitator Site Facilitator PA PA PA PA PA PA AREA COORDINATOR PA Support Structure

6. PAs assist with patient treatment readiness & assessment that include: • Psychosocial assessments to identify barriers to adherence including disclosure • Pre-treatment initiation education to ensure the understanding around the need for adherence • Plan support services to suit individual client needs through planned home visits and clinic support • Follow-ups. Information gathered is presented at the treatment initiation Multidisciplinary Team meetings.

7. Achievements and Results • The median retention in care time for patients at sites with PA services was 561 days while the median retention in care time for patients at sites without PA services was 455 days • Patients with PAs were more likely to disclose their HIV status (58%) versus those without (42%; p = 0.005). • Patients with PAs were also significantly more likely to be receiving clinic based counselling. • A significantly higher proportion of patients with PAs had viral loads of less than 400 copies/ml at six months (p = 0.001). • The proportion of patients with unsuppressed viral loads at six months was higher among those without PAs (42%) than those with PAs (24%; p > 0.001).

8. The Impact Impact of PA services on the rate of virologic failure • The median time in which patients at sites with PA services maintained a suppressed viral load was 235 days while the median time in which patients at sites without PA services maintained a suppressed viral load was 199 days (χ2 = 143.46; p = 0.001). • The probability of having an unsuppressed viral load was thus significantly lower at sites with PA services as compared to sites without PA services

9. Key Considerations • Community outreach program must be closely linked and coordinated with the clinical program • Monitoring & evaluation must be linked so that the full impact can be measured • Training of community workers must be in depth and comprehensive & ongoing- SA has an opportunity to career path young talented unemployed youth while in a cost effective manner support the primary health service delivery • Quality of service depends on ongoing supervision, mentoring & support/debriefing of community workers

10. THANKS to: Our patients Patient Advocates Donors Jude Igumbor EsthaScheepers RadiaEbrahim Anita Jason Geoff Fatti