Strengthening ARV Roll Out in South Africa: The Integration of ARV Provision into Primary Health Care Services

The project, which began in response to the rapid roll out of Antiretroviral Therapy (ART), sought to devolve ART services from tertiary to primary health care settings to ensure services are more accessible and to take the strain off over-burdened tertiary facilities. A situational analysis tool using a range of cross-cutting quality dimensions was designed to examine systems and resources required to support the integration of HIV services within a comprehensive primary health care package, including HIV, sexual and reproductive health (SRH) and TB services. A questionnaire and rapid appraisal were administered in six PHC clinics in Gauteng's Region F. Based on these results, a range of quality improvement interventions were implemented, including training and on-site mentoring and support to PHC providers in clinical staging, CD4 counts, and PCRs. The assessment identified a range of strengths and weaknesses required to provide effective integrated HIV services. As a result, the project trained and provided on-site mentoring and support to PHC providers, resulting in an increased number of clients up-referred for ARV and wellness management. The integration of HIV testing into existing SRH and TB services was strengthened, resulting in increased case-finding and increased access to HIV treatment and care at an earlier stage of illness. Improved referral and communication between different levels of care has been supported. The integration of HIV services has been a major quality improvement focal point for some clinics, with Esselen clinic showing the highest increase in CD4 counts due to the high number of VCT, SRH, and TB clients using the service. The project also developed standards for HIV and ARV services at health facilities to enhance compliance with national guidelines. This tool will help providers internalize new concepts related to case management, integrate VCT into sexual and reproductive health and TB services, and measure the quality of service they are providing their clients. The project's results show a steady improvement in the number of PCRs performed in clinics, with Joubert Park clinic showing the greatest increase with 30 PCRs done in March. The integration of HIV testing into existing SRH and TB services has resulted in increased case-finding, with a total of 1393 VCTs performed in March. The project has also improved referral and communication between different levels of care, with 66 clients referred to the ARV services in March. The two-way communication between referral sites needs to be improved and monitored to ensure that patients are not lost in the system.