Presented by: Dr Richard Cooke

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Madwaleni HIV Wellness and ARV Programme

• Presented by Dr Richard Cooke Lynne Wilkinson

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Where is Madwaleni?
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Barriers encountered by Madwaleni patients

• Topography
• Impoverished community Poorest district in South
  Africa
• Transport issues lack of taxi routes and
  exploitative taxi fares
• No time community are busy trying to survive!
• Hospitals can be an intimidating environment
• Nursing staff have been unsupported for many
  years and can be unmotivated

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Cornerstones to model

• Promotion of HIV wellness early access to
  healthcare and social support.
• VCT community outreach
• HIV wellness programme access through active
  HIV support groups

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Madwaleni VCT outreach

• VCT outreach to social welfare pay points
• Social welfare uses designated pay sites every
  month
• VCT team arranges testing with headman
• One nurse and three counsellors
• Use of empty hut/house/tent for testing and post
  test counselling
• Open field used for pre-test counselling

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Community understanding that the next step after
testing HIV positive at VCT Outreach is to join
to your local HIV support group
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Join HIV wellness - EARLY

• Health outcomes better
• Fewer resources spent in patient management long
  term
• Time for psychosocial self acceptance less
  chance of defaulting treatment later on
• Allows for more easily managed decentralisation
  of service

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CD4 counts on joining the HIV wellness programme
and starting ARVs

• All patients joining the HIV wellness programme
  (including in and out patients, patients tested
  for HIV at a health facility and at VCT outreach)
  (end Sept 08)
• mean CD4 count 277.52
• CD4 counts at initiation of HAART at Madwaleni
  (end Sept 08)
• mean CD4 count 137.02

• Mean
• U.S 187Europe 200Australia gt200
  Africa 86-125(Matthias E. Outcomes of ART in
  resource limited and industrialised countries Feb
  2007)

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Cornerstones to model

• 2. Integrated Services
• Paediatric
• PMTCT
• Womens health
• Nutrition
• In patient
• OVC
• HBC

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PMTCT model
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In-patient model
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OVC model
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Cornerstones to model

• 3. Task shifting at all levels

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Cornerstones to model

• 4. Decentralisation to primary healthcare
  clinics bring the same level of care closer to
  our community PHASED

• 1 VCT
• 2 HIV Support Group
• 3 HIV Wellness Programme
• 4 ARV readiness Programme
• 5 Infant Follow Up Clinic

1 Adult and paediatric ARV repeat prescription
plus adherence check ups 2. Adult and paediatric
ARV clinical management and monitoring
CLINIC LEVEL
Referrals to Madwaleni HIV Clinic for 1. Adult
ARV initiation of ARVs 2. Paediatric HIV wellness
and initiation of ARVs 3. PMTCT clinic
obstetric/ARVs
HOSPITAL LEVEL
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Cornerstones to Model

• 5. Community involvement at all levels through
• Community participation
• Creating a flat structure ito knowledge and
  involvement in decision making
• Expert patients
• Patient advocacy

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Cornerstones to model

• 6. System support of all team members

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Cornerstones to model

• 7. Strategic development and management

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Where are we in client numbers?(End Sept 2008)
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Challenges

• Separation of HIV management at district vs
  hospital
• Disadvantages of high unemployment rate promote
  model success
• Private funding aids resource allocation
• Broadening HIV hospital services difficult to
  replicate at clinic level
• Pharmaceutical services HIV dept vs pharmacy
  leadership
• Integration into general out patient services
• Management and leadership of nursing staff

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THE MADWALENI HIV TEAM
richacooke_at_yahoo.com lynneswilkinson_at_yahoo.com