Senwamokgope Clinic, Limpopo, transfers ART patients to DOH clinics

Senwamokgope,  Sacred Heart Clinic, in Limpopo formed part of the Kurisanani ART programme of the Diocese of Tzaneen.  With the changes in PEPFAR funding it has had to transfer patients to DOH clinics, and will cease operations by the end of May 2013.

Sacred Heart Clinic, Senwamokgope, Limpopo.

1 Jan. – 31 Mar. 2013

1. Current Status and Progress:

No new clients have been tested for HIV since December 2012. This is in view of transferring all clients to Government clinics before May 2013.

Our clinic has continued to receive anti retroviral drugs from the government.

As our numbers have decreased considerably due to the transferring of increasing numbers of clients, we require less drugs, and have not experienced any difficulty in getting them.

2. HIV Care:

Fewer patients have defaulted or are lost to follow up. Intensive efforts continue to be made by the carers to visit these clients, and assess their situations. A small number have died, others have moved to the big cities for jobs, or moved elsewhere. Some clients working in Johannesburg, Pretoria or other cities have gone to clinics in those cities to receive ARVs, but have returned to our clinic when they return home. They do not always have referral letters making it more difficult for us to assess them. Patients with high CD4 counts are advised to attend a wellness clinic. HBC cards continue to be used.

3. ART provision:

Reasons for patients no longer taking ARVs include going to Faith Healers, moving out of the area, not having enough money to come to the clinic. (In this situation some patients are brought by the local catholic priest who regularly attends the clinic to offer counseling and spiritual help to those who want it)

Some are given money to pay the taxi fare. People living near our clinic are highly mobile, moving to wherever they can find work. This makes follow-up difficult.

Recently more patients who have defaulted or were lost to follow up for various reasons have returned.

4. Tuberculosis:

The infection control plan in place is being rigidly adhered to. There are open waiting areas, patients are routinely screened for TB and coughing patients are triaged. Sputum is collected from patients who have 3 or more symptoms of TB on screening. Patients are also referred to Government hospitals for chest X-Rays and treatment of TB if found to suffer from Pulmonary TB. Patients who have no money to go to the hospitals for chest X Rays are given money for the taxis. Extra pulmonary TB is not commonly found in our clients. We now have several patients on both TB treatment and ARV’s. Our clinic does not initiate TB treatment.

We have one patient, who was transferred in, on INH prophylaxis. He has continued to receive this.

5. Cotrimoxazole:

Cotrimoxazole is given to all HIV infected adults with CD4 counts less than 350, and those in WHO stage 3 and 4 irrespective of CD4 counts. All HIV infected children <5years who are symptomatic (WHO stage 2, 3, or 4) Or CD4<15% or 500 cells/cmm. Children >6 with CD4 <350cells/ cmm or 15% or WHO stage 3 or 4 disease including TB, receive prophylactic Cotrimoxazole. All infants who come to the clinic with their mothers are already being cared for at government clinics. Many of our more stable patients on ARVs, whose CD4 counts have reached 350cells/cmm, or more, have been taken off prophylactic cotrimoxazole.

6. Men:

We still have some male clients who are awaiting transfer to Government clinics.

As mentioned in previous reports, they tend to have lower CD4 counts, have severe weight loss, and some have concurrent pulmonary TB.

7. South African Government collaboration:

We continue to work closely with government clinics.

We are continuing to arrange transfer of all our clients. We have had several meetings with DOH representatives, and have gone around to the local Government clinic to discuss the transfer. The personnel in these clinics have been very helpful. A transfer form is completed for each client, who is then advised to go to the clinic of their choice, so that ARV treatment can be ordered for them.

8. Monitoring and Evaluation:

Data flow, site based procedures/SOP and PDS use is fully in operation.

We are now using the Government drug order sheets, and statistic sheets. We are also completing the antiretroviral treatment Registers, the Wellness Registers, and the Children’s Register.

9. Significant successes, changes in approach or challenges experienced:

The transfer of all our clients to Government clinics has been a traumatic experience for clients and staff. Over the past 5 years, the clients have attended our clinic, got to know the staff very well, and had trust and confidence in the quality of care they received.

They are very apprehensive about the quality of care they will receive in Government clinic. We do our best to reassure them, but it is very difficult at times.