Anticipating future challenges to ART provision in South Africa: reflections on the Khayelitsha ART programme

Abstract

The Khayelitsha ART programme has been in existence for five years. The emerging challenges are indicative of challenges other districts will face in the future. The number of adult patients started on ART annually in Khayelitsha has increased from 80 to 1 500. The gap between need and provision has narrowed, with a concomitant increase in the baseline CD4 count at ART initiation. Over time, adherence preparation has become less intensive, but the patient-centred approach has been retained. Consultations and staffing (especially doctors and counsellors) have increased   substantially over four years, without deterioration in clinical outcomes. To keep up with projected demand, the service needs to quadruple enrolment over the next five years. This will only be possible by utilising the full breadth of the primary care system and by integrating TB/HIV/ART care at each service point.