Treatment

Introduction

In June 2008, SABCOHA began to offer supply, or vendor chain, companies the opportunity to provide free VCT and treatment to their employees as part of a comprehensive workplace programme. This project seeks to shift the burden of the HIV/AIDS pandemic from the employer to SABCOHA in recognition of the fact that companies exist to be productive and profitable. SABCOHA signed an agreement with Shell and BP South African Petroleum Refiners (Sapref) and the Durban Automotive Cluster (DAC) in July 2008 to implement HIV/AIDS management programmes in their organisations’ vendor supply chains.

In recognition of its experience and expertise, SABCOHA has been awarded funding from the US Centers for Disease Control (CDC). This funding now gives SABCOHA the opportunity to offer a comprehensive workplace programme – as well as affordable, sustainable VCT and treatment that many SMEs cannot afford. With the CDC’s support, SABCOHA is now offering participating member companies the opportunity to provide free, high-quality treatment to their employees. Click here for more information:

A number of sectors in South Africa have initiated advanced programmes to tackle HIV/AIDS. Research and other information on these sectors will be published here.

Additionally, in 2003 the Bureau for Economic Research found that small, medium and micro enterprises (SMMEs) in South Africa did not have the infrastructure or the capacity to develop HIV/AIDS workplace programmes. SABCOHA is working with a number of organisations to address this issue, including Eskom Holdings Limited, Daimler Chrysler and the ILO Project (involving Volskwagen SA’s eight supplier companies as part of a broader ILO Pilot Project) and the Japan Bank for International Co-operation (JBIC) .

Click here for more information on SABCOHA’s sector-specific initiatives.

The ins-and-outs of VCT

VCT programmes must be part of a broader HIV/AIDS programme that enables the employee to access HIV prevention, care and – if necessary – treatment. VCT should also be part of a broader health service delivery for employees so that they don’t view the initiative as an attempt to “screen” them. And unless a VCT programme is run in a climate of confidentiality and non-discrimination, it will fail.

VCT campaigns in the workplace have been shown to be only partly successful, with uptake rates seldom more than 45 percent, due to stigma, denial, fear and ignorance. This means that uptake for treatment– even if offered free by the company – is also low. Many South African companies and medical aids report low uptake of treatment.

Research shows that compulsory counselling and voluntary testing ensures better testing rates among employees. Also, campaigns led by senior management and characterised by short, intensive “know your status” drives, have significantly increased uptake rates. Some companies now use the HIV saliva test, which is quick, accurate and easy to use.

Treatment programmes

Employers can prolong the health and productivity of employees living with HIV/AIDS by offering care, treatment and support services – either in the company or by partnering with health care providers in the private or public sector. Research shows there are large savings to be made regarding a reduction in death, disability and sick leave costs as well as human resource and medical costs. A service – whether in-house or not – needs to include the treatment of other sexually transmitted diseases, opportunistic infections, particularly TB (less costly than ARVs), counselling support, ARVs, home-based and palliative care.

Due to partnerships with government, medical aids, international donors and NGOs, ARVs are now far cheaper and easier to access.

Click here to access the Department of Health’s National ARV Rollout data for November 2007:  national_data_arv_roll-out_nov._2007

Updates:

March 2008: Merck & Co., Inc., Whitehouse Station, New Jersey the parent company of MSD (Pty) Ltd (a subsidiary registered in South Africa) has granted a non-exclusive, royalty–free license under its South African patent to Cipla Medpro for the manufacture and supply of a generic form of efavirenz (an antiretroviral [ARV] supplied by MSD under the trade name STOCRIN and used for the treatment of HIV infection).

Community Outreach

Successful interventions seldom operate in isolation and many companies implementing HIV/AIDS workplace programmes soon see their initiatives impacting on a broader community: the employee who goes home to a family; the community living near the workplace; the consumers who buy products …

Forging partnerships with other organisations in the surrounding community generates new awareness about community needs and offerings. Read our Case Studies for inspirational examples of HIV/AIDS initiatives that have evolved into fully-fledged outreach programmes. Anglo PlatinumDe Beers and Daimler Chrysler South Africa are excellent examples.

Clinical trials

NIMH Project Accept

Project Accept is an NIMH-funded HIV prevention trial in 48 communities at five sites in South Africa, Tanzania, Thailand, and Zimbabwe. Randomized communities receive either a community-based HIV voluntary counseling and testing (CBVCT) intervention plus standard clinic-based VCT (SVCT), or SVCT alone.

The CBVCT intervention has three major strategies: 1) to make VCT more available in community settings; 2) to engage the community through outreach; and 3) to provide post-test support.

These strategies are designed to change community norms and reduce risk of HIV infection among all community members, whether they participated directly in the intervention or not. This is the first international, randomized, controlled Phase III trial to determine the efficacy of a behavioral/social science intervention with an HIV incidence endpoint.

UCLA serves as the multi-site coordinating center for Project Accept, and partners with sites in Soweto and Vulindlela, South Africa.

For more information, visit the Project Accept website: