Strengthening the HIV Continuum of Care in South Africa

By Anna Caroll October 16, 2013

Since 2002, the number of people receiving antiretroviral therapy (ART) for HIV/AIDS in low- and middle-income countries has increased dramatically, from 300,000 in 2002 to 9.7 million in 2012. Despite this striking improvement, this represents only 34% of people currently eligible for ART under the 2013 WHO guidelines.

The National Alliance of State and Territorial AIDS Directors (NASTAD) Global Program has worked hard to reduce this massive treatment gap in South Africa, where an estimated 5.6 million people are living with HIV and AIDS, the greatest number of people in any country worldwide. In 2009, the South African government initiated the Integrated Access to Care and Treatment (I ACT) Program as one important component of its national response to the HIV epidemic. As a primary partner to provincial departments of health in South Africa, NASTAD began working in partnership with the Free State and Mpumalanga Provincial Departments of Health (PDoH) to support the implementation and development of I ACT in these provinces.

The I ACT program in South Africa focuses on linkage to and retention in HIV treatment and care. The program targets people recently diagnosed with HIV and recruits them into community and health facility based pre-ART care and support programs. These support programs provide critical information about HIV, healthy living strategies, and treatment and care options, and help to reduce the high rate of loss to the care system from the time of HIV diagnosis to successful commencement of ART.

NASTAD has supported the two provinces to implement the I ACT program by providing focused mentorship and coaching, and facilitating regular review meetings at the district, provincial and national levels. NASTAD has also provided ongoing technical assistance and training to I ACT implementing NGOs, partners, and department of health staff, particularly around I ACT-related data management, analysis and use, and I ACT program monitoring and evaluation.

NASTAD South Africa’s early and ongoing contribution to the development of strong and sustainable I ACT referral networks and linkages reflects NASTAD’s mission to respond to the health systems strengthening needs identified by ministries of health and their affiliates. Through this partnership with the PDoHs, NASTAD South Africa is working to build the capacity of local public sector and ministry of health staff to plan, manage, and evaluate care and treatment programs.

Last week, Habtamu Girma, NASTAD South Africa Country Lead, visited the NASTAD South Africa office, and took a trip to the Hlalanikahle Clinic in Mpumalanga Province, one of many health care sites where I ACT is being implemented. Habtamu reported, “Despite the slow scale-up of the program in Mpumalanga, we are pleased with the gradual integration of I ACT into the Provincial Department of Health HAST (HIV/AIDS, STIs and TB) and CCMT (Comprehensive Care, Management & Treatment) programs and the integration of I ACT into routine programs at health care facilities. I ACT trained support group facilitators are not only running support groups for PLHIV, but they are also supporting clinics as they track patients lost to follow-up and link them back to care.”

If you are interested in learning more about what NASTAD is doing in South Africa to improve access and adherence to pre-ART care and ART treatment, strengthen health systems and build capacity, please contact Habtamu Girma [link to Habtamu’s email].

Visit to learn more about the NASTAD Global Program, and to learn more about the IACT program in South Africa.

Habtamu Girma, Manager, Global Program, NASTAD also contributed to the development of this post.