ART Programme - update 2008

Dr. Shelagh Parkinson - SFH Excutive Director
January 2008

The Antiretroviral Therapy (ART) programme is having a major impact on the overall work of the hospital and providing hope to the large number in our community with HIV/AIDS. Since 2004 the programme has been funded by AIDSRelief through Catholic Relief Services (CRS). There was already an HIV clinic but it could only offer Antiretroviral drugs (ARV’s) to patients who could afford to buy their own. The AIDSRelief programme provides all the ARV’s free of charge and funding for all the other drugs required to treat ‘opportunistic infections’ caused by the virus. Laboratory equipment and reagents are provided to enable close monitoring of the patients: a vital aspect of ART. Record keeping is important too: AIDSRelief has supplied computers and database software. The grant also covers all staff costs associated with the programme.

The benefits have not been just for the ART programme, but for the hospital as a whole – the pharmacy now has air conditioned stores for all drugs, not only ARVs. The Laboratory is similarly equipped.

Once the treatment became free our numbers rose rapidly. St Francis’ now has one of the largest clinics in the country and is the biggest amongst AIDSRelief and CHAZ (Churches Health Association of Zambia) members. Over 7500 patients have been enrolled on the programme and almost 4000 patients are on ARVs. At the start the clinic was held one afternoon a week and was staffed by a doctor and a nurse. It is now open all day, five days a week and staffed by doctors, clinical officers and nurses. There are also visits to 10 satellite clinics each month by a team of doctors/clinical officers, nurses, pharmacy and laboratory staff, and two visits per month by a clinical officer/nurse to more remote clinics using a motorbike. We have trained a large number of staff, mainly nurses, in ART provision, so the service is run mainly by nurses and clinical officers with doctors overseeing and dealing with the more complicated cases.

The growth of the clinic brings many challenges - staffing, procuring supplies and having enough rooms to see all the patients and store all the records. We have already increased the size of Out Patients but if growth continues we will have to provide bigger premises next year. It has also had an impact on inpatient services with the Medical wards receiving many HIV related admissions and the management is often complex and demanding. The other major challenge is to ensure that the growth of the ART Programme does not have a detrimental effect on other hospital services.

Despite all the challenges it is a very rewarding programme. We come to know many of the patients very well: the change in their lives is amazing. Many would have died if the drugs had not been available. The treatment does not just keep people alive: many are able to return to work and live a normal life. This not only improves their ability to support the family, but also has a very positive effect on their self-esteem: they become able to contribute to their family and the community, where previously they were just a burden.