The Comprehensive HIV and Aids Care, Management and Treatment (CCMT) Plan for the South African Department of Defence (DOD) including the Provision of ARV’s

Warrant Officer of the South African Military Health Service WO1 M.M.T. Sebone

Over the last 25 years, the HIV and AIDS (Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome) epidemic has escalated worldwide to pandemic proportions. This pandemic has continued to highlight obstacles to progress in the global development agenda. Of the eight key areas covered by the Millennium Development Goals, six, namely reduced poverty and child mortality, increased access to education, gender equality, improved maternal health and efforts to combat major infectious diseases; are being undermined by high rates of HIV in many low- and middle-income countries. Sub-Saharan Africa, and in particular South Africa, has experienced the most devastating impact of this epidemic.

Since the cause of AIDS was identified in the early 1980s, standards of treatment and care have evolved considerably, primarily in high-income countries. Yet, the human immunodeficiency virus has spread across political, social and economic boundaries much more quickly than have the clinical and public health responses that help curb the epidemic and its impact. Until recently, antiretroviral therapy (ART) was accessible only to the fortunate few, while millions were denied their fundamental right to benefit from the advances of science.

In recent years an International consensus has emerged on the need to fight HIV/AIDS with a comprehensive response, including treatment, care, prevention and impact mitigation. There has been a sharp increase in available funding for HIV/AIDS in low- and middle-income countries, which has marked a new era in international public health, focussed on providing access to treatment, care and prevention for the people most in need, despite poverty and other daunting obstacles. The collective efforts of many countries and their international partners have generated real momentum in scaling up HIV treatment and prevention.

In South Africa, HIV and AIDS remains a major health risk and as such, is also a major health risk to the SA DOD. If the HIV epidemic were allowed to continue unabated in the military, it would inevitably have had a negative impact on national security and the operational capability of the South African National Defence Force (SANDF). The DOD would thus not be able to fulfil its mandate towards the Republic of South Africa.

The SA DOD, having realised this impact, developed a comprehensive approach to the management of HIV and AIDS including the provision of ART. The approach, more commonly known as Masibambisane, is based on the seven generic disease processes of prevention, promotion, diagnostics, treatment, rehabilitation, palliative care and research and development. It is important to note that prevention interventions remain the foundation of HIV management in the workplace and that prevention and health promotion should be integrated with treatment and care to ensure a disease management continuum that starts with prevention and ends with terminal/palliative care. There are various enabling and or crosscutting processes of governance, communication, stigma and gender, risk management, capacity building, monitoring and evaluation and co-operation and co-ordination that complete the strategic approach of the DOD towards HIV and AIDS management.

The vision of the DOD in this regard is to achieve a “healthy and HIV – free” military community. The mission of the DOD in this regard is to provide a comprehensive, multi-professional, multi-layered, military specific response to reduce the impact of HIV and AIDS on the operational capability of the DOD and all its officials, dependants and approved clientele. So in terms of equality, and to ensure a non-discriminatory environment free of stigmatisation, officials in the DOD living with HIV and AIDS must be treated the same as any other official with a chronic, debilitating and life-threatening illness/disease.

The Cabinet instructed the Minister of Health on 8 August 2003 to plan for the rollout of ARV’s in the Public Sector. The South African Military Health Service (SAMHS), being the health care arm of the Department of Defence (DOD), had to follow suit. The Comprehensive HIV and AIDS Care, Management and Treatment Plan for South Africa is a significant milestone both as a health sector intervention as well as a socio-economic enhancement strategy. The National Department of Health (NDOH) has established extensive minimum guidelines towards the achievement of comprehensive management of HIV and AIDS which formed the basis of the program and plan for the provision of ART in the DOD.

The Comprehensive HIV and AIDS Care, Management and Treatment Plan (CCMT) for the DOD is therefore in line with that of the NDOH plan. An important paradigm within which the plan is conceived and developed is the reality that singular problems, including HIV and AIDS, can only be addressed successfully in a context where the entire health system is simultaneously being strengthened and developed to adequately sustain equitable and quality care while promoting healthy lifestyles. The plan envisions significant investments to ensure that the highest available quality of care is provided to approved clientele of the SANDF in line with international and local norms and standards. The care and treatment protocols are thus based on international best practice.

The primary goal of ARV treatment is to decrease HIV-related morbidity and mortality. ARV treatment aims to ensure fewer opportunistic diseases and other HIV-related illnesses, to increase the immune function as measured by the CD-4 count and to reduce the viral load to undetectable amounts.

ARV treatment is offered to any individual that qualifies for such medication according to current policy. The infrastructure, human resource availability and capabilities of the Military Health Units may limit the availability of facilities that can provide such treatment, but it is envisaged that the SAMHS will maintain at least one such facility in every region. Geographical considerations have guided the establishment of ART facilities to ensure that all members of the Department of Defence can access ART that qualify for treatment. Accreditation of ARV treatment facilities according to the minimum standards set by NDOH is crucial to ensure quality of care within the DOD.

The DOD provides ART through research and non-research sites:

• Six ART research sites through Project Phidisa have been established at 1, 2 and 3 Military Hospitals, Umtata, Mtubatuba and Phalaborwa (opening March 2007). Any queries regarding access to treatment at any of the Phidisa sites can be obtained from:
  • Phidisa Headquarters at Telephone No: 012 347 9739
  • Phidisa Clinic – 1 Military Hosp at Telephone No: 012 651 9970/71
• In addition, six other ARV rollout sites have been accredited in partnership with the NDOH at 1, 2 and 3 Military Hospitals, Nelspruit, Potchefstroom and Durban. Any queries regarding these sites can be obtained from:
  • Directorate HIV/AIDS at Telephone No: 012 367 9168
  • Dr Dhesi Achary at Telephone No: 012 671 5143
• Ten more sites are envisaged to be accredited in the next year or two to ensure wider access to treatment sites.

All members and their dependants are encouraged to visit the nearest sickbay ot PHIDISA clinic to access HIV testing. It is important to “KNOW YOUR STATUS”. If a member/dependant tests positive, then he/she will be evaluated for ARV treatment, and if the client qualifies to receive ARV treatment they will be referred appropriately to a PHIDISA site or an accredited ARV rollout site within the SAMHS.

ARV treatment is not a cure for HIV/AIDS and is not an emergency treatment but it does improve the quality of life of an HIV-infected person.