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 Changing the world, one child at a time.Changing the world, one child at a time.

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Fighting HIV/AIDS in the Western Cape:
From defeat to victory

Summary

It all started at Cape Town's Groote Schuur Hospital.

There, in 2002, One to One Children's Fund (121 CF), in partnership with local NGO Kidzpositive, launched a ground-breaking pilot project, providing access to cutting-edge Anti Retroviral Treatment (ART) for 250 HIV+ children. This was aimed at slowing down or stalling the progression of their disease.

The project proved a major success. As paediatrician Dr Paul Roux observed, "children are surviving instead of dying. Mothers who previously had very little hope for the future of their children will now be able to make plans for school and grandmothers can start knitting bigger jerseys."

As a result of these life-saving developments, the Western Cape Provincial Government eventually took the landmark decision to take ownership of the project. As Rory Carroll wrote in The Guardian on 9th March 2004: "A British charity, the One to One Children's Fund, paved the way for yesterday's announcement by starting to treat children with HIV at Cape Town's Groote Schuur hospital two years ago. Sceptics who said the children's parents were too uneducated to adhere to the strict drug regime of administering pills at certain times every day were proved wrong as more children were successfully treated. The results convinced the provincial government that a wider treatment programme was feasible."

Today, the One to One ART programme in the Western Cape has been rolled out from 250 to more than 2500 children born with the HIV virus.

In 2005, One to One Children's Fund took things yet one step further and co-founded a new organisation, Paediatric AIDS Treatment for Africa (PATA), to promote the One to One ART model and share knowledge and experience with other healthcare professionals across sub-Saharan Africa.

I. The issue

In the Western Cape, until recently, 30% of all HIV infected babies didn't live to see their first birthday, 50% died before their 2nd birthday and 80% never reached the age of five.

The children were subject to recurrent infections, which gradually destroyed their immune systems, leading to ever-increasing soreness and pain.

Although life-saving Anti Retroviral (ARV) drugs cost just £1 per child per day, there was no government funding to address the problem comprehensively and make them available to children on a large scale. Also, there was a shortage of professional staff with the necessary skills and knowledge to implement a paediatric roll-out of ARVs.

II. Our response

In May 2002, One to One Children's Fund (121 CF) stepped in to confront this situation and joined forces with paediatrician Dr Paul Roux and local NGO Kidzpositive to fund a cutting edge and highly effective Anti Retroviral Treatment (ART) programme for HIV+ children at Groote Schuur Hospital, Cape Town.

Dr Roux explained that "the AIDS treatment does not cure, but it makes the patient feel better and reduces the risk of infection. We expect the general health to improve and therefore they will not have to be continually brought to the ward with infections. Our children will have a very good chance of leading normal lives."

The One to One ART Programme has facilitated the setting up of satellite clinics, such as Crossroads clinic and Nolungile Clinic in Kyalitcha, Cape Town. The programme also supports clinics as far afield as Oudtshoorn, George and Beaufort West.

A whopping 90% of all children started on ARV treatment have made radical improvement.

Only four months after the launch of the One to One programme, in September 2002, Dr Roux was quoted as saying that "the majority are doing exceptionally well. They are all gaining weight; the mothers all report that their children are more playful. It's difficult to quantify but it's that glint that returns to their eyes, that spring in their step that tells of the success."

The One to One ART programme has given families new hope and is changing attitudes to disclosure, voluntary counselling, testing and stigma. Also, it has significantly improved the morale of medical and nursing staff.

III. Impact

The One to One ART programme has had far-reaching benefits for South African public health policy, Africa-wide capacity-building and global HIV/AIDS research.

Those benefits include:

1. The large-scale roll-out of paediatric ART by the Western Cape government

The impact of the ART programme on HIV+/AIDS health care in South Africa has been immeasurable.

In 2004, the success of the project caused the Western Cape Provincial Department of Health to take ownership of the programme and roll it out to all relevant clinics throughout the province. Western Cape premier, Marthinius van Schalkwyk, announced that the Western Cape provincial government was to extend the One to One ART programme to every affected child in the province under the age of 14. Van Schalkwyk emphasized that this was made possible by the important public-private partnership between the Western Cape Provincial Department of Health and the UK-based One to One Children's Fund.

2. Capacity-building across the continent

As part of the roll-out of the ART programme, Dr Roux and his colleagues have established a training facility for health care workers in the Paediatric HIV/AIDS clinic at Groote Schuur Hospital. Doctors from municipal clinics around Cape Town and clinical teams from neighbouring provinces and countries have spent time there working with Dr Roux's paediatric HIV/AIDS clinic team. The facility helps build vital healthcare capacity, already benefiting thousands of children across the continent.

In 2005, One to One Children's Fund co-founded and sponsored a new organisation, Paediatric AIDS Treatment for Africa (PATA), to promote this model and share knowledge and experience with other healthcare professionals and clinic teams across sub-Saharan Africa. The result is a rapidly growing network of more than 50 paediatric AIDS treatment teams in 20 countries which provide treatment and support for 20,000 HIV/AIDS children, their families and communities across the continent.

Looking to the future, 121 CF will continue to be actively engaged in the management of new challenges arising out of the ARV treatment programme in the Western Cape. This is likely to include the development of adherence support systems and the facilitation of access to professional support for children who present challenging behavioural problems on treatment.

3. Advances in paediatric HIV/AIDS research

Pilot operational study: The roll-out of the ART programme has enabled the Groote Schuur Hospital clinic team to conduct a groundbreaking pilot operational study on the use of ARV drugs in paediatric HIV+/AIDS treatment. Dr Roux and his team have assessed the efficacy, benefits and practical operational issues of ART, and researched the impact of ART on the growth and development of patients, adherence indicators, mortality rates, the funding of associated therapies, hospitalisation and access to paediatric beds.

Adherence rates: The roll-out of the ART programme has offered an opportunity to examine issues of adherence to drug regimens amongst poorer populations in third world countries. Significantly, virtually all patients in the care of Dr Roux and his team have adhered properly to the drug regimen, quite spectacularly bringing Groote Schuur adherence figures up to levels recorded in any western country.

Adherence rates have been boosted by 121 CF's local project partner Kidzpositive and its hugely successful Beadwork Project for HIV+ mothers of children receiving ART at the clinic.

The Beadwork Project offers a model for a facilitated self-help industry to provide for the daily needs of HIV/AIDS affected families in the wider community and currently has over 100 mothers participating in it. The Project is purely a job creation enterprise with up to 80% of the purchase price going directly to the mothers. Every order gives the mothers an opportunity to generate income to support their families, provide nutrition for their children and regain a sense of dignity and pride.

High adherence rates have helped counter negative perceptions about the benefit of starting poorer patients on ARV and have boosted the case for the extension of the treatment in South Africa and across the continent.

IV. Royal Visit to the Crossroads Clinic

The Crossroads Clinic is part of the One to One ART Outreach Programme - a unique public-private partnership between One to One Children's Fund, the Provincial Government of the Western Cape Province and local NGO Kidzpositive, aimed at facilitating the roll-out of Anti Retroviral drugs to all the children who need them across the Western Cape of South Africa.

The Crossroads Clinic now provides more than 175 children with life-saving Anti Retroviral treatment.

On 16 October 2006, the Earl and Countess of Wessex visited the Crossroads Clinic, in a township near Cape Town, during their tour of South Africa.

Sister Nothemba Mbomyu of One to One Children's Fund's Outreach team with his Royal Highness, the Earl of Wessex

Commenting on the visit, David Altschuler, Co-founder of the One to One Children's Fund, said:

"We are delighted that the Earl and Countess of Wessex have decided to visit the Crossroads clinic. For people living in the UK it is hard to comprehend that every minute of every day a child is dying of the consequences of AIDS in Africa. If we are to save lives we must provide these children with access to treatment and support. But, across the continent, there is a deficit in trained professionals with the skills and knowledge to administer the Anti Retroviral Treatment so desperately needed.

The Crossroads Clinic is an example of the fantastic work already taking place to tackle this problem, but our challenge is to replicate this across Africa. I hope that the Royal Visit will focus the attention of people in the UK on the problem and encourage them to support our efforts to expand the PATA network and give a new generation of African children the chance of the future they deserve."

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