The national health department has instructed its provincial counterparts to urgently redeploy staff and dispense up to six months’ medication to HIV patients as it scrambles to fill the gap left by organisations previously funded by the US government.
Many of SA’s HIV/Aids services have been thrown into disarray by US President Donald Trump’s shock freeze on aid and subsequent moves to cut staff at the key agencies that support the US President’s Plan for Aids Relief (Pepfar), SA’s biggest HIV/Aids donor.
While the Treasury funds the lion’s share of SA’s HIV/Aids programmes, Pepfar has played an integral role in helping to provide services to key populations such as men who have sex with men, and sex workers. It also paid the salaries of more than 15,000 healthcare personnel in the public health sector.
Health department director-general Sandile Buthelezi sent a circular to provincial departments last week, instructing them to redeploy staff and institute a series of interventions “without delay” to ensure uninterrupted services for HIV patients.
The circular includes an instruction that patients who previously relied on now-shuttered clinics must not be turned away if they do not have a referral letter, and that they must immediately be provided with antiretroviral treatment. A break in treatment of only a few weeks can trigger drug resistance.
Trump’s January 20 freeze on foreign aid for 90 days pending a review was swiftly followed by stop-work orders to US-funded organisations, including those supported by Pepfar in SA.
A partial waiver for Pepfar programmes subsequently signed by US secretary of state Marco Rubio offered potential relief for some services, but it excludes programmes aimed at sex workers, men who have sex with men, transgender people and almost all prevention services aside from treatment to prevent mother-to-child transmission of HIV.
Most of the Pepfar funds provided to SA are channelled via the US Agency for International Development (USAID) and the Centres for Disease Control (CDC). While the CDC notified organisations last week that they could resume the activities it funds, by Monday afternoon USAID funds remained frozen.
Buthelezi directed provinces to reduce clinic visits and ease the future burden on health facilities by offering stable patients multimonth prescriptions, and provide self-testing kits to patients taking preventive treatment.
If feasible, and provided there were sufficient stocks, clinics should dispense supplies for six months of treatment, he said. A further six month repeat prescription should be automatically generated for these patients, using the same emergency system implemented during the Covid-19 pandemic, he said.
“While redeployment of department of health staff is necessary at this time, this may change in [the] very near future should the implementing partners resume services covered by the waiver. However, the priorities emphasised in this circular remain critical … to shield the HIV programme from potential risks should the US foreign assistance review process result in further cuts to Pepfar,” he said.
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