FEATURE AFRICA HEALTH 037 InnovatIve web tool
sparks dramatic increase in enrolment on HIV treatment programmes
By: Siraaj Adams, Senior Manager, HIV YourLife Programme, Cape Town, South Africa
from less than 30% to nearly 80%. Developed by the HIV Department of Metropolitan Health Risk Management, formerly known as Qualsa Healthcare, in association with the Bankmed network, the new HCT web tool screens for HIV, TB, blood pressure and glucose. Healthcare providers then capture the information directly onto the web tool, and it is automatically
L
ow enrolment rates remain the biggest problem with HIV management programmes in the private sector, but now an innovative new web tool looks set to provide the solution, with enrolment rates post HIV diagnosis potentially jumping
programmes in the early stages of their disease. Mortality rates for people who join when they are already sick,
i.e. they have a baseline CD4 count of less than 200, are much higher. Our experience has also shown that the cost savings are significant for employees who enrol with higher baseline CD4s. Hospital re-admission rates for patients with low baseline CD4s are
much higher than those employees that enrol with high baseline CD4s. Early treatment results in an improved quality and productive life. In addition to Anti-Retroviral Treatment, workplace programmes provide employees with access to other healthcare benefits such
“the traditional pattern has been for people to
join only when they are sick (advanced disease), and this delay was exacerbated by stigma and
the concerns around confidentiality of voluntary counselling and testing (vCt) for HIv”
downloaded onto the Metropolitan Health Risk Management database. The traditional pattern has been for people to join only when they are sick (advanced disease), and this delay was exacerbated by stigma and the concerns around confidentiality of voluntary counselling and testing (VCT) for HIV. With the South African government’s shift to HIV Counselling and Testing (HCT), which requires people to opt out of testing rather than volunteer for it, this has resulted in a huge increase in the number of people who are now aware of their status at an earlier stage of the disease. The challenge for the private sector has been that even when people know their status, they are still not enrolling on treatment
FIGURE 1: Illustrates the mortality rate relative to baseline CD4 in the past 12 months
9.0%
8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0%
7.9% 5.9% 2.8% 0.8%
CD4<=50 CD4 between 50 and 100
Baseline CD4 Category CD4 between
100 and 200
CD4 between 200 and 350
0.4% CD4 >=350
5,000.00 4,000.00 3,000.00 2,000.00 1,000.00 0.00
pathology, consultations and related prophylactic benefits to ensure that the employee has no out-of-pocket payments. The system was designed to encourage healthcare providers to
drive point of diagnosis enrolment, with the patients consent. Metropolitan Health Risk Management is able to track the success of the programme via real-time reports and has seen a marked increase in enrolment rates in the Bankmed HCT programme, which commenced in March 2011. The programme was rolled out to all GPs within the Bankmed
network as well as biokineticists, HCT providers and pharmacists who are accredited to perform HCT testing.
FIGURE 2: Illustrates the cost of an HIV patient before (12 months prior) and after enrolment (24 month after), where 0 is point of enrolment.
6,000.00
Consultations ART medication Hospitalisation Pathology
-12 -11-10 -9 -8 -7 -6
-5 -4 -3
-2 -1
0
1
2
3 Time Period *The financial results shown above is as per the history for all current enrolees.
4
5 6
7
8
9 10 11 12 13 14>
www.lifesciencesmagazines.com
Percentage Deaths
Benefit per Beneficiary
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