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HOPE to Home

One of the biggest challenges in paediatric HIV today is the retention of care of patients who have started ART. Good adherence to treatment is essential in order to avoid the development of drug resistant HIV. HOPE to Home is a project at Tygerberg Hospital that aims to help and their caregivers in making the transition between treatment as an inpatient in Tygerberg Hospital’s ward and being treated as an outpatient in the community health centre. This is done through relationship building, support, education and ongoing telephonic follow up.

The face of HIV/AIDS in South Africa is changing. The success of the Antiretroviral (ARV) rollout has led to many people having access to ARVs and initiating therapy. Therefore the focus has now shifted to retaining these patients in care and empowering them to lead full, happy and healthy lives. WHO and UNAIDS have initiated the 90 : 90 : 90 campaign, which has been adopted by the Western Cape Department of Health. This refers to 3 goals – 90% of people living with HIV should know their status, 90% of people who require ART should be on ART, 90% of those on ART should have an undetectable viral load. These goals are only possible if patients are adherent to ARV therapy.

The biggest emerging threat to HIV positive patients receiving ARVs is resistance to available antiretroviral drugs, often resulting from a lack of adherence to a treatment regimen. At HOPE Cape Town we recognise the importance of addressing the obstacles to adherence.

Retaining patients in care after they have been discharged from the hospital remains a challenge. As initial integration of patients into their community health care facilities plays a major role in retention, HOPE Cape Town initiated the HOPE to Home programme. This programme aims to facilitate a smooth transition between Tygerberg Hospital and local community facilities. We do this by preparing patients for discharge, confirming appointments, providing telephonic support after discharge or visiting them at home and accompanying them to the local facility, where possible.

We are providing services for the following HIV positive paediatric patients:

  • Newly diagnosed, HIV positive
  • Recently started on ARV or TB treatment
  • Has defaulted on ARV/TB treatment
  • Adherence problems
  • Has a detectable viral load

We are offering the following services:

  • Psycho-social support of patients and their families
  • Practical support of patients and their families
  • Support of staff members (administrative; link between patients and staff)
  • Access to resistance testing in consultation with an infectious diseases specialist
  • Appointment confirmation system (at local community Infectious Diseases Clinics) for HIV positive children
  • Patient follow up from discharge to community by phone calls or home visits
  • Facilitating first contact with local health facility after discharge
  • Patient defaulter tracking

We find that at least 300 children require this service per month.