PRIME South Africa brings persons with HIV/AIDS and NCDs into sharp focus
Contributors: Tasneem Kathree, Prof Inge Petersen
With the rollout of anti-retroviral therapy (ART), HIV/AIDS is transitioning to a chronic disease. Simultaneously, South Africa is confronted with a rising burden of chronic non-communicable diseases (NCDs), particularly cardiovascular disease and diabetes due to risk factors associated with more urban lifestyles. NCDs often co-exist with one another as well as with HIV/AIDS. With regard to mental disorders, depression, in particular, is more prevalent in people with HIV/AIDS (PLWHA) and in people with NCDs than in the general population. Comorbid depression and alcohol misuse is a public health threat as it compromises both prevention efforts as well as adherence to treatment and self-care, threatening the huge investment in ART and burgeoning cost of NCD care.
In response to the clash of these two epidemics, the national Department of Health is introducing an integrated chronic disease management model (ICDM). PRIME-SA is working in collaboration with the Department of Health to see how best to integrate mental health care into this model in one of the pilot sites in the North West Province (NWP).
Embracing a task sharing approach, PRIME-SA has developed collaborative care models for depression, alcohol misuse and schizophrenia. To aid implementation, accompanying tools have been developed. These include: i) Strengthening of the mental health components of Primary Care 101, which are nurse clinical guidelines for identifying and managing chronic conditions. In particular, screening and brief interventions for alcohol misuse have been strengthened; ii) Depression counsellor guidelines for HIV counsellors to provide counselling for chronic patients with co-morbid depression have been developed in alignment with the shift from a vertical HIV service to an integrated one. Thirdly, psychosocial rehabilitation guidelines for auxiliary social workers employed by the Mental Health Societies and Department of Social Development to provide psychosocial rehabilitation have been developed for patients with chronic schizophrenia who also chronic care patients. In the context of a shift to decentralize care for these patients, many have been discharged and receive their on-going medication from the clinic but very little support to help reintegrate them back into society is available; and iv) Take home information leaflets have also been designed for each disorder.
Piloting of the collaborative care models for each condition is currently underway with training of primary health care nurses, chronic care counsellors and auxiliary social workers completed. The two month pilot study will be evaluated for feasibility and sustainability to scale up the PRIME-SA mental health care plan in 2014.