Supporting the Tutu Tester Mobile Clinic

The Desmond Tutu HIV Foundation is driven by a passion for humanity and a vision of South Africa without AIDS. Over the years, it has become a source of advice for medical practitioners, support for people seeking testing or treatment, and leadership in preventative education. With an experienced and dedicated team of over 150 doctors, nurses, researchers, and community-trained field workers, the Desmond Tutu HIV Foundation offers a holistic approach to the HIV epidemic.

OVERVIEW

The concept of a mobile clinic that tests for HIV as well as other illnesses represents the Foundation’s vision that HIV should be viewed as a chronic, treatable condition rather than one attached to stigma, discrimination and shame. The Tutu Tester is a mobile clinic that takes sophisticated testing equipment and trained staff (including a nurse, a counsellor and an educator) into areas which do not have adequate health facilities. Through a flexible, accessible, and efficient service the Tutu Tester team hopes to facilitate first time and repeat HIV testing for those living in under-serviced and high HIV prevalence areas in the Western Cape. By offering testing that is within reach of more South Africans and works outside of the traditional clinical setting, the Tutu Tester sets out to promote disease prevention as a self-initiated activity. Since the programme's inception, thousands of individuals have tested on the Tutu Tester. Almost half of those testing are men and many have never before had a HIV test. Through this project, the Tutu Tester will expand its operations to include weekly visits to Mitchell’s Plein and Khayelitsha, areas which have been identified as Presidential Poverty Nodes .

The project's focus is to reduce the risk of HIV acquisition and transmission in all tested clients irrespective of whether the test is positive or negative. All clients testing negative are counselled on how to preserve their negative status through individualized and innovative risk reduction counselling. Those testing positive take an additional test to check how strong their immune systems are and whether they need to start antiretroviral therapy, as well as a physical examination to enable appropriate referrals to other centres for follow-up care.

WHAT WE LIKE ABOUT THIS PROJECT

• The Tutu Tester is a VCTplus service. The ‘plus’ indicates that aside from HIV testing, it also provides a range of health examinations to check for hypertension, diabetes and other health disorders.
• The intervention specifically targets people who do not test regularly. In particular, the Tutu Tester encourages working men to test, as their numbers are generally under-represented at normal VCT clinics.
• The Desmond Tutu HIV foundation has established relationships with partner organisations and government departments that enable the Tutu Tester team to make the appropriate referrals for those in need of treatment.
• The Foundation’s reputation as a research institution is excellent, and data captured by the Tutu Tester will be used in scientific research, and could help experts to better understand the occurrence of disease in these communities.
• Often people only go to clinics when their ailments have progressed to the extent that they are difficult to treat. By engaging people in everyday contexts and providing a convenient place to test that does not require beneficiaries to go out of their way on their daily routine, the Tutu Tester is able to identify problems early, which makes treatment much more manageable.

EXPECTED LIFE CHANGE

The project budget of R 250,000 is a portion of a larger intervention calculated at R 1,141,940. The programme is on-going and most of the additional funding has already been secured. An investment of R 250,000 will contribute to carrying out a year-long intervention in Khayelitsha and Mitchells Plein. The project will reach approximately 1575 people, at an estimated cost of R725 per person.

NEED

South Africa, with an estimated 5.7 million infected people, has the largest HIV-positive population in the world. According to the South African department of Health, women account for approximately 55% of HIV positive people. Women in the age group 25-29 are the worst affected with prevalence rates as high as 40%. The national average of HIV-positive women attending antenatal clinics in 2005 was 30.2%. The long incubation period between infection and illness means that infected persons may infect many others without realising it.

VCT is the entry point to all HIV related care and prevention. However, data from the Desmond Tutu HIV Foundation conducted in communities most affected by HIV/AIDS show that VCT is often inaccessible or inadequately performed resulting in missed opportunities for prevention, late referrals for care and antiretroviral therapy, and increased morbidity and mortality. Presidential Poverty Nodes, such as Khayelitsha and Mitchells Plein, are stark examples of such areas.

STRATEGY

The Tutu Tester is a brightly coloured mobile testing clinic which parks in predetermined community venues and markets preventive testing. The testing package includes blood pressure, blood glucose, body mass index (as determined by the weight and height) and HIV testing. This promulgates a culture of accountability for health. Clients who test negative are counselled on risk and strategies to reduce risk. They are also encouraged to retest and make the behavioural adjustments to make sure they avoid infection. Positive clients are counselled, and, if necessary, referred to specialist facilities for HIV care. This enhances the links to care, earlier referral for HIV treatment, reduction in morbidity and improved outcomes generally in treating HIV.

ACTION PLAN

Preparation

Preparation The Tutu Tester is currently operational. Before the extension into Mitchell’s Plein and Khayelitsha can occur, an assessment of community venues and City and Provincial health clinics will be conducted. Key stake holders in health will also be consulted.

Implementation

• Additional staff will be recruited, including additional educators, counsellors, an additional driver and a support vehicle.
• The Tutu Tester will visit pre-arranged community venues in Khayelitsha and Mitchell’s Plein once a week to conduct VCTplus services. An expected 35-40 people will undergo testing each week.

Monitoring and Evaluation

The Tutu Tester keeps electronic databases on all of their beneficiaries. When a beneficiary arrives at the Tester, their fingerprint is scanned in and all of their medical information is then linked to their fingerprint. In this way information regarding to previous tests and medical conditions are recalled automatically when a beneficiary arrives at the Tester. This information is also collated by into a series of databases to reflect the outputs and impacts of the Tester. These include:

• A database of first time and repeat testers
• A database of self reported sexual behavioural change over time
• A database of HIV test results at first and repeat tests
• A description of the stage of the disease at first testing and tracking improvements and declines in repeat testers
• An HIV Incidence by cohort of repeat testers
• Description of STIs and other related illnesses at screening

In addition, during the course of the project, the Foundation will monitor:

• The changes in HIV prevalence in clients accessing services, VCTplus uptake, and links to care for those testing positive.
• Risk behaviours and other epidemiological data to provide a framework for possible epidemic drivers and potential areas of intervention.
• Treatment outcomes in those testing positive.

ORGANISATION ASSESSMENT

The strategy of the Foundation focuses on two broad areas of activity. On the one hand it offers certain services (such as VCT, training and education for adherence and prevention) directly to the community, while on the other it seeks to conduct high-level research and clinical trials that can be used to find solutions to the HIV pandemic. The Tutu Tester will serve both functions as it will provide a service to communities where access to VCT is not readily available, while at the same time collecting data that will be used for research purposes.

The organisation is very well resourced, with a large number of both local and international funders. The Foundation is staffed by highly qualified people with a very strong research background, some of them world-renowned experts.

The various programmes that are undertaken by the Foundation are all run relatively independently, with a medical doctor filling the role of project manager in each of the projects. Project managers are thus highly qualified, and have a significant input in shaping their individual projects. This combined with the centre’s access to world-class research enables them to constantly review and update their project strategies.

RISK PROFILE

Key Strengths

• Concept: By providing a highly visible point that can move into areas with poor access to health facilities and conduct tests quickly, the Tester is able to eliminate the cost and inconvenience of travel and reach groups of people who would otherwise be unlikely to test.
• Design: By using a VCTplus model, HIV is treated as a manageable chronic condition. This serves to fight the stigma that surrounds the disease. The captured information will also be used to inform research that will help shape more effective interventions in the future.
• Capability: The Desmond Tutu HIV Foundation serves as a source of world-class expertise on HIV/AIDS. The project is directly managed by a medical doctor and is ably staffed by qualified nurses, counsellors and educators.
• Control: The Foundation has robust reporting systems in place for all projects. The electronically captured information from the Tutu Tester will help identify potential problems.

Key Risks - Low

• Design: The Tutu Tester team are in contact with their beneficiaries for a relatively short amount of time. This allows it to conduct a high number of tests, but might limit the impact it might have in bringing about substantive behavioural change.
• Sustainability: The Tester will continue to rely on donor funding, as it generates no income of its own. The Foundation, however, has undertaken to ensure that the project is funded for at least the next three years.
• External: The Tester operates in areas with high crime rates, and security has already proven to be a major concern. There has been an incident where security has been compromised. The organisation is however aware of these problems and additional security measures have been adopted.