The Tshepang Trust

It has a two-pronged strategy:
i)    recruit GP’s trained in HIV / AIDS management and treatment to assist at public sector ART roll out sites. (The public facility model);
ii)    recruit GPs trained in HIV / AIDS management and treatment to treat public patients from their consulting rooms, thus alleviating the burden on clinics, and allowing patients to be treated close to where they live, in conditions of privacy. (The private GP model).

Tshepang has managed to develop an excellent relationship with the Gauteng Department of Health (DoH) which is clearly critical for the success of the project. It has an official Memorandum of Agreement in operation with the Gauteng DOH to provide and pay trained GPs to work on a sessional basis at agreed government ART sites; and in the second phase, to provide and pay GPs to treat public HIV patients filtered from the sites, in their rooms. The Department of Health agrees to take over the payments to the GPs after two years, to ensure sustainability. This should be in March 2008. In its private GP model, Tshepang, through its partnership with the Treatment Action Campaign (TAC), has recruited three out of a possible five GPs in Orange Farm to see public patients in their consulting rooms. Orange Farm is a large under-resourced area with extremely high unemployment in the Ekurhuleni region of Gauteng. TAC approached the DOH about the desperate situation of people in Orange Farm, and it agreed to Tshepang’s involvement there.

Innovation

It is based on the simple idea of using the abundant medical human resources that already exist in the private sector to assist HIV patients, who are overwhelmingly public patients, to receive ART.

Effectiveness

Currently in its public facility model, Tshepang has sessional doctors operating in 6 ART roll out sites in Gauteng. 6000 patients have been initiated into ART and 25,000 patients have been seen in the above sites combined over the last two years. The Orange Farm GPs, in the private GP model have enrolled 328 patients and initiated 150 on ART over the past 18 months. Tshepang uses two TAC treatment councillors to assist the GPs with patient follow up, adherence counselling and organising of support groups. Tshepang is also a partner in an HIV programme for teachers called the Prevention, Care and Treatment Access (PCTA) set up by the American Centre for Labour Solidarity. This programme is national and offers free HIV testing and treatment to teachers, their partners and dependants through Tshepang GPs in their rooms. They have enrolled 709 patients and initiated 343 on treatment in the last 18 months.

Poverty Impact

In providing GPs to assist with HIV patients in public facilities more people in need of ART can receive it, and can be restored to health and the possibility of employment. This assistance reduces the queues for treatment measurably, which saves on transport costs for hospital visits by poor and unemployed patients. In the private GP model, patients are able to receive treatment in privacy where they live and are saved expensive trips to distant hospitals. 

Sustainability

This project cost approximately R2 700 000 to run in 2006. The Nelson Mandela Foundation provided the start-up income for the project, however funding from NMF recently ended. The Solidarity Centre funds the teachers programme. Tshepang also receives donations from the Anglo-American Chairman’s Fund and Reckitt Benckiser as well as other private donors. Tshepang has negotiated with the Gauteng Department of Health (DOH) to take over funding after a two-year period. The DOH also supplies the infrastructure for programme operations. Tshepang has been able to cover its costs in the past but is faced with funding contracts that are ending and must continuously search for other sources of funding.

Replication

The project is clearly replicable, and Tshepang plans to extend operations to the other eight provinces, with one urban and one rural site per province.

Partnerships

• Prevention, Care and Treatment Access (implementation for teachers)
• Treatment Action Campaign (implementation in Orange Farm)
• The Nelson Mandela Foundation (funding)
• The Solidarity Centre (funding)
• Gauteng Department of Health (health-care professionals and infrastructure)
• The Anglo-American Chairman’s Fund (funding)
• Reckitt Benckiser (funding)

Visit www.tshepangtrust.org for more information