The Scale Up: Next Steps in Expanding HIV Support in South Africa
In 2009, Joellen Lambiotte moved from the U.S. to South Africa to launch South Africa Partners’ program for AIDS/HIV care and support – the Integrated Access to Care and Treatment, known by its acronym, I ACT.
“One of the things that I do is work on major project start-ups,” says Lambiotte. Indeed, her resume is rich with health care roles around the world: management team member of Management Sciences for Health; Vietnam Country Representative for Pathfinder International; Regional Africa Representative for Planned Parenthood Federation of America. Taking on the Interim Director role for the I ACT launch was right up her alley.
Six years after its founding, I ACT is thriving, and the program is about to take a major leap forward. In the spring of 2015, South Africa Partners received a $17.5 million grant from the U.S. Centers for Disease Control and Prevention (CDC) to build upon I ACT and link it to a more broad-based program, called LinkCARE.
Lambiotte, meanwhile, has continued her work as a health care activist. She currently is Senior Program Advisor for Jhpiego, an international non-profit health organization that’s an affiliate of Johns Hopkins University. She also joined South Africa Partners’ Board of Directors in 2008 and has served as Board President since 2014. Here, she talks about the flourishing efforts in South Africa to support people living with HIV.
Let’s start with the big picture, of where South Africa is in its response to the HIV/AIDS crisis.
It’s important to know that South Africa has the biggest and probably the highest profile HIV epidemic in the world. At the same time, it also has the largest antiretroviral treatment program in the world, largely financed from its own domestic resources. Those are all things that are distinct about HIV prevalence in South Africa.
As many people know, during the years when Thabo Mbeki was president, from 1999 to 2008, there was denial of HIV. It was only after that, with the new government and a really good health Minister in place, that a new direction of HIV treatment emerged. The government acknowledged the challenge and began moving the country toward really innovative HIV work, such as home-based testing. It’s in that context that the I ACT program was launched in 2009.
There must have been so much to do in 2009, once the government began to embrace HIV/AIDS treatment.
The I ACT program reflects very much the approach of South Africa Partners to facilitating partnerships and having a very organic approach to program development. The problem we were trying to address — and this is a problem that is everywhere, not just South Africa — is that when people are tested for HIV and aren’t ready for treatment, they very often don’t get into any system of support. You don’t see them again until they’re really sick. The whole focus of this program was that as soon as someone tests positive for HIV, get them into a network of care and support and empowerment. They meet other people living with HIV who have gone through the process and who know how to manage their own care.
What was new or different about I ACT’s approach to HIV care?
The thing that’s different about I ACT’s support groups and the basic package of care is that there is a very structured curriculum. There is a very structured process of a certain number of sessions and a chronology of what those sessions cover. The content of those sessions is clearly defined.
The support groups are closed groups, meaning that when a person enters an I ACT support group they stay with that same group of people throughout all the sessions. As well, the support group facilitators are almost all people who are living with HIV, who have been through this process themselves, and who have been trained to be facilitators. All this was different at the time from other AIDS support groups that were being set up when we started.
I ACT has grown so much since you helped launch it in 2009. It’s now established in all the provinces of South Africa and is poised to expand further with this $17.5 million grant. Tell us what this expansion will involve.
Part of what will be involved is people management. Mary [Tiseo, South Africa Partners’ Executive Director] has always been very, very good at finding the right people and figuring out what people will bring to the party. You know, with recruitment, after you do all the right things, there is still a little bit of luck in getting the right person. And we’re very lucky, because Tony Diesel, who started as the Project Director for I ACT and now is the Country Director for South Africa Partners in South Africa, is really the right person. We also have a fantastic partnership with CDC, the funder. They have very strategic leadership and very collaborative leadership.
What will really be different going forward is the handover of the program to South Africa’s National Department of Health. This is about having the Department really take hold of this and become the implementers of it.
The outcome, of course, is for the program to serve more people. I ACT has become the model for how South Africa will get people into that care and support, and LinkCARE will bring that to even more people.
So the goal is both simple and complex: Get as many of South Africa’s 6.4 million HIV-positive citizens into support programs.
Yes. Because HIV is now a chronic condition. People who are on treatment and manage the treatment well have a normal lifespan. The goal is to get everyone who is HIV-positive into a program where they’re empowered to take care of themselves and where they’re getting both the emotional and healthcare support that they need.
What’s the big picture approach for the scale-up?
Well, the process of scale up is similar in many different countries. It really involves having the right relationships in place and moving from your staff doing the work to supporting partners and counterparts to implement, something which we’ve already done.
This scale up will be done through a phased process. We’ve already been working closely with the National Department of Health, and we’ll continue to do that. We’ll also continue to work with the different local partners and provincial departments of health, preparing them to take on more and more of the program management.
You know, South Africa Partners, we are an American organization, but we are so embedded in South Africa. We have the right relationships and trust, and this has just grown step by step.