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HEALTH PORTFOLIO COMMITTEE
20 August 2002
INFECTIOUS DISEASES RESEARCH: BRIEFING
Chairperson: Lincoln Vumile Ngculu
Documents handed out:
Briefing by Dr. Douglas Wilson of UCT on infectious diseases research
Dr Douglas Wilson of UCT related his experience on infectious disease treatment as a clinical practitioner in the Khayelitsha area of Cape Town. Using case studies of actual patients, he addressed the needs of HIV-infected South Africans and recommended particular courses of action for health authorities, including the establishment of a database of voluntary counselling and treatment (VCT) sites, and the provision of medicines at state prices to patients in the private health system. Dr Wilson was well received by the members of the committee, who encouraged him to discuss issues including treatment dynamics, HIV/AIDS screening, and antiretroviral (ATV) drugs.
Briefing by Dr. Douglas Wilson of UCT on infectious diseases research
Dr Wilson introduced himself as a practising clinical doctor unqualified to discuss the epidemiology, economics, or prevention of HIV/AIDS, but eminently equipped to speak on the needs of HIV-infected South Africans.
For the details of Dr Wilson's presentation, please see the attached briefing notes.
Mr Gous (NNP) noted that Dr Wilson's presentation was very practically oriented. With respect to the availability of drugs, Mr Gous noted that, since people tended to prefer private sector medical services, the provision of drugs to the private system at state tender prices would prove problematic. He suggested that private doctors' scripts might be honoured at state pharmacies for a specific list of medicines.
Dr Wilson agreed that this was a potential route forward with regard to drug accessibility.
Ms Luthuli (ANC) noted that it might help to classify AIDS as a chronic illness like hypertension or diabetes, in order to destigmatize it.
Dr Wilson noted that in the US, UK, and Germany, HIV was classified with hypertension and diabetes and treated as a chronic illness.
Ms Luthuli also observed that private doctors are limited in their ability to deliver voluntary counselling and treatment (VCT) by time constraints, and that patients might be referred to freestanding VCT facilities instead; yet, because patients have come to private doctors in confidence, they may not be willing to visit such facilities. Ms Luthuli also suggested that GPs should be able to refer patients to public hospitals where they can obtain drugs at state tender prices.
Dr Wilson acknowledged that not all private doctors are willing or able to offer VCT services, and should have a way out (recommending patients visit freestanding VCT facilities). He also noted that most patients cannot afford to go to VCT facilities.
On the issue of private patients accessing drugs through state pharmacies, Dr Wilson agreed that this was a useful step forward, and noted that allowing this practice would feed money back into the state system.
Ms Mnumzana (ANC) asked how private doctors might be engaged to work with the government, for example, by referring patients to the extant nevirapine (NVP) test sites or state community-based home care. Recognizing that the government had done much to inform and train healthcare professionals and the public in urban areas, she inquired as to how the same might be done in rural areas.
Ms Kalyan (DP) asked whose responsibility Dr Wilson believed it would be to provide a database of VCT sites and raise awareness among healthcare professionals of available services. She also inquired as to Dr Wilson's experience with regards to the treatment success rates of depressed HIV/AIDS patients.
Dr Wilson replied that the best treatment for HIV positive individuals is the "human touch" of friends and family, and that destigmatization of the disease would allow for better support of patients. With regards to programme responsibility, Dr Wilson recalled that the British government ran a "Ministry of War" during the Second World War, because it needed the infrastructure and resources to coordinate the war effort; he suggested that South Africa was facing a similar magnitude of commitment, and that the infrastructure was not currently in place to coordinate the response to HIV/AIDS.
Ms Mnumzana asked at what stage antiretrovirals (ATVs) should be utilized by HIV infected patients, and what side effects were correlated with beginning treatment earlier or later. She asked whether the prohibitive cost of treating so many HIV infected South Africans with ATVs would impair the government's ability to treat other chronic illnesses.
Dr Wilson said that, in cases of TB, private doctors cannot treat patients, but must refer them to a national treatment programme; he advocated a similar approach to HIV/AIDS. With respect to the timing of ATV treatment, Dr Wilson stated that a CD4 count approaching 200 (a substantially weakened immune system) was now prerequisite. He acknowledged that people with advanced HIV/AIDS cases could also experience significant side effects.
With regards to costing, Dr Wilson acknowledged that HIV treatment is expensive, but that in terms of equality of life adjusted years, the outcomes were significantly better than those recorded for treatment of diabetes and hypertension. He stated that there was no place for brand drugs in South Africa due to the prohibitive costs. He also stated that AZT and could be manufactured more cheaply than the pharmaceutical industry has claimed.
Ms Rabinovitch (IFP) asked whether there was some way to encourage pharmaceutical companies to reduce their prices, perhaps through state tenders, or provide free drugs.
Dr Wilson supported the suggestion that state tenders might be used to lower costs, and noted that the pharmaceutical industry would be able to lower prices if massive quantities of drugs were being purchased.
Noting that rates of mother-to-child transmission are relatively low, and lowered further by nevirapine or AZT treatment, Ms Rabinovitch also inquired as to whether other treatments had been used to bring down infection rates without NVP or AZT.
Dr Wilson replied that multivitamins had been used in an African test case with no discernible benefit. He noted that ATVs worked extremely well to prevent mother-to-child transmission.
Ms Rabinovitch called the committee's attention to tests in Ghana of a blood test that screened for a multiplicity of diseases that was cheap and permitted authorities to screen entire populations. She asked Dr Wilson whether this was something worth developing in the South African context, and whether it could be manufactured domestically.
Dr Wilson acknowledged that the technology was experimental, but suggested that, so long as issues of informed consent were properly addressed, a full battery of tests and general screening was advisable.
Ms Luthuli asked if anything could be done to reduce the cost of tests associated with the comprehensive management of HIV/AIDS.
Dr Wilson said costs were presently coming down, and that as lessons were learned from the present pilot sites, care could be improved through research.
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