Tag: South Africa

Categories : Antibiotics PaediatricsTags :

Antibiotic Resistance is Putting SA’s Newborns at Risk

On By ModernMedia
Photo by Christian Bowen on Unsplash

By Sue Segar

Experts say bacterial infections are responsible for more infant deaths than is generally recognised, and things may get worse as more of the bugs become resistant to commonly used antibiotics. We asked local experts about this growing threat to newborns.

A two-week-old baby is referred to the Red Cross War Memorial Children’s Hospital (RCWMCH) in Cape Town. The infant, who was born prematurely at six months, has come from a nearby neonatal hospital.

She’s developed complications, including a feed intolerance and constant vomiting. On investigation, she is found to have a bowel perforation and a condition called necrotising enterocolitis. Surgeons conclude she needs an operation to repair the perforation. A sample of pus from inside her abdomen is sent to a laboratory to identify any infections. While the tests are being done, the infant is started on second-line antibiotics. The doctors suspect she picked up an infection due to pathogens that may be resistant to first-line antibiotics while in the neonatal hospital.

“But 48 hours later, when the results are available, they may show that the antibiotics we’ve been treating the baby with are not treating the bacteria that have now been detected in the lab,” says Associate Professor James Nuttall, a paediatric infectious diseases sub-specialist at RCWMCH and the University of Cape Town.

“In response to those results, we’d change to a different set of antibiotics to try and target the bacteria that have been detected. In the meantime, the child has deteriorated and requires a second operation. Throughout all the subsequent treatments, we are testing samples for infections she might – and frequently will – acquire along the way.”

From then on, he says it’s a case of trying to keep up with the sequence of infections that the baby might develop. Some of these infections may have originated at the neonatal hospital, while others could have been acquired during her treatment in the Intensive Care Unit (ICU) at RCWMCH, possibly from the operating theatre, intravenous lines, or healthcare workers’ hands.

“This is the kind of scenario we are faced with all the time,” says Nuttall. “The fact is, an infant might come into hospital with one infection and, unfortunately, pick up a bunch of other infections while in the hospital from transmission of pathogens that may be resistant to one or more of the commonly used first- or second-line antibiotics.”

Sitting in a boardroom at the Red Cross Hospital, close to the paediatric wards and clinics in which he treats sick children referred from other hospitals in Cape Town and beyond, Nuttall says there are two possible outcomes for this baby.

“She might turn the corner and respond to the new antibiotics, together with interventions from the surgical doctors and expert management in an ICU. Or she might not respond to the treatment, and die two days later, because of ongoing infection that doesn’t respond to treatment.”

Nuttall is discussing the ongoing issue of rising antibiotic resistance, particularly among neonates, the group most vulnerable to this. He’s responding to Spotlight’s main question: Will the antibiotics used to treat bacterial infections, such as Klebsiella pneumoniae – which have seen hundreds of babies die in hospitals in recent years – keep working? And, how big is the risk of antibiotic resistance to infants?

“The short answer to whether the antibiotics we currently use to treat bacterial infections will keep working is no,” he says.

‘Almost endemic’

In some South African healthcare facilities, especially in the public sector, antibiotic-resistant bacteria have become “almost endemic”, says Professor Shabir Madhi, director of the Wits Vaccines and Infectious Diseases Analytics Unit at University of Witwatersrand (WITS VIDA).

“There are a large number of deaths occurring on an ongoing basis. We still have clusters of outbreaks, but those are underpinned by a really widespread dissemination of these antibiotic-resistant bacteria, and persistently high rates of hospital-acquired infections, especially in the first month of life,” he says. “Despite the best of efforts, we haven’t been able to get on top of this.”

Madhi headed up a study at the Chris Hani Baragwanath Academic Hospital in Soweto in which they used molecular testing to look at evidence of infections in 153 babies who had passed away. The researchers found that infections were the immediate or underlying cause of death in 58% of all the neonatal deaths, including the immediate cause in 70% of neonates with complications of prematurity as the underlying cause.

Overall, 74.4% of 90 infection-related deaths were hospital-acquired, mainly due to multidrug-resistant Acinetobacter baumannii (52.2%), Klebsiella pneumoniae (22.4%), and Staphylococcus aureus (20.9%).

Also asked whether the antibiotics used to treat Klebsiella and other bacterial infections will keep working, Madhi says: “The short answer is that we’ve already run out of antibiotics in the public sector that can treat all of these different bacteria.”

He says that there are two bacteria that are of particular concern in South Africa.

“The one is Klebsiella pneumoniae, which that has become resistant to almost all of the antibiotic classes that are available for use, except perhaps for colistin, (a reserve antibiotic which is seen as a last-resort treatment for multidrug-resistant Gram-negative infections), but even antibiotic resistance to colistin in bacteria is emerging.

“The other big one is Acinetobacter baumannii, which is also a common cause of hospital-acquired infections. Here the bacteria have become resistant to all classes of antibiotics including colistin.”

Madhi says compared to other African countries, South Africa is better equipped to provide high-level care, including intensive care, to prematurely-born babies.

“Consequently, we end up spending a mini fortune to get these very premature children to survive the first few days of life, only for them then to succumb to hospital-acquired infections. Whereas in other settings many of these babies will die in the first few hours of life.”

He adds: “The single leading cause of neonatal mortality in South Africa is antibiotic resistant bacterial infections, but that is underpinned by other conditions which increases the susceptibility of babies to eventually succumb to these hospital-acquired infections.”

In the public sector, Madhi says hospital-acquired infections are a major reason why children are dying. In the private sector, there is more attention on identifying these infections, along with better resources, which helps reduce the problem.

Meanwhile, physicians like Nuttall are put in impossible situations at Red Cross.

“When doing blood tests on an infant to check for infection, you can’t wait for those results. You have to start treatment with what you think is the appropriate treatment. That’s the empirical treatment,” explains Nuttall.

“Then, when you isolate a bacterium and know its resistance profile (or antibiotic susceptibility profile), you must redirect your treatment to what’s known as ‘directed’ or definitive treatment. But there’s now been a time gap of 24 to 72 hours where the infant is on treatment, and you don’t know if it’s the right treatment. That’s a critical issue, because the baby might deteriorate in that time because they’re not on the right treatment,” he says.

He says the choice of empiric antibiotics is becoming more difficult, “as what we previously used as empiric antibiotic treatment is less and less reliable to treat serious infections, particularly in patients who acquire resistant infections in hospital”.

In a position paper, Nuttall and his colleagues write that growing antibiotic resistance is linked to the increased use of “reserve” and “watch” antibiotics. The WHO classifies antibiotics into three groups. Access antibiotics are the common ones used to treat everyday infections in the community. Watch antibiotics are broad-spectrum antibiotics that carry a higher risk of causing resistance, so their use must be carefully monitored and limited. Reserve antibiotics are last-resort treatments for infections caused by multi-drug-resistant bacteria and should only be used when all other options have failed.

‘Totally underestimated’

Following the research described earlier, Madhi says they convened an expert panel, to deliberate on what the causes of death was in children.

Unfortunately, he says, it’s become completely monotonous in that there’s a clear series of events for children born prematurely, who die: They’re admitted to hospital, they usually require ICU, they improve in ICU, and two to three days later, they appear very sick again. “Often you don’t actually identify the bacteria causing the clinical deterioration when you investigate ante-mortem, and you only realise the child actually succumbed to antimicrobial resistant bacterial infections after you’ve done the postmortem sampling”. Postmortem sampling is not done systematically across the country.

“What the post-mortem sampling has unmasked, is that we’ve totally underestimated the contribution of antibiotic-resistant bacteria in relation to causes of neonatal death. If we were to do the same investigations in other facilities, there would be much greater heightened awareness of what is really an unrecognised endemic public health crisis across our healthcare facilities,” says Madhi.

Professor Angela Dramowski, Head of the Clinical Unit: General Paediatrics at Tygerberg Hospital, agrees that outbreaks in low- and middle-income country hospitals, including South Africa are under-reported.

“What we see in the literature and in the headlines of newspapers is the tip of the iceberg. The vast majority of outbreaks in fact are either undetected or unreported. This is almost an invisible problem because a lot of the deaths are currently labelled due to another cause, for example, prematurity.

“This is a crucial public health crisis. We cannot practice modern medicine without effective antibiotics, and, especially for newborns the situation is perilous as we have very few effective treatment options left.”

‘Existential threat’

Though more acute in some areas, the problem is a global one. Marc Mendelson, Professor of Infectious Diseases at the University of Cape Town, describes antibiotic resistance as an existential global health threat.

“If antibiotic resistance is not mitigated, in the next 25 years, 39 million people globally will die of an antibiotic-resistant bacterial infection. That will dwarf HIV, tuberculosis, and malaria,” he says.

“There are bacteria currently causing infections in our hospitals in South Africa that are totally resistant to antibiotics. Those patients would usually die or need extraordinary measures to keep them alive such as amputating a limb to remove the infection in a bone or joint,” Mendelson says.

“People have always assumed if you get sick with a bacterial infection, there will be an antibiotic to treat it. Doctors in and out of hospitals have been too lax in how they prescribe antibiotics. Now we’re paying the price as some bacterial infections are not easily treatable,” he says.

As Dramowski points out, there is a lot of good science confirming the extent of the problem. A systematic review published in The Lancet found that almost 5 million deaths in 2019 were associated with bacterial infections resistant to antibiotics.

“That huge number is more than deaths from HIV and malaria combined,” she says.

Dramowski also points to another review study that found 3 million cases of neonatal sepsis globally each year, with at least 570 000 deaths (likely an underestimate). Over 95% of deaths from neonatal antibiotic resistance occur in low- and middle-income countries (LMICs).

“In a nutshell, in five big studies … they showed that antibiotic resistance to the World Health Organization-recommended antibiotic treatments ranges anywhere between 40 to 70%, so almost half of all babies with severe bacterial infection have resistance to the recommended antibiotic treatment,” she says.

What to do?

To address the major issue of antibiotic resistance in infants, Dramowski stresses the importance of prevention. This includes improving Water, Sanitation, and Hygiene (WASH) as well as Infection Prevention and Control programmes to reduce the spread of antibiotic-resistant bacteria in communities and healthcare facilities. She also stresses the need to prevent pre-term births as much as possible, as hospital admissions carry a high risk of acquiring antibiotic-resistant bacteria and developing infections.

She says increased surveillance of infections in LMICs is also crucial, along with more antibiotic trials to provide better alternatives. Additionally, there is a strong need for responsible antibiotic use (stewardship) to ensure they are only used when necessary, helping to prevent the development of antibiotic resistance.

A challenge in practicing stewardship is the difference in resources between the public and private sectors, says Professor Vindana Chibabhai, Head of the Centre for Healthcare-associated Infections, Antimicrobial Resistance, and Mycology (CHARM) at the National Institute for Communicable Diseases. Expensive antibiotics are more easily accessible in the private sector, while they are often not available in the public sector.

“Antibiotic stewardship is happening all over the country but we need to have a national monitoring system,” she says.

Chibabhai says that private sector clinicians often work independently and are not required to follow stewardship programmes as strictly as those in public sector hospitals. To address antibiotic resistance, she says we need monitoring systems to track the effectiveness of these programmes and provide support to hospitals struggling with them. Even though some hospitals have dedicated pharmacists, microbiologists, and clinicians, Chibabhai says they may need additional help to strengthen their antibiotic stewardship efforts.

‘Lots of lovely paper’

A major issue highlighted by experts is the lack of a clear AMR strategy in South Africa. The last strategy, which covered 2019 to 2024, was not funded, and its impact has not been evaluated.

“We have lots of lovely paper and lots of committed people doing great work but in terms of interventions, none of it is funded,” says Mendelson, who chaired the Ministerial Advisory Committee on Antimicrobial Resistance for the eight years until 2022. “If these interventions were funded, we could save lives.”

Madhi says the consequences of not implementing South Africa’s AMR plan are exactly what we are seeing now. “The problems have become endemic and entrenched in public healthcare facilities and lead to large numbers of unnecessary deaths which could have been prevented if we implemented a proper strategy in place.”

He says the situation now calls for a multi-faceted approach. “It’s not just about the type of antibiotics that should be available but about mitigating the many contributing factors that resulted in these outbreaks. That requires immense investment in terms of resources and expertise.”

Republished from Spotlight under a Creative Commons licence.

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Categories : HIVTags :

How an SAMRC Study Found that HIV Deaths in SA May be Massively Undercounted

On By ModernMedia
Photo by Sergey Mikheev on Unsplash

By Chris Bateman

It is widely acknowledged among health and demographic experts that relying solely on what is written on death certificates does not paint an accurate picture of what people in South Africa are actually dying of. Now, an SAMRC study has provided evidence that the undercounting of deaths due to HIV might be even greater than previously thought.

Many in health circles were surprised by a recent South African Medical Research Council (SAMRC) study that found that 23% of deaths in a nationally representative sample drawn from 2017/2018 were due to HIV. By comparison, Stats SA data for roughly the same period puts the figure at only 5.7%.

That Stats SA’s HIV mortality figures differs from other sources is not new and not in itself surprising. This is because Stats SA reports a relatively straight-forward count of what is written on death certificates – where it is known HIV is often not indicated, even if it is the underlying cause of death. By contrast, the new SAMRC study looked at autopsy reports, death certificates, medical records, and interviews with next of kin to come up with its much higher estimate.

The thing that did come as a surprise, is just how much higher the SAMRC figures were than anticipated. Previously, the real number of HIV deaths were thought to be around double the Stats SA number, rather than four times as much. For example, according to Thembisa, the leading model of HIV in South Africa and the basis for UNAIDS’s estimates for the country, around 12% of deaths in the country in 2018 were due to HIV.

“Accurate mortality data are essential for informed public health policies and targeted interventions; however, this study highlights critical gaps in our cause-of-death data, particularly in the underreporting of HIV/AIDS and suicides,” says Professor Debbie Bradshaw, study co-author and Chief Specialist Scientist at the SAMRC Burden of Disease Research Unit, in a media statement. (The study also found substantial under-reporting of suicide on death certificates.)

Multiple data sources

The study was conducted in three phases, examining deaths that were registered in 27 randomly selected health sub-districts between 1 September 2017 and 13 April 2018.

In addition to the examination of autopsy reports, death certificates, and medical records, trained fieldworkers interviewed next of kin to conduct verbal autopsies using a World Health Organization (WHO) questionnaire that had been translated into the country’s nine official languages.

Based on these various sources of data, the cause of each death was categorised into one or more of 44 categories and then compared to the cause of death indicated on the person’s death certificate. (The process for ensuring accuracy, including a review shared by a team of 49 medical doctors, is described in detail in this report.)

The researchers collected data for over 26 000 deaths, although not all types of data were available for each death. Medical records were available for over 17 600 cases, forensic pathology (autopsy) records for 5 700, and about 5 400 verbal autopsies were conducted. In the end, “to save costs”, not all medical records were reviewed.

Overall, for just over 15 000 deaths, the researchers could link and compare their assessment of why a person died to what was written on death certificates.

‘Poor agreement’

The researchers found that “there was poor agreement between the underlying cause of death obtained from the study and the official cause of death data”. The cause of death was the same in only 37% of cases. In addition to the under-reporting of HIV, the researchers also identified “severe under-reporting” of suicide as a cause of death.

A strong link between TB and HIV was observed, with TB responsible for 46% of deaths among people with HIV and 63% of TB deaths occurring in individuals with HIV. Together, these two diseases accounted for almost 30% of deaths.

Some question marks

As noted earlier, the new numbers are substantially higher than estimates from the highly respected Thembisa model. According to their data only 12% of deaths from mid-2017 to mid-2018 were due to HIV-related causes, with a further 9% of deaths occurring in persons with HIV but due to other causes.

Dr Pam Groenewald, a co-author of the new study and also with the SAMRC, describes Thembisa as “an excellent source”. She tells Spotlight they had a long discussion with the Thembisa researchers, “but we weren’t able to fully explain the differences”.

The study authors cite several factors that might contribute to a higher proportion of HIV deaths in their study. Firstly, the weighted national causes of death validation sample aimed to represent the registered deaths in the country, and it was known that deaths in rural areas and child deaths were under-represented. Secondly, deaths that occurred in private sector hospitals were not represented. Groenewald says the HIV-linked deaths in private hospitals are “definitely lower”, but doubts they would have had a significant impact on their findings.

One thing in favour of the study numbers is the fact that the cases they identified with HIV/AIDS as the underlying cause of death were independently reviewed by clinicians. As Groenewald points out, they looked at medical records of people admitted to and who died in hospital, including CD4 cell counts and HIV viral loads. The suggestion is that if someone had a very low CD4 count and a very high HIV viral load at the time of death, then it is very likely HIV played a role in their death, unless of course they died of a clearly non-associated cause like injuries from a car accident.

On the other hand, it might be argued that since HIV is very widely tested for in South Africa, it is more likely to appear on medical records than other less tested for diseases.

Another interesting wrinkle is that the proportion of deaths from HIV/AIDS from this study was higher than anticipated based on observed declines in adult mortality. It is widely accepted that the decline in adult mortality and the increase in life-expectancy over the last two decades was driven by antiretroviral therapy keeping more people with HIV alive. While the new findings do not challenge this narrative, it does suggest the effect may be less pronounced than previously thought.

What to do?

The researchers suggest their study has immediate implications for the country’s response to HIV and TB.

“The study recommends strengthening case finding, follow-up, prevention, and treatment for HIV, AIDS and TB to reduce mortality rates, and underlines the importance of government’s rapid response to counter the recent abrupt withdrawal of Pepfar funding,” Bradshaw comments in the media release.

But more broadly, the findings put the spotlight on major problems in the country’s death certification systems.

“Our findings highlight the need for improved record quality and adherence to testing guidelines within the medical community. Poor record keeping included incomplete documentation of clinical findings and results,” the study authors write.

“A lot of doctors’ report HIV as ‘retroviral disease’, for example, and it’s not coded as HIV,” Groenewald explains to Spotlight.

Urging doctors to record the actual underlying cause of death when writing up death certificates, she also called for improved training in death certification at medical schools.

Doctors’ reluctance to report HIV on death certificates likely has various reasons, including stigma related to HIV and the fact that some medical insurance policies used to exclude HIV, though policies now treat HIV like any other chronic condition.

Overall, Groenewald says, we need to step back and probe the rationale of compiling underlying cause of death statistics.

“The public health aim of the medical certificate of cause of death, (MCCD), is to prevent premature deaths. We therefore need to record the cascade of events or causal sequence of medical conditions leading to death and target our interventions at the underlying cause of death. The coding rules focus on the underlying cause of death, (UCOD), to compile the mortality statistics,” she says.

Groenewald stresses that the law requires doctors to provide accurate information on death causation. The Health Professions Council of SA’s ethical rules also recognised that a statute requiring disclosure about a deceased person’s health must be complied with and is not considered unethical. Contrary to common physician misconception, Groenewald says all this combined to show “it is completely ethical to disclose on a death certificate that a person has died from an AIDS related illness”.

In the meantime, routine mortality data from Stats SA should clearly be taken with a pinch of salt. As Groenewald points out, vital registration data should not be accepted at face value but should be interrogated and cross-checked with other data sources to get coherent and consistent estimates that fit within an envelope of all causes of mortality.

– Additional reporting by Marcus Low.

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and Regulations Medical Research & TechnologyTags :

Inside the SAMRC’s Race to Rescue Health Research in SA

On By ModernMedia
Mycobacterium tuberculosis drug susceptibility test. Photo by CDC on Unsplash

By Catherine Tomlinson

Health research in South Africa has been plunged into crisis with the abrupt termination of several large research grants from the US, with more grant terminations expected in the coming days and weeks. Professor Ntobeko Ntusi, head of the South African Medical Research Council, tells Spotlight about efforts to find alternative funding and to preserve the country’s health research capacity.

Health research in South Africa is facing an unprecedented crisis due to the termination of funding from the United States government. Though exact figures are hard to pin down, indications are that more than half of the country’s research funding has in recent years been coming from the US.

Many health research units and researchers that receive funding from the US National Institutes of Health (NIH) have in recent weeks been notified that their grants have been terminated. This funding is being slashed as part of the efforts by US President Donald Trump’s administration to reduce overall federal spending and end spending that does not align with its political priorities.

Specifically, the administration has sought to end spending supporting LGBTQ+ populations and diversity, as well as equity and inclusion. As many grants for HIV research have indicators of race, gender, and sexual orientation in their target populations and descriptions, this area of research has been particularly hard hit by the cuts. There have also been indications that certain countries, including South Africa and China, would specifically be targeted with NIH cuts.

On 7 February, President Donald Trump issued an executive order stating that the US would stop providing assistance to South Africa in part because it passed a law that allowed for the expropriation of land without compensation, and separately because the South African government took Israel to the International Court of Justice on charges of genocide in Gaza.

Prior to the NIH cuts, some local research funded through other US entities such as the US Agency for International Development (USAID), and the Centers for Disease Control and Prevention (CDC) were also terminated.

How much money is at risk?

“In many ways the South African health research landscape has been a victim of its own success, because for decades we have been the largest recipients of both [official development assistance] funding from the US for research [and] also the largest recipients of NIH funding outside of the US,” says president and CEO of the SAMRC Professor Ntobeko Ntusi.

Determining the exact amount of research funds we get from the US is challenging. This is because funding has come from several different US government entities and distributed across various health research organisations. But the bulk of US research funding in South Africa clearly came from the NIH, which is also the largest funder of global health research.

According to Ntusi, in previous years, the NIH invested, on average, US$150 million – or almost R3 billion – into health research in South Africa every year.

By comparison, the SAMRC’s current annual allocation from government is just under R2 billion, according to Ntusi. “Our baseline funding, which is what the national treasury reflects [approximately R850 million], is what flows to us from the [Department of Health],” he says, adding that they also have “huge allocations” from the Department of Science, Technology and Innovation. (Previous Spotlight reporting quoted the R850 million figure from Treasury’s budget documents, and did not take the additional funds into account.)

How is the SAMRC tracking US funding terminations

Ntusi and his colleagues have been trying to get a clearer picture of the exact extent and potential impacts of the cuts.

While some US funding given to research units in South Africa flows through the SAMRC, the bulk goes directly to research units from international research networks, larger studies, and direct grants. Keeping track of all this is not straight-forward, but Ntusi says the SAMRC has quite up to date information on all the terminations of US research awards and grants.

“I’ve been communicating almost daily with the deputy vice-chancellors for research in all the universities, and they send me almost daily updates,” says Ntusi. He says heads of research units are also keeping him informed.

According to him, of the approximately US$150 million in annual NIH funding, “about 40%…goes to investigator-led studies with South Africans either as [principal investigators] or as sub-awardees and then the other 60% [comes from] network studies that have mostly sub-awards in South Africa”.

Figures that Ntusi shared with Spotlight show that large tertiary institutions like the University of the Witwatersrand, the University of Cape Town, and the University of Stellenbosch, could in a worst case scenario lose over R200 million each, while leading research units, like the Desmond Tutu Health Foundation and the Centre for the AIDS Programme of Research in South Africa, could each lose tens of millions. The SAMRC figures indicate that while many grants have already been terminated, there are also a substantial number that have not been terminated.

Where will new money come from?

Ntusi says the SAMRC is coordinating efforts to secure new funding to address the crisis.

“We have been leading a significant fundraising effort, which…is not for the SAMRC, but for the universities who are most affected [and] also other independent research groups,” he says. “As the custodian of health research in the country, we are looking for solutions not just for the SAMRC but for the entire health research ecosystem.”

Ntusi explains that strategically it made more sense to have a coordinated fundraising approach rather than repeating what happened during COVID-19 when various groups competed against each other and approached the same funders.

“Even though the SAMRC is leading much of this effort, there’s collective input from many stakeholders around the country,” he says, noting that his team is in regular communication with the scientific community, the Department of Health, and Department of Science, Technology and Innovation.

The SAMRC is also asking the Independent Philanthropic Association of South Africa, and large international philanthropies for new funding. He says that some individuals and philanthropies have already reached out to the SAMRC to find out how they can anonymously support research endeavours affected by the cuts.

Can government provide additional funds?

Ntusi says that the SAMRC is in discussions with National Treasury about providing additional funds to support health researchers through the funding crisis.

The editors of Spotlight and GroundUp recently called on National Treasury to commit an extra R1 billion a year to the SAMRC to prevent the devastation of health research capacity in the country. They argued that much larger allocations have previously been made to bail out struggling state-owned entities.

Government has over the last decade spent R520 billion bailing out state-owned entities and other state organs.

How will funds raised by the SAMRC be allocated?

One dilemma is that it is unlikely that all the lost funding could be replaced. This means tough decisions might have to be made about which projects are supported.

Ntusi says that the SAMRC has identified four key areas in need of support.

The first is support for post-graduate students. “There’s a large number of postgraduate students…who are on these grants” and “it’s going to be catastrophic if they all lose the opportunity to complete their PhDs,” he says.

Second is supporting young researchers who may have received their first NIH grant and rely entirely on that funding for their work and income, says Ntusi. This group is “really vulnerable [to funding terminations] and we are prioritising [their] support…to ensure that we continue to support the next generation of scientific leadership coming out of this country,” he says.

A third priority is supporting large research groups that are losing multiple sources of funding. These groups need short-term help to finish ongoing projects and to stay afloat while they apply for new grants – usually needing about 9 to 12 months of support, Ntusi explains.

The fourth priority, he says, is to raise funding to ethically end clinical and interventional studies that have lost their funding, and to make sure participants are connected to appropriate healthcare. Protecting participants is an important focus of the fundraising efforts, says Ntusi, especially since many people involved in large HIV and TB studies come from underprivileged communities.

Ultimately, he says they hope to protect health research capacity in the country to enable South African health researchers to continue to play a meaningful and leading role in their respective research fields.

“If you reflect on what I consider to be one of the greatest successes of this country, it’s been this generation of high calibre scientists who lead absolutely seminal work, and we do it across the entire value chain of research,” says Ntusi. “I would like to see…South Africa [continue to] make those meaningful and leading pioneering contributions.”

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and RegulationsTags :

Government Announces 1200 New Doctor Positions – But Nursing Loses out

On By ModernMedia

In a move that will come as a relief for the hundreds of unemployed doctors currently seeking positions within public healthcare, the Department of Health has announced the creation of 1650 new positions for healthcare professionals. The move includes 1200 new positions for doctors – but only 200 for nurses.

Health Minister Dr Aaron Motsoaledi made the announcement at a media briefing on Thursday 10 April.

“We believe we’re in a position to announce today that the council has approved the advertisement of 1200 jobs for doctors, 200 for nurses and 250 for other healthcare professionals,” Motsoaledi stated. This would come with a cost of R1.78 billion – out of a healthcare budget that has not risen in line with inflation.

Jobless doctors picketed earlier this year as more than 1800 were left in limbo without positions – the true number is likely higher. The South African Medical Association (SAMA) had sent an urgent letter to President Cyril Ramaphosa, warning that if the problem was not addressed, doctors would leave for the private sector or emigrate, leading to the collapse of the public healthcare sector.

The road to specialisation had also been made more challenging by the shortage of positions, with junior doctors have been taking unpaid roles. Such unpaid work does not count toward the registrar component of specialisation and largely only serves to bump up the doctor’s CV by, for example, enabling them to apply for diplomas. Hiring freezes also saw GPs unable to move into government positions, and the limited number of registrar positions has also by some accounts become a bottleneck, with no additional registrar positions added for the past 10–15 years.

Regarding the loss of US funding for HIV programmes, he said that there was a buffer of stock for ARVS, and that “no person needing ARVs would lack” those drugs.

But the small number of new nurse positions was not well received. The Democratic Nursing Organisation of South Africa (DENOSA) was particularly unimpressed given the pressure on overburdened nurses.

DENOSA spokesperson Sonia Mabunda-Kaziboni said, “In the face of a nationwide crisis of nurse shortages, this announcement is not only shockingly inadequate but downright insulting to the nursing fraternity.”

Calling it a “slap in the face”, she continued: “The shortage of nurses in South Africa is nothing short of a devastating crisis. The Free State alone faces a 28% vacancy rate, and similar figures are reflected in other provinces such as the Eastern Cape. National projections estimate that South Africa could be short by over 100 000 nurses by 2030 if urgent interventions are not made.”

DENOSA plans to “name and shame” institutions that have become “dangerous to communities” as a result of unresolved poor conditions.

Categories : Medical IndustryTags :

Next Biosciences Marks 20 Years of Biotech Innovation

On By ModernMedia
Dr Yvonne Holt, Chief Medical Officer of Next Biosciences (left) with Kim Hulett, Founder and CEO of the company (right) celebrating 20 years of innovation and leadership in stem cell banking, genetic testing and regenerative medicine.

As Next Biosciences celebrates its 20th anniversary, the pioneering South African biotech company reflects on two decades of significant advancements in science and healthcare.

From its roots in medical innovation to its transformative contributions in regenerative medicine, genetic testing and wellness, Next Biosciences has not only shaped the local industry, but also positioned itself as a leader in Africa’s growing biotech sector.

Founded by Kim Hulett, an entrepreneur with a background in finance and technology, and Dr Yvonne Holt, the company has expanded its range of products and services that cover biologics, stem cells, exosomes, genetic testing, longevity and reproductive health.

“The journey of Next Biosciences has been about bringing cutting-edge science and technology to South Africa, and making advancements in health and wellness accessible,” says Dr Holt, Chief Medical Officer at the company. “Every innovation we develop is driven by our mission to positively impact people’s health with science, by transforming lives, improving health outcomes and shaping the future of medicine on the continent.”

With a team of 90, Next Biosciences stands as one of the country’s leading biotech innovators. Women make up 80% of the workforce, with 20% of them being scientists – underscoring the company’s strong commitment to diversity and inclusion. Their lab is accredited by the Association for the Advancement of Blood and Biotherapies (AABB) and ISO 13485 standards, a testament to their excellence in stem cell banking, cord blood services and other biotechnological advancements.

From its beginnings with Netcare, Next Biosciences’ focus on research and development has enabled the company to expand beyond local borders, bringing its innovative healthcare solutions to a wider audience. They now lead initiatives that support regenerative medicine with products like OptiSerum, a revolutionary umbilical cord blood serum for ophthalmic use, and AmnioMatrix, used in a range of medical applications from ophthalmology and wound care to dentistry.

Next Biosciences’ state-of-the-art Netcells storage lab, ensuring the safe preservation of precious stem cells for future medical advancements.

“Biotechnology and regenerative medicine are advancing at an unprecedented pace, offering new possibilities for treating diseases that were once thought incurable. Our focus remains on harnessing these innovations responsibly, ensuring that the latest advancements in cellular therapies, genetic diagnostics and biologics translate into real, life-changing solutions for patients,” says Dr Holt.

The biotechnology landscape has evolved worldwide, and South Africa has not been left behind.

Credit: Global Biotech Indus

The global biotechnology industry is currently valued at $546 billion, growing at approximately 13% per annum. Remarkable advancements have been achieved in genetic research, stem cell therapies and personalised medicine. “The potential for biotechnology over the next decade is extraordinary,” says Hulett, CEO of Next Biosciences. Breakthroughs in regenerative medicine and longevity science are revolutionising healthcare as we know it.”

Next Biosciences’ path hasn’t been without challenges. From navigating regulatory hurdles to sourcing cutting-edge technologies, the company’s growth has been driven by passion, resilience and innovation. As a majority female-led team, the company exemplifies the power of women in science and business, and they have become a beacon for female entrepreneurs looking to make a mark in the science and technology sectors.

“Building a biotech company in SA, with all its complexities, required tenacity and a relentless commitment to our mission. Over the years, we have witnessed our industry evolve and we are proud to have been at the forefront of that change,” says Hulett. “The future holds great promise and we are excited to see what the next 20 years will bring.”

Looking ahead, Next Biosciences aims to expand its footprint in Africa, focusing on reproductive, regenerative and longevity health to empower individuals to invest in their health and live their best lives. With a strong commitment to innovation, accessibility, convenience and sustainability, Next Biosciences plans to integrate cutting-edge biotechnologies, while maintaining a patient-centric approach. By staying at the forefront of the biotech industry, the company is set to strengthen its position as a trusted leader in African healthcare.

Categories : DentistryTags :

Beyond the Smile: South Africa Must Prioritise Oral Health as a Public Health Imperative

On By ModernMedia
Photo by Hush Naidoo Jade Photography on Unsplash

South Africa’s burden of oral diseases is not only inextricably linked to non-communicable diseases but also presents an urgent public health challenge, with rising concern over its impact on mental health.

Oral diseases are a major health concern for many countries and negatively impacts people throughout their lives. Oral diseases lead to pain and discomfort, social isolation and loss of self-confidence, and they are often linked to other serious health issues. And yet, there is no reason to suffer: most oral health conditions are preventable and can be treated in their early stages.

Globally, every year on March 20, World Oral Health Day is commemorated with the aim to empower people with the knowledge, tools, and confidence to secure good oral health.

This year, the Day’s focus shifts to the mind-mouth connection, with the tagline from the FDI World Dental Federation: “A Happy Mouth Is… A Happy Mind”. This campaign aims to raise awareness of how poor oral health can negatively impact quality of life, highlighting the importance of a healthy mouth for mental well-being.

Macelle Erasmus, Head of Expert at Haleon South Africa – a leader in consumer health and self-care, says, “Oral health is not just about bright smiles and good-looking teeth – it is a critical component of overall well-being. In South Africa, the high prevalence of oral diseases, particularly among children and vulnerable communities, reinforces the urgent need for improved oral health education and preventive care.”

Haleon’s leading oral health brands Aquafresh and Sensodyne, are committed to improving oral health education and access across the country.

Over the course of just three months, we have conducted more than 39,000 gum health screenings across 16 clinics. In 2025, our expansion aims to reach 100,000 underserved communities as part of Haleon’s oral health care outreach programs.

According to the South African Dental Association (SADA), 41% of children aged 1-9 years and close to 28% of people aged 5 years and over experienced untreated tooth decay in milk and permanent teeth respectively, while nearly 25% of people aged 15 years and over experienced severe periodontal disease in 2019. The country also saw 1,933 new cases of lip and oral cavity cancer in 2020.

The World Health Organisation’s Global Strategy and Action Plan on Oral Health 2023–2030, explains that oral health encompasses a range of diseases and conditions. The most prevalent public health issues include dental caries, severe periodontal (gum) disease, complete tooth loss (edentulism), oral cancer, oro-dental trauma, noma and congenital malformations such as cleft lip and palate, most of which are preventable.

The main oral diseases and conditions are estimated to affect close to 3.5 billion people worldwide. These conditions combined have an estimated global prevalence of 45%, which is higher than the prevalence of any other NCD.

However, oral diseases and conditions share risk factors common to the leading NCDs, including all forms of tobacco use, harmful alcohol use, high intake of free sugars and lack of exclusive breastfeeding.

The Department of Health’s National Oral Health Policy and Strategy 2024-2034 acknowledges that oral health is poorly integrated in other health programmes, “though it is an integral part of general health.” It further recognises that: “Its role in management and care of communicable diseases, genetic disorders, trauma, injury, and violence is often overlooked.”

This integration is particularly important as more than three million patients are treated in the country’s public primary healthcare facilities annually, at a cost of R650 million. Addressing oral health holistically – within the broader healthcare system – can significantly reduce this burden.

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

What does it Mean for Health? SAMRC Experts Weigh in on Budget 2025

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Finance Minister Enoch Godongwana holding a copy of the 2025 Budget Speech. (Photo: Parliament of RSA via X)

By Charles Parry, Funeka Bango, Tamara Kredo, Wanga Zembe, Michelle Galloway, Renee Street and Caradee Wright

While the 2025 national budget boosts health spending, researchers from the South African Medical Research Council stress the need for strong accountability measures. They also raise concerns about rising VAT and omissions related to US funding cuts and climate change.

The 2025 budget speech by Finance Minister Enoch Godongwana saw a welcome boost to the health budget with an increased allocation from R277 billion in 2024/2025 to R329 billion in 2027/2028. This signals a government that is responding to the dire health needs of the public sector, that serves more than 80% of the South African population.

As researchers at the South African Medical Research Council (SAMRC), we listened with interest and share our reflections on some of the critical areas of spend relevant for health and wellbeing.

We note the increase in investment in human resources for health and allocations for early childhood development and social grants. At the same time, we also raise concern about increasing VAT, with knock-on effects for the most vulnerable in our country. There were also worrying omissions in the speech, such as addressing the impact of the United States federal-funding freeze on healthcare services nationally, and a noticeable absence of comment on government’s climate-change plans.

Health and the link with social development: Recognising the importance of early childhood development

Education and specifically early childhood development (ECD) is known to have critical impacts on children’s health and wellbeing, with longstanding effects into youth and adulthood. In South Africa, eight million children go hungry every day, and more than a third of children are reported to live in households below the food poverty line, that is below the income level to meet basic food requirements, not even covering other basic essentials such as clothes.

While the increase in the number of registered ECDs is laudable, many more ECD centres in low-income areas remain unregistered, which means they do not get support from the government in terms of subsidies and oversight.

Social grants

The increase in social grants is welcomed. However, the marginal increase of the Child Support Grant (CSG) by only R30, from R530 to R560, is too little to impact on the high levels of child hunger and malnutrition. The release of the Child Poverty Review in 2023, which highlighted the eight million children going hungry every day, including CSG recipients, proposed the immediate increase of the CSG to at least the Food Poverty Line (R796 in 2024).

Social relief of distress still too small

The Social Relief of Distress (SRD) Grant is an important source of income for low-income, working-age, unemployed adults. Its continuance in 2025 is welcomed. However, it remains too small at R370 per person per month, and the stringent means-test criteria which disrupt continuous receipt from month-to-month, makes it an unreliable, unpredictable source of income for low-income individuals.

Strengthening the healthcare workforce

The Minister stated that “R28.9 billion is added to the health budget, mainly to keep about 9 300 healthcare workers in our hospitals and clinics”. It will also be used to employ 800 post-community service doctors, and to ensure that our pharmacies do not run out of medicines. The speech highlighted the necessary commitment to strengthening the healthcare system, specifically human resources for health.

Considering the pressures on resources, primarily due to the escalating disease burden and challenges within the health workforce, the proposed budget increase from R179 billion to R194 billion – an increase of 8.2% – to maintain the current workforce and employ additional healthcare workers signifies a positive step forward that will aid in addressing staff shortages.

However, this seems to fall short of what is needed to ensure all medical graduates are placed, and government’s own 2030 Human Resources for Health Strategy.

VAT vs. health taxes

Despite the gains in health spending, the proposed increase in VAT raises substantial concerns to partially negate the potential benefits to the health sector. As the World Bank reports that approximately 60% of people living in South Africa live below the poverty line, increases to VAT will likely drive poverty levels higher.

A focus on other forms of taxation may be better, more evidence-based, and less likely to disproportionately affect those at the highest levels of poverty.

On the issue of alcohol taxes, often mischaracterised as “sin taxes” rather than “health taxes”, the Minister has proposed excise duties of 6.75% on most products for 2025/26. This is 2% above consumer inflation, which stands at 4.75%.

Raising alcohol prices through higher excise taxes is globally recognised as an effective way to address alcohol-related harms. National Treasury is to be commended for adjusting alcohol excise tax rates above CPI in the 2025/26 Budget. This is a move in the right direction, but it does not address the current anomalies in tax rates across different products. This failure to address shortcomings in the excise tax regime is expected, given the release of a discussion document on alcohol excise taxes in December 2024 with a February 2025 response date. The earliest we can expect substantial changes in excise tax rates is in February 2026.

From a public-health perspective, it makes sense to link alcohol excise taxes to the absolute alcohol content of the product to standardise across products. Ethanol is ethanol. The current differential in excise tax rates on different alcohol products is indefensible. Specifically, it makes no sense to tax wine and beer so much less than spirits in terms of absolute alcohol content. Wine, especially bag-in-box wine, is the cheapest product on the market in South Africa, and its affordability increases consumption, leading to more societal harm.

Beer is the most consumed product in the country and is increasingly sold in larger, non-resealable containers. A 2015 SAMRC study in Gauteng found the highest level of heavy episodic drinking with beer products, largely due to their affordability, especially in larger, non-resealable containers. Heavy episodic drinking is a major public-health concern in South Africa, with 43.0% of current drinkers engaging in heavy episodic drinking at least monthly, 50.9% of male and 30.3% of female drinkers. Increasing the excise tax on beer is a powerful tool that the state can use to reduce the level of such behaviour.

Additionally, it makes sense to have lower taxes on alcohol products with lower alcohol content, as this could shift consumption to less harmful products. The current excise tax regimen does not account for this within a single product type like beer or wine, as all products are taxed at the same rate regardless of their alcohol content.

During the COVID-19 pandemic, we saw the benefits of decreased access to alcohol: fewer injuries, fewer unnatural deaths, and communities less disrupted by patrons visiting liquor outlets. While no one advocates for total liquor sales bans, increasing excise taxes on wine and beer would decrease alcohol consumption and reduce harms on drinkers, on others around them, and on society more broadly.

Acute risk to lives with knock on effects due to US federal funding cuts

We believe the South African government has a responsibility to step into the gap left by the sudden US federal funding freeze on HIV and TB services. The US President’s Emergency Plan for AIDS Relief (PEPFAR) funds 17% of HIV and TB services in South Africa and covers salaries for thousands of health workers, including the vital services of community health workers.

The implications for people living with HIV and TB and affected by the externally funded services will be devastating. It will also have ripple effects on the health system as we see inevitable increases in demand for health services to address advancing illness, effects on families caring for ill relatives or losing income.

This area needs to be addressed and clear communication from the National Department of Health is urgently awaited. The US funding cuts clearly impact on essential research funding available to institutions like the SAMRC and no indication has been given in the budget of any plans to augment or replace such funding.

National Health Insurance for South Africa’s public sector

The Minister addressed budget allocations for NHI implementation, specifically, the mid-term indirect and direct conditional grants for NHI were R8.5 billion and R1.4 billion respectively. Although these amounts in themselves are minor compared to other health-budget allocations, allocations for infrastructure (R37.4 billion over the mid-term economic framework period) and additionally allocations for digital patient health information systems, chronic medicine dispensing and distribution systems, and medicine stock surveillance systems are vital for healthcare efficiency and improved outcomes.

Least said not soonest mended: climate change – ‘no comment’?

From a climate-crisis perspective, although the budget speech did not explicitly mention climate change or its related health challenges, there seems to be positive steps being taken to address these issues. Initiatives such as clean energy projects and efforts to improve water management have the potential to benefit all sectors of society, while helping to mitigate the health risks associated with climate change.

Promising spend on health, but who will measure the impact?

Ultimately, increasing health spend is a promising step to increase access to quality health services for South Africa’s population. However, this is not enough, government must seize the opportunity to translate the budget increase into improved health outcomes. The effectiveness of the additional funds must be maximised through efficiency, transparency, and sound governance. The government can reinforce the integrity of public-health services by aligning these increases with robust accountability measures.

Government-academic partnerships represent an opportunity to share knowledge, technical skills and resources to support evidence-informed decision-making for national health decision-making and strengthen monitoring and evaluation mechanisms. There are many examples of this working well, and we trust that the SAMRC, along with the network of higher education institutions are well placed to provide the necessary support.

*Parry, Bango, Kredo, Zembe, Galloway, Street and Wright are researchers with the SAMRC.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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Categories : Cancer General InterestTags :

A Right to Life: Ensuring Access to Stem Cell Transplants for SA’s Children

On By ModernMedia
Photo by Jeffrey Riley on Unsplash

Every year, hundreds of South African children courageously battle blood disorders which are treatable through stem cell transplants. Yet, while at least 250 paediatric transplants are needed annually, only 18 are performed – leading to survival rates of just 20%, compared to 80% in countries like the USA and Europe.

Ahead of Human Rights Day, Palesa Mokomele, Head of Community Engagement and Communications at DKMS Africa, highlights the urgent need for action: “Every child has the right to healthcare, which should include stem cell transplants. By working together – government, healthcare providers, and the private sector – we can remove the barriers preventing children from receiving the treatment they need.”

Overcoming Barriers to Life-Saving Transplants

Mokomele notes that while there are challenges, there are also solutions. “By addressing issues such as financial constraints, medication shortages, and limited infrastructure, we can ensure that more children receive these vital treatments. Through collaboration, we can create meaningful change.”

Addressing the Cost Challenge

One of the major hurdles in providing this life-saving treatment is the high cost of stem cell transplants, which ranges from R1 million to R1.5 million. “When a child has a matching family donor, the public healthcare system covers their transplant fully. However, for the 70% of patients who require an unrelated donor, the state covers the transplant, but not the additional costs of finding and securing a suitable donor such as tissue typing, donor searches, and stem cell procurement.,” explains Mokomele.

“Public-private partnerships, however, can ensure that all associated costs are also covered,” she points out. “Together, we can make a difference in the lives of children who need these life-saving procedures. To be effective, we must collaborate more closely and take a holistic approach.”

Building Medical Expertise

“South Africa is challenged by the lack of clinically skilled haematology nurses and clinical haematologists, but we are looking into how ways to increase capacity at this level. Training and scholarships for medical and non-medical staff in haematology and transplantation can improve the level of care provided,” says Mokomele.

She outlines some of the work of non-profit organisations like DKMS Africa in supporting knowledge transfer initiatives for healthcare professionals. “Through a combination of theoretical courses, hands-on observerships, or a hybrid of both, we aim to enhance patient outcomes. We also frequently host and participate in symposia for the medical community to exchange knowledge and explore best practices, which are essential for providing the highest quality care.”

Encouraging Donor Commitment

A strong donor registry is crucial, yet despite DKMS Africa recruiting over 100 000 potential donors, 56% of those matched decline to donate when called upon. “Becoming a donor is a powerful act – it’s a chance to give a child a second chance at life,” urges Mokomele.”

Expanding Transplant Capacity

Increasing the number of transplant beds is another crucial step. Currently, only four paediatric transplant beds are available in public transplant centres – two in the Western Cape and two in Pretoria. However, she shares encouraging news: “We are in conversations with the private sector to support the expansion of more beds in Gauteng, where the bulk of patients reside. This expansion represents a crucial step toward improving access to care.”

A Call to Action: How You Can Help

“The progress we’re seeing is promising. Together, we can ensure that no child is denied a life-saving transplant due to financial, medical, or infrastructure constraints,” concludes Mokomele. “Whether by registering as a donor, supporting fundraising efforts, or advocating for policy changes, every contribution makes a difference. With collective effort and commitment, South Africa could transform paediatric stem cell treatment – offering hope, healing, and a future to the children who need it most.”

Categories : Expert Opinion IT in HealthcareTags :

The Future of Healthcare Interoperability: Building a Stronger Foundation for Data Integration

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Henry Adams, Country Manager South Africa, InterSystems

Healthcare data is one of the most complex and valuable assets in the modern world. Yet, despite the wealth of digital health information being generated daily, many organisations still struggle to access, integrate, and use it effectively. The promise of data-driven healthcare – where patient records, research insights, and operational efficiencies seamlessly come together – remains just that: a promise. The challenge lies in interoperability.

For years, healthcare institutions have grappled with fragmented systems, disparate data formats, and evolving regulatory requirements. The question is no longer whether to integrate but how best to do it. Should healthcare providers build, rent, or buy their data integration solutions? Each approach has advantages and trade-offs, but long-term success depends on choosing a solution that balances control, flexibility, and cost-effectiveness.

Why Interoperability Remains a Challenge

Despite significant advancements in standardisation, interoperability remains a persistent challenge in healthcare. A common saying in the industry – “If you’ve seen one HL7 interface, you’ve seen one HL7 interface” – illustrates the lack of uniformity across systems. Even FHIR, the latest interoperability standard, comes with many extensions and custom implementations, leading to inconsistency.

Henry Adams, Country Manager South Africa, InterSystems

Adding to this complexity, healthcare data must meet strict security, privacy, and compliance requirements. The need for real-time data exchange, analytics, and artificial intelligence (AI) further increases the pressure on organisations to implement robust, scalable, and future-proof integration solutions.

The Build, Rent, or Buy Dilemma

When organisations decide how to approach interoperability, they typically weigh three options:

  • Building a solution from scratch offers full control but comes with high development costs, lengthy implementation timelines, and ongoing maintenance challenges. Ensuring compliance with HL7, FHIR, and other regulatory standards requires significant resources and expertise.
  • Renting an integration solution provides quick deployment at a lower initial cost but can lead to vendor lock-in, limited flexibility, and escalating costs as data volumes grow. Additionally, outsourced solutions may not prioritise healthcare-specific requirements, creating potential risks for compliance, security, and scalability.
  • Buying a purpose-built integration platform strikes a balance between control and flexibility. Solutions like InterSystems Health Connect and InterSystems IRIS for Health offer pre-built interoperability features while allowing organisations to customise and scale their integration as needed.

The Smart Choice: Owning Your Integration Future

To remain agile in an evolving healthcare landscape, organisations must consider the long-term impact of their integration choices. A well-designed interoperability strategy should allow for:

  • Customisation without complexity – Organisations should be able to tailor their integration capabilities without having to build from the ground up. This ensures they can adapt to new regulatory requirements and technological advancements.
  • Scalability without skyrocketing costs – A robust data platform should enable growth without the exponential cost increases often associated with rented solutions.
  • Security and compliance by design – Healthcare providers cannot afford to compromise on data privacy and security. A trusted interoperability partner should offer built-in compliance with international standards.

Some healthcare providers opt for platforms that combine pre-built interoperability with the flexibility to scale and customise as needed. For example, solutions designed to support seamless integration with electronic health records (EHRs), medical devices, and other healthcare systems can offer both operational efficiency and advanced analytics capabilities. The key is selecting an approach that aligns with both current and future needs, ensuring data remains accessible, secure, and actionable.

Preparing for the Future of Healthcare IT

As healthcare systems become more digital, the need for efficient, secure, and adaptable interoperability solutions will only intensify. The right integration strategy can determine whether an organisation thrives or struggles with inefficiencies, rising costs, and regulatory risks.

By choosing an approach that prioritises flexibility, control, and future-readiness, healthcare providers can unlock the full potential of their data – improving patient outcomes, driving operational efficiencies, and enabling innovation at scale.

The question isn’t just whether to build, rent, or buy – but how to create a foundation that ensures long-term success in healthcare interoperability.

Categories : HIVTags :

SA Unveils Ambitious New HIV Campaign amid Aid Crisis

On By ModernMedia
Photo by Miguel Á. Padriñán: https://www.pexels.com/photo/syringe-and-pills-on-blue-background-3936368/

By Ufrieda Ho

Amid major disruptions caused by aid cuts from the United States government, the health department aims to enrol a record number – an additional 1.1 million – of people living with HIV on life-saving antiretroviral medicine this year. Experts tell Spotlight it can’t be business as usual if this ambitious programme is to have a chance of succeeding.

Government’s new “Close the Gap” campaign launched at the end of February has set a bold target of putting an additional 1.1 million people living with HIV on antiretroviral treatment by the end of 2025.

Around 7.8 million people are living with HIV in the country and of these, 5.9 million are on treatment, according to the National Department of Health. The target is therefore to have a total of seven million people on treatment by the end of the year. Specific targets have also been set for each of the nine provinces.

The initiative is aimed at meeting the UNAIDS 95–95–95 HIV testing, treatment and viral suppression targets that have been endorsed in South Africa’s National Strategic Plan for HIV, TB, and STIs 2023 – 2028. The targets are that by 2030, 95% of people living with HIV should know their HIV status, 95% of people who know their status should be on treatment, and 95% of people on treatment should be virally suppressed (meaning there is so little HIV in their bodily fluids that they are non-infectious).

Currently, South Africa stands at 96–79–94 against these targets, according to the South African National Aids Council (SANAC). This indicates that the biggest gap in the country’s HIV response lies with those who have tested positive but are not on treatment – the second 95 target.

But adding 1.1 million people to South Africa’s HIV treatment programme in just ten months would be unprecedented. The highest number of people who started antiretroviral treatment in a year was the roughly 730 000 in 2011. In each of the last five years, the number has been under 300 000, according to figures from Thembisa, the leading mathematical model of HIV in South Africa. According to our calculations, if South Africa successfully adds 1.1 million people to the HIV treatment programme by the end of 2025, the score on the second target would rise to just above 90%.

The record for the most people starting antiretroviral treatment in a single year was approximately 730 000 in 2011. (Graph by Spotlight, based on Tembisa data.)

The ambitious new campaign launches at a moment of crisis in South Africa’s HIV response. Abrupt funding cuts from the United States government – the PEPFAR funding – has meant that the work of several service-delivery NGOs have ground to a halt in recent weeks.

These NGOs played an important role in getting people tested and in helping find people and supporting them to start and restart treatment. The focus of many of these NGOs was on people in marginalised but high-risk groups, including sex workers, people who use drugs and those in the LGBTQI community. As yet, government has not presented a clear plan for how these specialised services might continue.

“We will need bridging finance for many of these NGOs to contain and preserve the essential work that they were doing till we can confer these roles and responsibilities to others,” says Professor Francois Venter, of the Ezintsha Research Centre at the University of the Witwatersrand.

He says good investment in targeted funding for NGOs is a necessary buffer to minimise “risks to the entire South African HIV programme” and the looming consequences of rising numbers of new HIV cases, more hospitalisations, and inevitably deaths.

Disengaging from care

South Africa’s underperformance on the second 95 target is partly due to people stopping their treatment. The reasons for such disengagement from HIV care can be complex. Research has shown it is linked to factors like frequent relocations, which means people have to restart treatment at different clinics over and over. They also have to navigate an inflexible healthcare system. A systematic review identified factors including mental health challenges, lack of family or social support, long waiting times at clinics, work commitments, and transportation costs.

Venter adds that while people are disengaged from care, they are likely transmitting the virus. The addition of new infections for an already pressured HIV response contributes to South Africa’s sluggish creep forward in meeting the UNAIDS targets.

The health department has not been strong on locating people who have been “lost” to care, says Venter. This role was largely carried out by PEPFAR-supported NGOs that are now unable to continue their work due to the withdrawal of crucial US foreign aid.

Inexpensive interventions

Other experts working in the HIV sector, say the success of the Close the Gap campaign will come down to scrapping programmes and approaches that have not yielded success, using resources more efficiently, strategic investment, and introducing creative interventions to meet the service delivery demands of HIV patients.

Key among these interventions, is to improve levels of professionalism in clinics so patients can trust the clinics enough to restart treatment.

Professor Graeme Meintjes of the Department of Medicine at the University of Cape Town says issues like improving staff attitudes and updating public messaging and communications are inexpensive interventions that can boost “welcome back” programmes.

“The Close the Gap campaign must utilise media platforms and social media platforms to send out a clear message, so people know the risks of disengagement and the importance of returning to care. The longer someone interrupts their treatment and the more times this happens, the more they are at risk of opportunistic infections, severe complications, getting very sick and needing costly hospitalisations,” he says.

Clinics need to provide friendly, professional services that encourage people to return to and stay on treatment, Meintjes says, and services need to be flexible. These could include more external medicine pick-up points, scripts filled for longer periods, later clinic operating hours, and mobile clinic services.

“We need to make services as flexible as possible. People can’t be scolded for missing an appointment – life happens. Putting these interventions in place are not particularly costly, in fact it is good clinical practice and make sense in terms of health economics by avoiding hospitalisations that result from prolonged treatment interruptions,” he says.

The Close the Gap campaign, Meintjes adds, should reassure people that HIV treatment has advanced substantially over the decades. The drugs work well and now have far fewer side effects, with less risk of developing resistance. More patients are stable on the treatment for longer and most adults manage their single tablet once-a-day regime easily.

Insights from our experiences

Professor Linda-Gail Bekker, Chief Executive Officer at the Desmond Tutu Health Foundation, says to get closer to the target of 1.1 million people on treatment by year-end will mean using resources better.

“Additional funding is always welcome, so are new campaigns that catalyse and energise. But we also need to stop doing the things we know don’t have good returns. For instance, testing populations of people who have been tested multiple times and aren’t showing evidence of new infections occurring in those populations,” she says.

There is also a need for better data collection and more strategic use of data, Bekker says. Additionally, she suggests a status-neutral approach, meaning that if someone tests positive, they are referred for treatment, while those who test negative are directed to effective prevention programmes, including access to pre-exposure prophylaxis (PrEP) for people at high risk of exposure through sex or injection drug use.

But Bekker adds: “We need to be absolutely clear; these people aren’t going to come to us in our health facilities, or we would have found them already. We have to do the work that many of the PEPFAR-funded NGOs were doing and that is going to the last mile to find the last patient and to bring them to care.”

She says the impact of the PEPFAR funding cuts can therefore not be downplayed. “The job is going to get harder with fewer resources that were specifically directed at solving this problem.”

Venter names another approach that has not worked. This, he says, is the persistence of treating HIV within an integrated health system. Overburdened clinics have simply not coped, he adds, with being able to fulfil the ideal of a “one-stop-shop” model of healthcare.

Citing an example, he says: “Someone might come into a clinic with a stomach ache and be vomiting, they might be treated for that but there’s no investigation or follow-up to find out if it might be HIV-related, for instance. And once that person is out of the door, they’re gone.”

Campaign specifics still lacking

The Department of Health did not answer Spotlight’s questions about funding for the Close the Gap campaign; what specific projects in the campaign will look like; or how clinics and clinic staff will be equipped or supported in order to find the 1.1 million people. There is also scant details of the specifics of the campaign online.

Speaking to the public broadcaster after the 25 February campaign launch, Health Minister Dr Aaron Motsoaledi said South Africa is still seeing 150 000 new infections every year. He said they will reach their 1.1 million target through a province-by-province approach. He used the Eastern Cape as an example.

“When you look at the 1.1 million, it can be scary – it’s quite big. But if you go to the provinces – the Eastern Cape needs to look for 140 000 people. Then you come to their seven districts, that number becomes much less. So, one clinic could be looking for just three people,” he said.

Nelson Dlamini, SANAC’s communications manager, says the focus will be to bring into care 650 000 men, as men are known to have poor health-seeking habits. Added to this will be a focus on adolescents and children who are living with HIV.

He says funding for the Close the Gap campaign will not be shouldered by the health department alone.

“This is a multisectoral campaign. Other departments have a role to play, these include social development, basic education, higher education and training, etc, and civil society themselves,” Dlamini says.

The province-by-province approach to reach the target of finding 1.1 million additional people is guided by new data sources.

“Last year, SANAC launched the SANAC Situation Room, a data hub which pulls data from multiple sources in order for us to have the most accurate picture on the status of the epidemic,” says Dlamini.

These include the Thembisa and Naomi model outputs and data from the District Health Information System and Human Sciences Research Council, he says adding that SANAC is working to secure data sharing agreements with other sectors too.

Dlamini however says the health department, rather than SANAC, will provide progress reports on the 10-month project.

Republished from Spotlight under a Creative Commons licence.

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