Eshowe: MSF closes well-known HIV project but remains committed to HIV/TB and South Africa
On 01 December, Doctors Without Borders (MSF) officially closed its long-term HIV/TB project based in the KwaZulu-Natal town of Eshowe (2011-2023), ending 23 years of continual MSF HIV/TB operations in South Africa.
MSF’s Eshowe project and its principal partner, the KwaZulu-Natal Department of Health, attracted international attention in 2019 for achieving the UNAIDS 90-90-90 targets two years ahead of deadline, with results of 90-94-95 (90% of people living with HIV know their status, 94% of those were on antiretroviral treatment and 95% of those had a suppressed viral load).
“Our withdrawal does not mean that we think that HIV is over – it is not,” said Tom Ellman, the head of MSF’s Southern Africa Medical Unit.
“We know that 90-90-90 isn't enough – there is a growing realisation that even if you reach 90-90-90, you are going to stumble as people become fatigued and cycle in and out of care. Nevertheless, today South Africa has one of the world’s most impressive rollouts of HIV services, leaving less of a role for the large vertical projects that used to make up the bulk of MSF HIV activities,” said Ellman.
Earlier MSF HIV/TB projects in Khayelitsha (1999-2022) and Lusikisiki (2002-2006) were known for innovating new approaches to treating and caring for HIV and drug-resistant TB patients and mustering the right levels of defiance needed to ensure that those models of care became policy, not just in South Africa but regionally and elsewhere.
“The Eshowe project was a little different,” said Liesbet Ohler, MSF Eshowe’s medical coordinator.
“Its scope was massive - we implemented activities at all levels of HIV care in an area of more than 2000km². We took everything that we know you need to do to reduce HIV-related illness and death, adapted these models to a unique context and showed that if you do all of these things intuitively, shifting as much of the response to community health workers as possible, you can make a difference,” she said.
In a detailed analysis of the project’s HIV work, MSF’s Stockholm Evaluation Unit found that it “demonstrated the importance of investing in relationships, with community, traditional leaders, government structures, personnel from districts and clinics, TVET College management, farm owners, and Civil Society Organizations.”
Ntombi Gcwensa, MSF Eshowe’s Patient Support Manager, concurred: “This is a highly traditional area in which levels of HIV and TB stigma were off the charts, so we needed to consult deeply and repeatedly before we could launch activities, everyone from patients and their families to traditional leaders and health practitioners, to ensure that the community felt a sense of ownership.”
The Eshowe project handed its HIV activities over to the government and other partners in 2018 and shifted focus to TB, aiming to replicate its successful, patient-centred approach to combatting HIV.
“There have been several TB milestones, including a study aimed at enhancing TB diagnosis in hospitalised adults that almost doubled TB diagnosis, and a similar study for children that demonstrated how TB detection can be significantly improved. However, successive COVID-19 lockdowns hampered the work,” said Ohler, who added that MSF remains concerned about the slow pace at which services for DR-TB patients have been decentralised in King Cetshwayo District.
“Progress has been made but children with DR-TB and patients with extensively drug-resistant TB still have to travel several hours to King Dinizulu Hospital in Durban for treatment and care,” Ohler said.
MSF continues to make major investments in HIV/AIDS in places that have been most neglected in the roll-out of HIV services, including the Central African Republic, Mozambique, Guinea and the Democratic Republic of Congo, with a focus on the populations that are known to be most neglected.
MSF’s regional operations director, Philip Aruna, said that MSF remains committed to South Africa and the southern Africa region.
“In October 2023 we launched a new non-communicable diseases (NCD) project in the Eastern Cape, where NCDs account for half of all deaths. We believe that much of what MSF in South Africa has learned over the last two decades in working with HIV and tuberculosis (TB), including in the recently concluded Eshowe project, is relevant to the management and care of type-2 diabetes and hypertension, and that these lessons can be easily adapted to transform the ways in which NCDs are identified and managed,” he said.
Eshowe_PR_WAD 2023.doc
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About Doctors Without Borders (MSF)
Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.
In South Africa, the organisation is recognised as one of the pioneers of providing Antiretroviral Treatment (ART) in the public sector and started the first HIV programmes in South Africa in 1999. Until today, the focus of MSF’s interventions in the country has primarily been on developing new testing and treatment strategies for HIV/AIDS and TB in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape).
In Tshwane, we run a migration project, and we offer medical and psychosocial care to migrants, refugees, and asylum seekers, who struggle to access public health services under South Africa’s increasingly restrictive.
Previously, we offered free, high-quality, confidential medical care to survivors of SGBV in Rustenburg.
To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work:
- SMS “JOIN” to 42110 to donate R30 Once-off
- Visit https://www.msf.org.za/donate
