No abstract available.

The gap in HIV testing remains significant and new modalities such as HIV self-testing (HIVST) have been recommended to reach key and under-tested populations. In December 2016, the World Health Organization (WHO) released the Guidelines on HIV Self-Testing and Partner Notification: A Supplement to the Consolidated Guidelines on HIV Testing Services (HTS) and urged member countries to develop HIVST policy and regulatory frameworks. In South Africa, HIVST was included as a supplementary strategy in the National HIV Testing Services Policy in 2016, and recently, guidelines for HIVST were included in the South African National Strategic Plan for HIV, sexually transmitted infections and tuberculosis 2017–2022. This document serves as an additional guidance for the National HIV Testing Services Policy 2016, with specific focus on HIVST. It is intended for policy advocates, clinical and non-clinical HTS providers, health facility managers and healthcare providers in private and public health facilities, non-governmental, community-based and faith-based organisations involved in HTS and outreach, device manufacturers, workplace programmes and institutes of higher education.

BackgroundHIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.MethodsWe conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.ResultsNationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.InterpretationThere was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.

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Overview and summary Introduction: What is palliative care and what are its essential elements? Definition: Palliative care is:• Care that places the relief of suffering at its core, affirms life and does not hasten nor postpone death, but regards dying as a normal process, according to World Health Organization (WHO). • Care that is individualised: the person or patient is its core focus. The recipient is someone who has been diagnosed with a chronic, life-threatening illness that is no longer responsive to curative treatment, for example, cancer, irreversible end-stage end-organ failure, HIV infection and related disorders unresponsive to available treatment, et cetera. ß 'End-of-life' care is an aspect of palliative care that specifically refers to the care of persons estimated to have a life expectancy of ≤ 12 months, according to the National Council for Palliative Care, United Kingdom. • Care that is directed towards the control of distressing symptoms including the relief of pain: ß 'Total Pain' -this concept refers to pain that cannot be adequately controlled without addressing its contributory factors, namely, physical, emotional, social and spiritual factors. ß The opioid-use crisisinappropriate opioid use is a major contributor to the opioid addiction crisis currently reported from high-and middle-income countries. Under-use of and insufficient access to opioids however characterises opioid use in Africa and other low-income countries. Palliative care offers appropriate access to opioids without the risk of addiction and within the context of a professionally competent team. (Knaul et al.). 42 • Care that is provided by a team. The team is multidisciplinary and comprises nurses, doctors, paramedical persons, for example, physiotherapists, counsellors and accredited members of the religious community. The patient and their personal support network (e.g. family, partner and friends) are advisors to the team and receive support from the team. The team has a leader who takes responsibility for the totality of care, plans specific therapy, prescribes medication, completes medico-legal forms, et cetera. This is usually a medical doctor. ß Team care is intended to integrate the medical, practical, psychological and spiritual aspects of care in a system that promotes as active a lifestyle as possible until death. Team care provides support for the patient's family or partner, et cetera, during the illness and through the time of bereavement.

Background. Telephone helplines can facilitate referral, education and support for patients living with HIV or those concerned about the infection. The anonymity of helplines facilitates discussion of sensitive issues that are difficult to raise face to face. These services could support the expansion of HIV self-testing. However, maintaining quality and standardising messages in rapidly evolving fields such as HIV is challenging. Objectives. To evaluate the quality of the South African (SA) National AIDS Helpline. Methods. Mystery clients posing as members of the public made 200 calls to the service in 2014. They presented several scenarios, including having received HIV-positive results from a doctor's secretary or through self-testing. Following the call, 'clients' completed a semistructured questionnaire on the information received and the caller-counsellor interaction. Results. Calls were answered within a median of 5 seconds (interquartile range 2 -14). Conversations took place in 8 of the 11 SA official languages, though mainly in English. Overall, 75% of callers felt that with the information they received they could locate a nearby clinic for further services. Counsellors expressed appropriate levels of concern about inadequate counselling that callers had received and confidentiality breaches in some scenarios. Eight counsellors incorrectly mentioned the need for a waiting period to confirm a positive result. Consistent with policy, almost all said that being foreign would not affect HIV treatment access. About 90% explained the need for CD4+ testing and antiretroviral therapy, but only 78% discussed HIV prevention. Counsellors were mostly empathetic (83%), though some adopted a neutral tone (10%) or were brusque (6%) or unhelpful (2%). Conclusions. Overall, helpline counsellors were proficient at providing information about local clinics, HIV testing and steps needed for initiating ART. Dissatisfaction with the caller-counsellor interactions, instances of incorrect information and the relatively low attention accorded to HIV prevention are worrying, however. Training for both refreshing and updating knowledge, and supervision and monitoring of calls, could target these areas.

No abstract available.