The evolving impact of HIV/AIDS on outpatient health services in KwaZulu-Natal, South Africa

Abstract

Background and Objective
The high HIV prevalence in KwaZulu Natal (KZN) places immense pressure on the health system. The burden of HIV/AIDS on health services is evolving as the epidemic progresses and as Antiretroviral Treatment becomes more widely available. For health policy makers and managers, timely and appropriate information is needed to facilitate adaptive management of health services. Through longitudinal research covering outpatient health services in KZN we examined the dynamics of the evolving HIV/AIDS burden and the resource implications of this burden, necessary for resource allocation decisions.

Methods
Data was collected between 2004 and 2005 in outpatient services across six health facilities in the province. The burden of HIV/AIDS was measured by assessing the proportion of outpatients presenting as HIV positive, determined by a clinical diagnosis (and test result where available). The burden was also measured by looking at the type of diseases presenting at outpatient facilities. Moreover, the paper assessed the burden experienced by health care workers and financial implications for health facilities.

Results and Conclusions
The study demonstrates that the burden on outpatient services is significant but has not been increasing over time, suggesting that people aren’t accessing care if and when they need it. However, in terms of resources, this burden has been increasing and shifting from tertiary services to more primary services. Thus, in order to accommodate the demands of HIV/AIDS, our focus needs to turn towards outpatient services and in particular at the primary care level.