Bristol-Myers Squibb Foundation Secure
The Future
Technical Assistance Programme
(BMSF STF TAP)
&
Luthando Neuropsychiatric HIV Clinic
REGIONAL FOCUS
SCOPE OF
PARTNERSHIP:
Soweto, Orange Farm, in Johannesburg, South Africa
To improve the rate of uptake of HIV testing and TB
identification among mentally ill patients
OBJECTIVES:
VALUE OF
US$ 70,883,86
ASSISTANCE:
PERIOD OF
ASSISTANCE:
BACKGROUND
Luthando Neuropsychiatric HIV Clinic at Chris Hani-Baragwanath Hospital in Soweto,
Johannesburg, is conducting a programme to care and treat mentally ill patients living
with HIV/AIDS.
South Africa’s under-resourced and fragmented public mental health system has
marginalised this sector of society and provided no model for care and treatment for
patients with HIV, Mental Illness and Tuberculosis (TB) until Luthando’s bold move to
incorporate this cohort.
INITIAL PARTNERSHIP
In a pioneering project in 2008, the clinic partnered with BMS STF TAP to launch an
unprecedented approach to servicing this particular demographic group: integrating the
treatment of neuropsychiatric illness, HIV/AIDS care and TB identification.
Luthando provided outpatient treatment and care to patients from the greater Soweto
catchment area. In addition to medical care, the clinic offered support groups, writing
workshops and income-generation activities (IGAs) in crafts and gardening.
The IGAs were established to encourage adherence, generate an income and form
support groups for patients in order to cover costs for public transport to hospital for
treatment and therapy sessions.
By July 2009 the clinical part of the project, which is the initiation of antiretroviral
medication to HIV positive mentally ill patients, was growing at a tremendous rate. In the
first six months Luthando clinic staff pre-tested and counselled 511 patients of which 208
were commenced on antiretrovirals. The clinic had a total of 232 patients on antiretroviral
treatment.
Through this innovative approach, the clinic plays a leading role in policy formation and
development. The dire need for the service countrywide and growing recognition for the
project’s success by peer organisations has opened doors for growth and expansion
beyond Soweto.
EXTENDED PARTNERSHIP
BMSF STF and Luthando are now looking to replicate the model in various areas in
South Africa. The vision is to expand the service locally, regionally and internationally
through a centre of excellence for the care of patients with triple diagnoses. The centre of
excellence will serve as a centre of excellence with activities that incorporate policy
formation and care through research, teaching locally and internationally, advocacy,
consultancy and collaboration.
The centre of excellence, to operate from the current Luthando premises at Chris HaniBaragwanath Hospital, will serve mentally ill patients with HIV and their families: offering
integrated HIV education and testing, and neuropsychiatric and TB screening.
It is run by primary health care practitioners and peer educators, some of whom have HIV
and a mental illness and have been long standing patients of Luthando Clinic.
The objective of the centre is to educate mentally ill patients in the community by way of
peer educators and other primary health care staff. The service will encourage patients
with mental illness to know their status by testing for HIV.
Studies show that the co-morbidity of TB among mentally ill patients is high. Luthando
peer educators educate clients and use questionnaires to determine the infection.
Sputum will be obtained from patients suspected of having TB, a register is kept and
results obtained, where-after sputum positive patients are contacted and encouraged to
attend their clinic for treatment. Adherence to treatment is encouraged through a homebased care model.
Luthando believes the centre will help to improve the rate of uptake of HIV testing and TB
identification among mentally ill patients. Furthermore, the service will provide a patient
and community driven process to increase access to care for the patients. The clinic sees
improved contact between its service and the community playing a role in alleviating the
huge burden faced by peer community psychiatric services.
The introduction of the HCT and mental illness education coincides with the psychiatric
clinic days. Patients identified as “complicated patients” receive a home-visit by one of
the counsellors / home-based care practitioners. The 12 peer educators involved in
Luthando’s current project will be incorporated onto the centre with additional patients still
to be trained. Counsellors will be available to work on a rotational basis to ensure a
continuous and sustainable service that extends to the community. Senior psychiatric
staff will train health care personnel.
THE RESULTS
By May 2012:

Luthando clinic is now serving Orange Farm, a peri-urban area outside of
Johannesburg.

The clinic was been invited to share its experiences using the unique model of
care both locally and internationally.

The project had held a three-day training workshop for 119 participants at a
mental health unit in Mthatha, Eastern Cape. The workshop was attended by
doctors, nurses, nursing students, administration staff and community works.

As a result of the afore-mentioned workshop, plans were underway for Luthando
to replicate the project in the province. Luthando’s inroads into the Eastern Cape
would see the project collaborating with Walter Sisulu University and the Mthatha
Mental Health Unit. BMS STF TAP, Bambisanani and Luthando will strengthen
capacity for the project by, among others, provide training for both professional
and non-professional staff

Internationally, Luthando had formed partnerships with the Cleveland Clinic,
Case Western University and University Hospital in Cleveland, Ohio. The
collaboration would use telemedicine as a platform, with the partners providing
supervision and consultation on difficult cases. Faculty exchange and skills
transfer was also on the cards to strengthen capacity and maximize the skills of
the South African partner.
LESSONS LEARNED

Buy-in from community authorities and government departments like agriculture,
arts and culture and education, is key to sustaining IGA programs

There is a need to involve the patients’ family members and other key community
members (buddies) in the programme, as support people to be trained in
treatment literacy and gardening.