CORRESPONDENCE

The impact of the national HIV health care worker hotline

To the Editor: The National HIV Health Care Worker (HCW) Hotline was established in 2008, in collaboration with the Foundation for Professional Development (FPD) and PEPFAR/USAID, to support the safe and effective roll-out of antiretroviral treatment in South Africa. It is based in the Medicines Information Centre, Division of Clinical Pharmacology, UCT, and has access to the latest information and numerous clinical experts.

The toll-free hotline operates weekdays, 8h30 -16h30, providing up-to-date information to all health care workers on aspects concerning the treatment of HIV infection and related diseases. Use of the service has consistently increased to over 300 calls a month.

HCWs who called the hotline in August and September 2009 with patient-specific queries were asked to complete a standardised questionnaire which evaluated whether the information provided was used and how this affected patient care. The most frequent users of the hotline were doctors (69%), pharmacists (14%) and nurses (11%), which may reflect the fact that doctors remain predominant in decisions around HIV care.

Of those who called the hotline with a clinical query, 96% reported that they changed their patient management as a result of the information provided. Most actions that were a consequence of the advice given concerned direct treatment-related decisions; these included treatment initiation (34%), dose adjustment (19%), discontinuation (44%) and change of ART. A substantial proportion of actions concerned the overall management of patients, such as the initiation of further diagnostic procedures, referrals to specialist services and hospital admissions. These figures demonstrate that the hotline is used for medicine-specific questions and the overall management of patients. Almost all callers interviewed confirmed that the information provided was useful, timely and of benefit to the patient.

The public health sector aims to substantially increase the number of HIV-infected individuals receiving ART. Nurse-initiated management of ART (NIMART) is a goal of the Department of Health,¹ and nurses will increasingly initiate and manage patients.

We conclude that a telephonic helpline, such as the HIV HCW Hotline, providing clinical advice and support, is a valuable resource for supporting all health care workers in South Africa.

Annoesjka Swart
Briony Chisholm

Medicines Information Centre
University of Cape Town
briony.chisholm@uct.ac.za

Karen Cohen
Marc Blockman

Division of Clinical Pharmacology
University of Cape Town

Hans-Friedemann Kinkel

HIV & TB Medicine Unit
Foundation for Professional Development
Pretoria

Tamara Kredo

South African Cochrane Centre
MRC
Cape Town

1. South African National Department of Health. Clinical Guidelines for the Management of HIV and AIDS in Adults and Adolescents, 2010. http://www.doh.gov.za/docs/facts-f.html (accessed 1 November 2010).         [ Links ]