BroadReach Healthcare Down Referral Model (Northwest Province, South Africa)

Category 3

BroadReach Healthcare's North West Province Down Referral Model in South Africa reduces overburdened public health resources by leveraging the private sector in treatment delivery for PLHA. Patients are initiated at a public healthcare facility, the Wellness Centre, where they are stabilized for six months, and then down referred to a private GP or clinic for continued government-funded treatment. Should a patient acquire an opportunistic infection or require treatment for another condition, they are referred back to the Wellness Centre, and down referred again to the private GP/clinic once stabilized. Funding for health services, training, doctors' fees, patient education and other health products comes from South Africa's MOH and PEPFAR, while the North West Provincial DOH funds the provision of medication and labs. Private clinicians provide care for these patients at a capitated rate and receive training, mentoring, and a monitoring system for patient outcomes, in addition to free ARVs. Quality of care is monitored by Aid for AIDS, the largest Disease Management Organization (DMO) in South Africa.

Goal of the Practice
  • To initiate and maintain eligible patients on ART, and ensure that patients adhere to their medication
  • To provide high standard of care
  • To ensure knowledgeable health professionals, patients and the community at large
  • To support public health facilities in order to expand capacity for HIV care and treatment
  • To use data to optimize program management
Core Components
  • GPs are provided with training, mentoring, monitoring system, free ARVs and payment for clinic visits
  • Program focus on family and buddies when conducting adherence support
  • Employing HIV positive peer educators and speakers: The trainer is positive, open about her status and taking ARVs, and patients start to show an interest in attending training
Noteworthy Results
  • This program has proven highly effective, with a patient retention rate of 97.3% and a viral load suppression rate of 96%. In a recent study of a subset of patients in the North West program (n=170), 73% reported perfect ART adherence over the last month, 98% reported not missing a pill in the last week, and 91% had a viral load of less than 400 at the time of the interview.
Lessons Learned
  • Having political support and leadership from the government are key to program success.
  • Aligned goals and clear agreements for roles and responsibilities among all partners contributed to the program's success.
  • The specialized computer-based monitoring program disseminated to participating private GPs allows for exceptional quality control, which contributes to program efficacy.
  • Treatment literacy is vital to treatment adherence success.
  • Credit sharing and trust among partners is central to success.
Focus Areas
Private Sector
Implemented By
BroadReach Healthcare, LLC
Participating Organization
  • North West Provincial Department of Health
  • Tshepong Hospital
  • Aid for AIDS
  • NHLS Laboratories
  • Dr. Steve Andrews and Associates
South Africa
Clinic/Health facility
Target Population
People Living with HIV (PLWH)
1000 - 5000
Implementation Years
01/2005 - ongoing