Piloting ART in South Africa: the role of partnerships in the Western Cape's provincial roll-out

In 1999, the provincial government of the Western Cape entered into a partnership with Médecins Sans Frontières (MSF) to provide HIV treatment through public health clinics in the peri-urban settlement of Khayelitsha. From 2000 onwards, this partnership ran South Africa’s first antiretroviral treatment (ART) programme. Due to the province’s limited experience in 1999 in implementing and monitoring an ART programme, and the National Health Department’s opposition to the public provision of ART, this partnership was instrumental in piloting and later scaling-up the Western Cape’s ART programme. The partnership demonstrated that ART programmes could be implemented successfully within resource-constrained settings, with high levels of adherence, low rates of loss to follow up, and excellent health outcomes. Its components and strategies are therefore of vital significance to the roll-out and maintenance of ART programmes in various contexts across the developing world. Based on information gathered through interviews with key players, this article examines the factors that facilitated the public provision of ART in the Western Cape. With a focus on Khayelitsha, it explores the partnerships that were established between the provincial government, civil society organisations, research institutes and service providers to support and expedite the public provision of ART.