Healthcare workers not providing explanations of people’s test results is one among a number of challenges outlined in a new Ritshidze State of Health data set for Ehlanzeni (Mpumalanga). The report looks at the impact of the PEPFAR disruptions in our clinics, following the U.S funding cuts and slow response of the government earlier this year.
Treatment literacy educates and empowers ordinary people in South Africa to understand how HIV and TB work in the body, how they can be treated, and how transmission can be prevented. It helps people understand the importance of taking treatment as prescribed.
However, after the PEPFAR withdrawal just 76% of people surveyed in Ehlanzeni reported that healthcare workers explained the results of their viral load tests to them. This is a worrying decline from 82% in January 2025 before the withdrawal of PEPFAR support from the district. Ehlanzeni actually performed worst out of all 16 districts monitored by Ritshidze.
“ARVs work by reducing the amount of HIV to very low levels in the blood (less than 50 copies). This is called having an undetectable viral load or being undetectable. It is what is measured when you have a viral load test,” explains Phumzile Thabethe, who has been teaching the science and treatment of HIV through the Treatment Action Campaign’s (TAC) flagship treatment literacy programme for many years.
“An undetectable viral load will keep you healthy. Your life expectancy will be similar to before you were living with HIV. An undetectable viral load also means HIV cannot be passed on. Understanding all this empowers people living with HIV to start, and stay on treatment.”
The consequence of healthcare workers not taking the time to talk to people about their results, is that people end up not understanding the importance of taking treatment effectively.
Only 69% of people surveyed agreed that having an undetectable viral load means treatment is working well – down from 79% in January 2025. Further only 66% agreed that having an undetectable viral load means a person cannot transmit HIV – down from 72% in January 2025. Ehlanzeni was the worst performing district on both indicators.
“If no-one has explained the importance of staying on HIV treatment to you, then why would you keep going to the clinic to wait for hours on end, or get shouted out and disrespected if you are late, just to pick up your pills?” asks Daniel Mathebula, from TAC. “Failing to give people the information and support they need directly undermines the National Department of Health goal to get 1.1 million more people on, or back on, treatment.”
The Department of Health must urgently investigate and address the decrease in healthcare workers explaining test results, which has led to a major reduction in treatment literacy levels in Ehlanzeni since January 2025. All facilities must explain the results of people’s viral load tests and help them understand the importance of taking treatment effectively.
For more information or to arrange interviews contact:
Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za
Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org
Notes:
The Ehlanzeni State of Health presentation is available here: https://ritshidze.org.za/wp-content/uploads/2025/10/Ritshidze-Ehlanzeni-State-of-Health-October-2025.pdf
More can be learnt about treatment literacy through TAC, Ezintsha, and HIV i-base’s campaign – Modern ART: https://modernartforsouthafrica.co.za/resources/
What is Ritshidze?
Ritshidze is a community-led monitoring (CLM) system implemented by the Treatment Action Campaign (TAC). Through Ritshidze, community members systematically collect data at clinics and in the community that are analysed, and then used to generate solutions to problems that are put to duty bearers for action. Community-led monitoring is an indispensable strategy for improving the state of our public healthcare system, and getting more people on ARVs.
How does Ritshidze collect data?
Ritshidze collects both quantitative and qualitative data through observations, as well as through the implementation of standardised surveys and in depth interviews with healthcare users (public healthcare users, people living with HIV, members of key populations) and healthcare providers (Facility Managers, pharmacists/pharmacist assistants). All Ritshidze’s data collection tools, our data dashboard, and all raw data are available through our website.
What changes have been made in where Ritshidze collects data following the PEPFAR disruptions?
Since inception, Ritshidze data has been consistently collected across sites in the two PEPFAR priority districts in Mpumalanga: Ehlanzeni and Gert Sibande. Following cuts in funding, Ritshidze monitoring has continued in Ehlanzeni only, with aims to expand back into Gert Sibande. PEPFAR implementing partners have now had their contracts terminated in all districts in the province – Ehlanzeni, Gert Sibande, and Nkangala – the province is no longer receiving PEPFAR support. Ritshidze data will be able to document any changes in the quality of service provision following the PEPFAR withdrawal.
What changes were made to data collection to determine the impact of PEPFAR funding cuts on HIV services?
A new tool was developed in this reporting period to survey patients as they exit the clinic. This was to gather evidence to the state of service provision that day – to better understand the impact of the PEPFAR disruptions on clinics. All monitoring tools are available here: https://ritshidze.org.za/category/tools/
Data collection periods and locations
Facility level data was collected between April 2025 and June 2025 at 20 public health facilities in Ehlanzeni. Surveys were carried out with 20 Facility Managers, 1,023 public healthcare users and 518 people living with HIV.