title: The evolving impact of HIV/AIDS on outpatient health services in Kwazulu-Natal, South Africa.
abstract: BACKGROUND AND OBJECTIVE; The high HIV prevalence in KwaZulu-Natal (KZN) places immense pressure on the health system. The burden of HIV/AIDS on health services is evolving as the epidemic progresses and as antiretroviral treatment becomes more widely available. For health policy makers and managers, timely and appropriate information is needed to facilitate adaptive management of health services. Through longitudinal research covering outpatient health services in KZN we examined the dynamics of the evolving HIV/AIDS burden and the resource implications of this burden, necessary for resource allocation decisions.
  
  
  METHODS
  Data were collected between 2004 and 2005 in outpatient services across six health facilities in the province. The burden of HIV/AIDS was measured by assessing the proportion of outpatients presenting as HIV positive, determined by a clinical diagnosis (and test result where available). The burden was also measured by looking at the types of diseases presenting at outpatient facilities. Moreover, the study assessed the burden experienced by health care workers and financial implications for health facilities.
  
  
  CONCLUSIONS
  The study demonstrates that the burden on outpatient services is significant but has not been increasing over time, suggesting that people are not accessing care if and when they need it. However, in terms of resources, this burden has been increasing and shifting from tertiary services to more primary services. In order to accommodate the demands of HIV/AIDS, our focus therefore needs to turn towards outpatient services, in particular at the primary care level.
authors.affiliation: Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban. anokhip@gmail.com
authors.forename: Anokhi
authors.initials: A
authors.lastname: Parikh
authors.forename: Nina
authors.initials: N
authors.lastname: Veenstra
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006291:Health Policy; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D010865:Pilot Projects; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology