SA’s crucial HIV and TB Healthcare Worker Hotline goes offline

Around two decades ago when Dr Laurel Giddy first started working with people living with HIV, they were already very ill. She remembers five of her patients that she put on antiretroviral treatment dying. She says it was heartbreaking.

“I was just at sea. I felt like I was in the deep ocean, and it was very difficult to get help. There just wasn’t a lot of knowledge going around at the time,” she tells Spotlight. “Getting trapped in an environment where you’re not sure what you’re doing and where people die and you feel unsupported is just demoralising.”

This is the kind of high-stakes situation that the team at the South African National HIV & TB Healthcare Worker Hotline responded to when South Africa’s antiretroviral rollout started gathering steam after the end of state-sponsored AIDS denialism.

And with their help, the milestones at Giddy’s HIV treatment clinic that she help set up at the Knysna Provincial Hospital followed: first 100 people on HIV medicine and a couple of years later, 5 000.

“I’m getting quite emotional, but they helped our programme just fly,” says Giddy.

The free hotline has to date answered more than 86 000 queries from doctors, nurses and pharmacists in public and private healthcare facilities in all corners of the country. The service is run by the University of Cape Town’s Medicines Information Centre.

“Over 18 years, the hotline has provided trusted, evidence-based clinical support to healthcare workers across South Africa, contributing significantly to patient care and strengthening health system capacity,” Annoesjka Swart, manager of the Medicines Information Centre, tells Spotlight.

“Regrettably, we no longer have the financial resources required to sustain the service, having received no funding support for the hotline since April 2025,” she says. “Although we submitted a bid for a tender that was released on 1 April 2026, to our knowledge the bid has not yet been awarded.”

The suspension of a free hotline service dedicated to providing clinical advice for the management of HIV and TB is particularly worrying in South Africa where the two diseases remain deeply intertwined public health crises.

South Africa has one of the highest TB incidence rates in the world and the largest HIV epidemic in any single country. TB and HIV is among South Africa’s leading causes of death. Each is estimated to claim over 50 000 lives per year, although there is substantial overlap between the two since TB is the top killer of people with HIV.

The connection between HIV and TB is relatively straightforward. People with untreated HIV infection typically suffer severe damage to their immune systems, which dramatically increases the risk of falling ill with TB and dying of it.

One study showed how usage of the hotline by nurses increased dramatically in its first few years. Such support for nurses is particularly important in the context of the health department’s decision to authorise specially trained nurses to diagnose HIV and prescribe antiretroviral medicines in terms of its NIMART (nurse-initiated Management of Antiretroviral Therapy) programme.