these valuable diagnostic analyses and to encourage discussion among healthcare pro- viders about the introduction thereof in routine work-up of patients with these ocular conditions in rural South Africa.
Apart from infectious keratitis and uveitis, non-infectious ocular conditions remain common among HIV-infected individuals after ART initiation which warrants the need for regular routine ophthalmological screening for ocular disease among HIV-infected individuals. However, currently eye care is not incorporated in existing clinical guidelines for HIV-infected individuals in the (pre)ART program of South Africa. As such, eye care should become part of standard clinical care for HIV-infected individuals in the (pre)ART program and development of regular routine ophthalmological screening guidelines is highly needed. Also, increased awareness among healthcare providers in the field of HIV in rural South Africa is highly warranted for early recognition, diagnosis and initiation of treatment or prompt referral to the adequate level of care.
Theoretically, today’s eye care in South Africa should be provided at all healthcare levels with primary eye care, rendered by professional, non-ophthalmic or ophthalmic and rural healthcare providers, as its cornerstone [119]. However, during the course of our studies we observed a significant delay in presentation to hospitals suggesting that eye care receives limited attention in PHC facilities in rural settings. Although oph- thalmic nurses are trained in these settings, their deployment to provide eye care and ophthalmological screening after completion of their training is limited and in practice they predominantly work as general nurses covering all clinical fields. Moreover, oph- thalmologists are unavailable since they are concentrated in urban areas only, leaving rural communities devoid of the highest quality of eye care professionals [120]. As a result, individuals in rural settings are at increased risk of suffering from ocular morbid- ity. Eye care therefore needs to be prioritized at local and national health level in South Africa. Effective eye care depends on many factors including the availability of budget, essential resources and drugs, human resources and referral and mobility options as most important. Lack of ophthalmological expertise and skills, essential resources, oph- thalmic drugs and referral systems are major challenges in rural settings. This stresses the need for further studies to obtain insight in determinants, barriers and challenges of ophthalmology services in South Africa in order to provide urgent in-depth health system strengthening that will improve eye care and reduce preventable visual impair- ment.
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