How dedicated case managers help Discovery Health Medical Scheme members live well with HIV

The dedicated nurses who serve as case managers for Discovery Health Medical Scheme's HIV Care Programme provide truly holistic support - caring for members' physical, mental and emotional wellbeing every step of the way. Every call, every check-in, and every question answered represents a moment of compassion - and sometimes, a life-changing difference.

A comprehensive programme of care

"Discovery Health Medical Scheme's HIV Care Programme is designed to provide holistic support to members living with HIV," says case manager Vashnee Govender. "The programme covers everything from blood tests and doctors' consultations to antiretroviral and supportive medicines. But it's so much more that. We look at each member holistically - not just at their lab results. We work to build trust, reduce stigma and empower members to live full, healthy lives.

• Discovery Health Medical Scheme offers voluntary access for its members to the HIV Care Programme if they are registered for HIV on the Scheme's Chronic Illness Benefit. This programme combines advanced data science, technology, and clinical expertise to deliver world-class support for HIV-positive members. Members experience a coordinated, clinically guided experience that adapts to each member's needs - from diagnosis through long-term management

"When we take care of our patients, it's not just about ARV treatment," says Vashnee. "We consider their mental health, their lifestyle, and their environment. Education and empathy make all the difference."

Case manager Rose Harry adds, "We help reduce the fear and stigma that members might feel after an HIV diagnosis, empowering them with knowledge and support. We make sure members know that it's how you manage the condition that determines your outcome - and we're here to make sure you never have to do it alone."

The HIV Care Programme includes specialised sub-programmes for paediatric HIV care and the prevention of mother-to-child transmission, ensuring that vulnerable groups receive focused, expert support. "We also have a panel of specialist HIV clinicians and paediatric HIV experts," Vashnee adds. "When something unusual arises, these experts review the case and advise on the best way forward."

Members registered on the HIV Care Programme have access to a multidisciplinary team:

• Case managers - trained nurses who review clinical care and treatment, monitor results, and proactively support members.
• Treatment counsellors - who assist with adherence to medicine.
• Client relationship managers - who handle claims or benefit queries.
• Medical advisers - doctors who review complex or high-risk cases.

"It's a seamless, collaborative model designed to ensure that each member gets the right care, at the right time, with the right support," explains case manager Sasha Karaputhu.

• Find out more about the HIV Care programme.

One-on-one support that changes lives

Case managers like Vashnee, Sasha and Rose are nurses who combine their clinical expertise with empathy, offering support and helping to coordinate the relationship between treating doctors, pharmacists and members.

"The HIV Care Programme itself is excellent, but the case managers take it a step further," says Vashnee. "Our role is to help members understand their treatment regimes, the importance of adherence, and how their lifestyle and emotional wellbeing affect their overall health. When we phone members, it's not just to check in on whether they've taken their medicine. We listen and we find out how they're coping - physically, mentally, and emotionally."

Rose adds: "We track everything - blood results, prescriptions, consultations. If we notice that something isn't right - maybe a member hasn't been going for blood tests, or their viral load is rising - we step in immediately. We follow up with the member and their doctor to get things back on track."

That proactive approach often makes the difference between a setback and stability. "We don't wait for something to go wrong," says Rose. "We act early - whether that means adjusting medicine through the treating doctor, checking for side effects, or referring a member for mental health support. It's about protecting the member's health in every way possible."

Sasha agrees. "We use our clinical experience to review blood results and medicine for any potential issues, including interactions with other chronic conditions like diabetes or hypertension. We often pick up things early - a missed prescription, an unusual test result, or a side effect the member didn't mention to their doctor. Our job isn't just to manage the condition - it's to care for the whole person."

Case managers also spend time educating and empowering members. "Doctors and pharmacists might not always have the time to explain everything," says Rose. "We walk members through what their test results mean, why adherence matters, and how to manage side effects, or answer any other questions they may have. Sometimes, it's as simple as helping someone plan their medicine around their daily routine or offering reassurance when they feel overwhelmed."

Vashnee adds, "We look at the whole person - their physical health, mental wellbeing, and even social or financial stressors. Sometimes a member just needs encouragement - to hear that they're doing well, that they're not alone, and to remind them that people who live with HIV can live long, healthy lives. Those small moments build confidence and hope."

This holistic, proactive model of care is what sets the DHMS HIV Care Programme apart - transforming what could be a daunting experience into one of empowerment, education and ongoing support.

Walking the journey together

Vashnee, Rose and Sasha recall cases that show the profound human impact of their support.

Vashnee shares a story that has stayed with her for years. "I was helping a pregnant member living with HIV. She was incredibly compliant - took her treatment diligently and attended every doctor's appointment. When her baby tested positive for HIV a few weeks after birth, she was devastated. Something didn't feel right to me, so I reviewed the results and realised that the wrong test had been done on the baby - a viral load instead of a PCR test. I immediately arranged for the baby to have the correct test done by a paediatrician, and when it came back negative, I phoned the mom. She broke down in tears. She told me she'd been standing outside a hospital, ready to give up her baby, because she couldn't face the guilt of passing on the disease. That call reminded me why we do this work."

Rose remembers supporting a grandmother caring for her young granddaughter who was extremely ill. "The child's viral load was in the millions, and the grandmother was terrified of losing her - she'd already lost her daughter to HIV. I found out that the little girl couldn't swallow her medicine, because it tasted terrible. I found a doctor in their rural area, coordinated blood tests, and worked with our panel of medical advisers to review the child's treatment regime. I also arranged for a pharmacy courier to deliver the new medicine to them - even calling the driver personally to confirm delivery. Within three months, the little girl's viral load was suppressed. The grandmother phoned to tell me, 'I love you for what you've done. You saved my granddaughter.' That's what keeps me going."

For Sasha, seeing the progress of one young boy she supported still brings joy. "He was two years old when his doctors called us - his treatment wasn't working, and he was very ill. Our medical advisers approved a drug-resistance test and changed his treatment plan. I worked closely with his mom, helping her stick to the new treatment regime, follow up on appointments, and understand his condition. Today, he's thriving. Watching his progress over the years reminds me how powerful this programme is."

Sasha sums it up simply: "We all have a passion for what we do. Every member deserves to know there's hope - and we're here to walk that journey with them."

Find out more: An HIV success story for our members, and a Global Insurance Innovation Award!

Discovery Health Medical Scheme has just been recognised on the global stage - winning Best Health & Wellness Offering at the 2025 Global Insurance Innovation Awards for its pioneering HIV Care Programme. New data shows that what was once unimaginable is now a reality: Members with undetectable viral loads are now thriving just as well as those without HIV. This is a story of science, compassion, and transformation, with lives changed. Read it now.