Provision of Antiretroviral Therapy in South Africa: The Nuts and Bolts

Abstract

Public sector antiretroviral provision had a slow start in South Africa despite a raging epidemic and a World AIDS conference that shed significant public light on the disparities of therapy access globally. This was largely due to political prevarication in the midst of AIDS denialism. There has been an unprecedented expansion in the HIV treatment programme since 2008. As a result, South Africa now has the largest number of patients on antiretroviral drugs in the world, and South African life expectancy has increased by more than a decade. However, this has led to a number of fiscal, logistic and operational challenges that the country must face as the treatment programme continues to expand. Challenges include increasing detection within communities, linkage and retention in care, while strengthening operational support functions such as consistent drug supply, health staffing and infrastructure, diagnostic services, programme monitoring and sustainable financing. As a middle-income country, albeit with marked income inequality, and the heaviest HIV burden in the world, South Africa is a test case of whether a large-scale public health programme can boast of success in the face of numerous other health-system challenges.

How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa

“…[1,9,10] It focuses on the functioning of health systems [ 3,[11][12][13] and on the operational aspects of clinical care. [14][15][16][17][18][19] While the National Department of Health is committed to improving access to medicine, the procurement and distribution of medical supplies remains inadequate in many health districts. [20] Research on stock-outs has strived to quantify the extent and severity of shortages of medical supplies.…”

Changes in mortality of people living with HIV in South Africa and their potential implications for life assurers

“…2.2.3 Figure 3 shows the substantial increase in the number of patients receiving ART in South Africa from less than 50 000 in 2004 to almost 1.8 million in 2011, almost 2.5 million in 2013 (Bekker et al, 2014) and 3.1 million in 2014. 11 "A decision was made to increase the initiation threshold to 350 cells/μl for all adults, as well as to expand access thresholds for children" (Similela & Venter, 2014: 251 Bekker et al (2014);Mail and Guardian (2015) 12 were estimated to be living with HIV in South Africa, with an estimated 2.3 million on ART, and expanded access to 'third-line' drugs for patients experiencing resistance" (Similela & Venter, 2014: 261).…”

“…11 "A decision was made to increase the initiation threshold to 350 cells/μl for all adults, as well as to expand access thresholds for children" (Similela & Venter, 2014: 251 Bekker et al (2014);Mail and Guardian (2015) 12 were estimated to be living with HIV in South Africa, with an estimated 2.3 million on ART, and expanded access to 'third-line' drugs for patients experiencing resistance" (Similela & Venter, 2014: 261). During his 2014/2015 health budget vote speech, the Minister of Health announced that from January 2015, HIV-positive patients would be eligible for ART once their CD4 count fell below 500 cells/μl compared with the previous level of 350 cells/μl (Motsoaledi, 2014 13 Since then, life expectancy at birth has improved meaningfully with the help of the aggressive roll-out of ART.…”

The influence of HIV infection on the age dependence of squamous cell carcinoma of the skin in South Africa

“…Of those infected with HIV in SA, more than 50% are currently treated with antiretroviral therapy (ART), from a base of 7% in 2007. [8] A recent review of observational studies monitoring the risk of cancer concluded that the incidence of non-AIDS-defining cancers rose after starting ART, possibly owing to increased life expectancy or to the genomic instability caused by the drugs. [9] Two studies indicate that HIV-positive white individuals have a higher incidence of SCC than HIV-negative individuals.…”