Antiretroviral therapy patients easily exceeding long-term targets

One-third of all HIV-positive South Africans are accessing antiretroviral therapy (ART) far exceeding the enrolment targets of the country's National Strategic Plan (NSP) for 2007 to 2011.

According to Dr Leigh Johnson, an actuarial scientist at the University of Cape Town, the number of patients receiving ART in SA by the middle of last year had increased to 1.79 million from less than 50 000 in 2004. This was well in excess of the 80 percent target of patients who were eligible for ART. The percentages were found to be much higher in women than in men and children.

Johnson wrote in last month's issue of The Southern African Journal of HIV Medicine that ART was a powerful tool for reducing AIDS mortality and HIV transmission. The monitoring of access to ART was therefore critical to the evaluation of the impact of HIV treatment and prevention programmes, Johnson's research revealed that between mid-2004 and mid-2011, the total number of patients receiving ART in SA increased from 47 500 to 1.79 million.

Of the latter, 85 percent were receiving ART via the public sector, 11 percent through disease-management programmes in the private sector and the remaining four percent via community treatment programmes run by NGOs. The majority (61 percent) of patients were women aged 15 or older; men accounted for 31 percent; and children below the age of 15 comprised eight percent. KwaZulu-Natal and Gauteng were the provinces with the largest number of patients, together accounting for 56 percent of all those receiving ART.

Johnson wrote that the low rate of ART initiation in men relative to women might be a reflection of gender differences in health-seeking behaviour, and perceptions that men who sought care were weak. Alternatively, the high rate of ART initiation in women might be due to higher rates of diagnosis through antenatal screening.

According to Johnson, the relatively low rates of ART initiation in children were probably attributable to the lower rates of HIV testing in children and the greater complexity of paediatric ART relative to adult ART.

The new NSP for 2012-2016 proposes targets that are far more ambitious than those in the previous NSP; the ART enrolment target in 2016 is 80 percent of the new ART need in that year plus 80 percent of the unmet need from previous years. High levels of HIV testing and counselling, as well as expansion of the capacity to deliver ART, will be required to meet these targets.

Anso Thom: Health-e News Service, 25 April 2012