The South African Government has taken a major step towards improving HIV treatment compliance and cost with the announcement that the new antiretroviral (ARV) tender will include a triple fixed dose combination (FDC) tablet, which combines three pills into one. FDCs have shown to have major benefits for ART patients in terms of easier compliance and fewer side effects, with the added benefit for hospitals of reduced logistics and less storage space needed. The cost of the FDC is only R89.37, making it arguably the world’s lowest priced FDC. From April 2013 all pregnant women will be given the fixed dose combination during pregnancy and breast feeding and thereafter if their CD4 count is less than 350. According to Health Minister Aaron Motsoaledi, the fixed dose combination is more effective than dual therapy and has fewer side effects for the pregnant mother, in addition to its convenient dosage regimen. He confirmed that the most of the patients currently on the three ARV drugs would switch to the FDC from April 2013. Government will continue to stock the current ARVs for those unable to switch. Activists, who have been campaigning for FDCs for a number of years, welcomed the decision.
Equity and HIV/AIDS
South Africa has flunked with an E-symbol (0-20%) when it come to the amount of money spent on HIV/AIDS, but attained an overall B-symbol for its response to the epidemic on the AIDS Reporting Index, an AIDS Accountability International (AAI) scorecard. South Africa scored a D for data collection, which the AAI said was largely due to poor reporting, with no improvement since the last time the country was assessed. The country showed an improvement in antiretroviral coverage (2% in 2004 to 28% in 2008), but the AAI noted overall performance remained poor (D-symbol) with only just over a quarter of those needing treatment getting it. The overall low score is due to poor performance rather than poor reporting, it added.
South Africa has launched an extensive programme of HIV testing, treatment and prevention that United Nations officials say is the largest and fastest expansion of AIDS services ever attempted by any nation. In the past month alone the government has enabled 519 hospitals and clinics to dispense AIDS medicines, more than it had in all the years combined since South Africa began providing antiretroviral drugs to its people in 2004, according to this article. The government has trained the hundreds of nurses now prescribing the drugs — formerly the province of doctors — and will train thousands more so that each of the country’s 4,333 public clinics can dispense AIDS medicines. President Jacob Zuma has inaugurated a campaign to test 15 million of the country’s 49 million people for HIV by June 2011.
South Africa's new five-year AIDS battle plan entered the final stage of a lengthy drafting and consultative process. Government officials and representatives from various sectors met in Johannesburg to debate a draft version of the National Strategic HIV and AIDS Plan for 2007 to 2011, with the goal of hammering out a final version by the end of March. South Africa's HIV/AIDS epidemic is one of the worst in the world and continues to grow by an estimated 1,500 new infections a day, according to a report published this week by the Human Sciences Research Council. Government's past efforts to address the problem have been criticised for lacking the necessary urgency.
HIV/AIDS is sweeping through parts of South Africa's east-coast province of KwaZulu-Natal, where researchers are finding alarming HIV prevalence levels among women. 'The study might be considered somewhat biased, as only women were tested, but the figures do suggest a worrying upward trend which could be part of a bigger problem,' Medical Research Council (MRC) researcher Professor Gita Ramjee told PlusNews.
More than 400,000 HIV-positive South Africans have begun antiretroviral treatment (ART) since the government launched its programme in 2004. But this impressive-sounding figure still only represents one third of the estimated number of people in need of treatment, and that number is expanding by an additional half a million people every year. If South Africa is to achieve its ambitious goals for expanding treatment access, as well as the UN Millennium Development Goal of universal access, the current models for delivering treatment will need an overhaul. Despite the existence of national policies and guidelines for ARV treatment, implementation is strongly driven by what happens at provincial and district level. A comparison of 16 facilities providing treatment in the three provinces revealed wide variations in referral systems and staffing levels, but in all three provinces the researchers found a lack of integration of ARV services with other health services. Patients frequently had to go to other facilities for the treatment of TB, or for other opportunistic infections, or for antenatal care. The study also found that in many districts there were too few doctors and pharmacists providing ARV services, creating service bottlenecks. Systems for monitoring and evaluating patients on ARV treatment were also generally weak, and the use of data to improve services even weaker.
South African AIDS activists have called on doctors and nurses to act in the best interests of HIV-positive pregnant women and their unborn children by not waiting any longer for an official directive to switch from single antiretroviral (ARV) treatment to more effective dual treatment for the prevention of mother-to-child HIV transmission (PMTCT). At a meeting of the South African National AIDS Council in November 2007 South Africa’s Deputy President and the Director-General of Health announced that public health facilities would abandon the regimen of administering nevirapine only in favour of a short course of two antiretroviral (ARV) drugs for pregnant HIV-positive women. Nearly two months later, the new PMTCT guidelines have yet to be published and disseminated to health workers at state facilities.
HIV/AIDS treatment guidelines for South Africa's public health sector are out of sync not only with those of many other countries in the region, but also with the latest research on how to most effectively treat people living with HIV. Various studies indicating that patients who start antiretroviral therapy (ART) earlier respond better to treatment and are less likely to develop AIDS-related illnesses have led the United States, the United Kingdom and a number of countries in Africa to change their treatment protocols. Deciding when to start a patient on life-long ARV drugs is usually based on a combination of CD4 cell count test results [which indicate the strength of the immune system] and HIV disease progression, which the World Health Organisation (WHO) has defined according to four clinical stages, with stage four being AIDS. The WHO revised its guidelines in 2003 to recommend that a patient who has reached stage three of the disease and has a CD4 count of less than 350 should begin treatment. Most countries in the region have revised their guidelines accordingly, but South Africa's national ART guidelines are still based on earlier WHO recommendations that ART be prescribed only for patients with stage four disease, or a CD4 count of less than 200. In April, the Southern African HIV Clinicians Society published guidelines in the Southern African Journal of HIV Medicine recommending that people living with HIV begin ART when their CD4 cell count drops below 350, regardless of disease progression. These guidelines are endorsed by the region's leading HIV specialists but have no direct influence on the South African government's ART programme.
Prince Mshiyeni Memorial Hospital, just outside the port city of Durban, in KwaZulu-Natal Province, has one of South Africa's busiest maternity wards. About 1,200 women a month give birth there, of which about 40% are HIV-positive, according to figures from the antenatal clinic. For staff working in the hospital's antenatal clinic and maternity ward, implementing the government's new guidelines for the prevention of mother-to-child HIV transmission (PMTCT) has not been easy. HIV-positive mothers with CD4 counts over 200 should now receive zidovudine, also known as AZT, from their 28th week of pregnancy until labour, as well as a single dose of nevirapine during labour. Their infants should get a single dose of nevirapine, and then AZT for seven days (or four weeks if AZT was started late). The new drug regimen means extra work for the hospital staff, while the number of doctors, nurses and counsellors providing PMTCT services at the hospital has not increased. This article reports on the workload and facility issues that arise inimplementing the guidelines.
An AIDS epidemic as severe as the one plowing through South Africa will change society. But how and along what lines? Buckling: The impact of AIDS in South Africa, a new publication by Hein Marais, tackles the question in distinctive and critical-minded fashion – and arrives at disquieting and surprising conclusions. A detailed, multidisciplinary review of research evidence, this short book adopts a unique perspective which reveals more clearly the contingency and complexity of the epidemic's effects. It shows how conventional conceptions of AIDS impact (and programme responses) tend to reflect dominant ideological fixations – particularly the overriding emphasis on productive processes and economic growth, governance and security – and how the wellbeing of humans typically is refracted through those preoccupations.