One third of all HIV infected 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, University of Cape Town actuarial scientist, the number of patients receiving ART in South Africa 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% target of patients who were eligible for ART. It was also found to be much higher in women than in men and children.
“ART is a powerful tool for reducing both AIDS mortality and HIV transmission. The monitoring of access to ART is therefore critical to the evaluation of the impact of HIV treatment and prevention pregrammes,” Johnson wrote in the March issue of the The Southern African Journal of HIV Medicine.
Johnson’s research reveals that over the period mid-2004 to mid-2011, the total number of patients receiving ART in South Africa increased from 47 500 to 1,79-million.
Of the latter 85% were receiving ART via the public sector, 11% were receiving there treatment through disease management programmes in the private sector and the remaining 4% via community treatment programmes run by NGOs.
The majority (61%) of patients were women aged 15 or older, men accounted for 31% of patients, and children under the age of 15% comprised the remaining 8%.
KwaZulu-Natal and Gauteng were the two provinces with the largest number of patients, together accounting for 56% of all patients receiving ART.
Johnson writes that the low rate of ART initiation in men relative to women may be a reflection of gender differences in health seeking behavior and perceptions that men who seek care are “weak”.
Alternatively the high rate of ART initiation in women may be due to higher rates of HIV diagnosis through antenatal screening.
The relatively low rates of ART initiation in children are probably attributable to the lower rates of HIV testing in children and the greater complexity of paediatric ART relative to adult ART, according to Johnson.
The new NSP for the 2012 to 2016 period proposes targets that are far more ambitious than those in the previous NSP: the ART enrolment target in 2016 is 80% of the new ART need in that year plus 80% of the unmet need from previous years.
High levels of HIV testing and counseling, as well as expansion of the capacity to deliver ART, will be required to meet these targets.
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