Today people with HIV, treatment advocates and health care providers across South Africa were celebrating as news spread that the South African government has finally approved a plan that promises eventually to deliver comprehensive care to the five million HIV-positive people in the country, including providing antiretroviral treatment to those patients who need it. “We’re ecstatic,” said Nathan Geffen of the Treatment Action Campaign (TAC). “This is what we have been working so hard for.”
Late on Wednesday, the South African cabinet approved The Operational Plan for Comprehensive Treatment and Care for HIV and AIDS. This follows a statement last week by finance minister Trevor Manual that 12 billion rand was being set aside in the budget to pay for implementation of the plan over the next several years.
Yet, the plan does not mean that antiretroviral therapy will be available immediately — in fact, it will take months or even up to a year before the programme distributes antiretroviral drugs to anyone. Furthermore, the government believes that it will take at least five years before the country can provide treatment to the entire HIV-infected population.
The plan’s approval has been widely been lauded by treatment advocates, doctors and AIDS-related organizations worldwide.
"There is now real hope for the millions of people living with HIV and their families," said Mr. Geffen. In fact, TAC is so pleased with the Cabinet’s decision that the advocacy organization is essentially adopting a new stance towards the government. "Obviously, we still need to see all the details of the plan, but now can finally move forward and begin working with the government to make this plan a reality." He noted however, "that there are many challenges ahead, especially at the local level."
Some of these challenges are noted in a TAC press release on the plan. "The success of the treatment plan rollout depends on our ability to mobilise our communities. Because of this fact, we are going to focus much of our energy at the level of the District Health Service. We are going to assist with service delivery but keep up our pressure through mobilisation and demonstrations when needed."
Building capacity the key challenge in first years
Most of the operational plan (and the resources allocated to it) is devoted to developing the health care infrastructure to deliver care to so many people. The plan is to shore up national laboratories, and develop a network of accredited clinical facilities that will be dedicated to HIV care. Care to people with HIV will be provided via these clinical “service points.”
Both the development of these service points and provision of care will occur in stages. The goal is to create or accredit at least one “service point” in every health district across the country within the first year (each province is divided into around a dozen health districts, and there are nine provinces in the country). By the end of the first year of the programme, the government plans to provide antiretroviral therapy to about 50,000 patients attending these service points. Within five years, the goal is to establish at least one service point in every local municipality to provide access to every patient who needs antiretroviral treatment.
It is likely that treatment will become available most quickly in the more urbanised provinces (Western Cape, Gauteng and Kwazulu Natal).
Patients will qualify for antiretroviral therapy if they have CD4 cell counts below 200 or if their clinician determines that they have symptomatic disease, regardless of their CD4 cell count. The programme will also provide 24 hour post-exposure prophylaxis to patients who may have been exposed to HIV (such as rape victims).
A large influx of nurses, doctors, laboratory technicians, counsellors and other health workers will be needed to staff and provide care at these “service points.” In Gauteng, for example, 28 doctors, 90 nurses, 44 pharmacists and 132 counsellors will be need to be recruited and trained during the first year in order to provide treatment for 10,000 patients estimated to be eligible for treatment. So the plan also commits substantial funds to the training and recruitment of skilled healthcare workers “to ensure the safe, ethical and effective use of medicines for people with HIV.”
Further information on the South African treatment roll out
ARVs for 10,000 Gauteng patients in 12 months
South African cabinet approves national antiretroviral distribution plan
South African government Q&A on antiretroviral distribution plan