Health Minister Aaron Motsoaledi announced a massive scale-up of the country’s HIV treatment programme during his health budget vote speech in Parliament on Wednesday.
“From January 2015 we shall start HIV-positive patients on [antiretroviral] treatment at a CD4 count of 500 or less, as opposed to the present count of 350,” he said. A CD4 count is a measure of the strength of someone’s immune system.
This expansion will bring South Africa in line with World Health Organisation treatment guidelines.
Furthermore, Motsoaledi said all HIV-positive pregnant women would receive lifelong treatment, regardless of their CD4 counts. Currently, HIV-positive pregnant women receive treatment until they stop breastfeeding.
According to health department figures, nearly one in three pregnant women in South Africa who attend government clinics is HIV positive.
Motsoaledi pointed out that South Africa already has 2.5-million people on antiretrovirals. This constitutes almost a third of the world’s HIV-positive population that receives treatment.
The announcement was lauded by Mediclinic executive, Roly Buys, as “progressive”.
“Starting people on treatment earlier means that these people will maintain their health status for longer. What the minister is doing is prolonging life,” he said.
While the Southern HIV Clinicians Society welcomed the policy, president Francesca Conradie warned that it will be “an enormous challenge to manage the ongoing needs of over three million people with a chronic disease”.
“I am not only referring to adequate drug supplies,” she said, “but also to ensuring that healthcare workers are trained and motivated, that patients are supported to stay on treatment, that facilities are well run, and that corruption is detected and eliminated within the health system.”
Supply problems remain
Daygan Eager, a health economist from the Rural Health Advocacy Project, also welcomed Motsoaledi’s new antiretrovirals plan, but said he was concerned about the lack of implementation details in the minister’s speech.
“It was mostly good news but there was not enough urgency around fixing the health system and that’s where we’re going to come short with the HIV and tuberculosis programmes. We can make commitments but the reality is a lot of people don’t have access to treatment,” he said.
According to Eager, supply chain problems have resulted in basic medical supplies and equipment not reaching facilities, particularly in the Eastern Cape and the Free State. “Even something as simple as Panado is often out of stock.”
Concerns over implementation
Another cause for concern for Eager was that Motsoaledi did not say when the National Health Insurance white paper, which will map out how the scheme will be implemented and funded, will be released.
“We’ve been waiting for two and a half if not three years. This would have been the prime opportunity to give more substance to the National Health Insurance.”
Other plans revealed by Motsoaledi include:
The decentralisation of multidrug-resistant tuberculosis treatment;
The scale-up of tuberculosis screening and treatment in high-risk populations such as prisoners and miners;
The launch of MomConnect in August, a cellphone-based information service for pregnant women; and
The establishment of a National Health Commission to deal with non-communicable diseases.