Government’s programme to put every person who tests HIV-positive at a public health facility on antiretroviral (ARV) treatment immediately, irrespective of their CD4 count, will commence on Thursday.
This is when government officially adopts the World Health Organisation’s “test-and-treat” guidelines for people with HIV.
As a result, they will be able to start treatment as soon as they are diagnosed, instead of having to wait until their immune systems are considerably weaker.
This marks another milestone for South Africa in terms of HIV treatment, and the decision has been widely applauded by HIV clinicians and activists locally and internationally.
However, the move will have serious implications for government’s health budget and has raised questions about whether the public health system will be able to cope with the predicted influx of new patients.
Dr Yogan Pillay, the deputy director-general for HIV/Aids, tuberculosis and maternal, child and women’s health at the national department of health, said it was not a question of whether government had the capacity to deal with the influx of patients, but “whether we can afford not to test and treat”.
He said government would have to figure out how best to do so.
South Africa has been hailed for having the largest ARV programme in the world. More than 3.6 million people are currently accessing ARV treatment in the public sector.
Government’s national strategic plan for HIV and Aids, sexually transmitted illnesses and tuberculosis set a target for 80% of people living with HIV to be on ARV treatment by this year.
This means that government still has an additional 2 million HIV-positive people to reach, excluding those who are positive but have not yet been tested.
Pillay said government had put measures in place for the test-and-treat campaign.
“One of the things we are doing is moving out all the stable patients – those who have been on treatment and are successfully managing to keep the virus undetectable – to support groups.
“From September 1, we plan to move 1.3 million patients into support groups. Most importantly, we are moving them into the drug courier system programme, whereby we courier drugs to a place convenient to them, outside of our facilities, every three months,” Pillay said.
This would make space for new people to receive the attention they need at public hospitals and clinics, he added.
However, the issue of the increasing ARV budget remains a challenge.
The department of health spends billions of rands on ARVs every year. Currently, the cost of the overall tender covering the three-year period from April 2015 to the end of March 2018 amounts to more than R14.2 billion.
When the fluctuating rand-dollar exchange rate is factored in, government may have to fork out billions more for the remaining period of the ARV tender.
“The cost of the drugs has increased from the cheap prices we had. We used to pay R87 for each patient’s monthly treatment. Now we pay R130,” Pillay said.
He acknowledged that the ARV drug prices were a concern, saying: “We need to make the provision of drugs cheaper as we implement the test-and-treat guidelines.”
The cost of ARV drugs is dependent on the rand-dollar exchange rate as none of the local pharmaceutical companies that supply ARVs to the public sector produce the life-saving drugs using local ingredients.
They import the ingredients that go into ARVs – called active pharmaceutical ingredients – from international pharmaceutical companies and formulate it into tablets or capsules. This leads to huge cost implications and escalated drug prices.