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
He said government would have to figure out how best to do
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
Pillay said government had put measures in place for the
“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
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
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
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.