ANTIRETROVIRAL TREATMENT IN RESOURCE-LIMITED SETTINGS: PROGRESS & CHALLENGES IN SOUTH AFRICA YOGAN PILLAY DEPARTMENT OF HEALTH, SOUTH AFRICA IAS, 2014

CONTEXT OF HIV IN SOUTH AFRICA Population - 52 million 6.4 million people living with HIV Prevalence amongst pregnant women: 29% Prevalence in the general population: 12.2% Incidence: 1.07% (0.71% in males; 1.46% in females) Current eligibility: CD 4<350 PMTCT: B Under 5 eligible regardless of CD4 and staging TB/HIV co-infected regardless of CD4

HSRC, 2014

HSRC 2014

HSRC 2014

PROGRESS 20 million tested in 20 months (campaign); currently 8 million tested annually Treatment at PHC level (NIMART) and integrated with TB Large numbers on treatment (initiation at CD 4>200) >90% of pregnant women tested and >80% on treatment Fixed dose combination since April 2013 (1.2m on FDCs); drug cost declines Courier service for stable patients piloted

Progress contd Significant domestic investment in the treatment programme MTCT: <2.6% at 6 weeks First ever independent integrated TB, HIV and PMTCT programme review conducted in Sept/Oct 2013 Investment case done since 2008/09; currently TB/HIV investment case being completed (used to convince Treasury to fund the programme)

Challenges Need to double patients on treatment by end 2016 (4.3 million) Overworked health facilities Need new models of service delivery Testing rate (especially children and men) needs to increase and linkage to treatment and care to be strengthened % of adolescents and young people on treatment needs to increase

Challenge: retention in care (HERO, 2014)

Next steps Consider full implementation of WHO 2013 guidelines Consider Prep for Sex workers Implement recommendations from the TB, HIV and PMTCT review Review service delivery platform for testing, initiation and retention in care Expand other prevention initiatives to reduce new infections by 50%

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