1. The Impact of HIV on a Future NHI
National Health Insurance Policy Brief 4
The Impact of HIV on a Future NHI
July 2009

2. Waves of the Epidemic
Cumulative AIDS deaths are estimated to have exceeded 1 million by 2004 and expected to exceed the total number of people living with HIV by 2017, some 6 million people. The period 1994 to 2003 saw an increase in total HIV infections from an estimated 533,000 to 4,742,000 people.
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

3. Staging of HIV Infection
In the absence of ART, adults are assumed to progress through four stages of disease before dying from AIDS (as defined in WHO Clinical Staging System). Two further stages are modeled: people receiving antiretroviral treatment and those who have discontinued treatment.
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

4. HIV Incidence Rates to 2025
A significant feature of the epidemic in South Africa has been the very different levels of infection by province with KZN the highest and Western Cape the lowest. The peak of new infections is estimated to have passed but see shape in Eastern Cape.
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

5. HIV Prevalence Rates to 2025
A significant feature of the epidemic in South Africa has been the very different levels of infection by province. Overall prevalence levels out when new infections are balanced with deaths. KZN has the highest prevalence and Western Cape the lowest.
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

6. HIV on ARVs in Medical Schemes in 2005: Diagnosis and Treated
About half diagnosed are not meeting “treated patient” criteria. Diagnosis requires proof that patient qualifies for ART according to the National Antiretroviral Treatment Guidelines. A “treated patient” has received ARVs in two of the three preceding months.
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

7. Treatment Costs Relative to Enrolment on Aid for AIDS
Very high spike in costs in the months just prior and after entry to the programme. Average hospital costs reduce significantly and remain stable once people are receiving anti-retroviral medicines.
Original source: Michael Hislop, Aid for AIDS, data Jan 2007
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

8. Multiple CDL Diseases in Medical Schemes with HIV
The rate of multiple chronic disease when one of the diseases is HIV seems to be lower than for other combinations of CDL diseases.
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

9. Common Combinations of Chronic Conditions with HIV
Data from REF Study 2005 in medical schemes. Analysis with HIV applies only to medical schemes in 2005.
Source: IMSA NHI Policy Brief 4: HIV and Future NHI

10. Costing of HIV for a Future NHI
Much is known about the future trajectory of the HIV/AIDS epidemic from the modelling work by Prof Rob Dorrington and Dr Leigh Johnson and their colleagues at UCT.
The earlier study of costs in the public sector is quoted which should form the basis for a future costing for NHI but needs updated figures.
Dr Leon Regensberg and Michael Hislop at Aid for AIDS have excellent data in a variety of settings and countries.
Sources of data for estimating the impact of TB are suggested and the new Johnson model of the impact of the interaction between HIV and sexually-transmitted infections is available.
In all, there are substantial resources and experienced people available to assist in producing estimates of the impact of HIV and related diseases on a future NHI.
This work needs to be commissioned, however the future NHI may be structured.

11. Innovative Medicines South Africa (IMSA) is a pharmaceutical industry association promoting the value of medicine innovation in healthcare. IMSA and its member companies are working towards the development of a National Health Insurance system with universal coverage and sustainable access to innovative research-based healthcare.
Contact details: Val Beaumont (Executive Director) Tel: Fax:
Innovative Medicines SA (IMSA) Cell:
PO Box 2008, Houghton, South Africa

12. Professor Heather McLeod
Material produced for IMSA by
Professor Heather McLeod