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

2. 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

3. HSRC, 2014

4. HSRC 2014

5. HSRC 2014

6. 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

7. 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)

8. 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

9. Challenge: retention in care (HERO, 2014)

10. 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%

11. I THANK YOU FOR YOUR ATTENTION