ORIGINAL ARTICLES Towards universal ARV access: Achievements and challenges in Free State Province, South Africa Kerry E Uebel, Venessa Timmerman, Suzanne M Ingle, Dingie H C J van Rensburg, Willie F Mollentze
Objective. To study the progress and challenges with regard to universal antiretroviral (ARV) access in Free State Province, South Africa. Methods. Data from the first 4 years of the public sector ARV roll-out and selected health system indicators were used. Data were collected from the public sector ARV database in Free State Province for new patients on ARVs, average waiting times and median CD4 counts at the start of treatment. Information on staff training, vacancy rates and funding allocations for the ARV roll-out was obtained from official government reports. Projections were made of expected new ARV enrolments for 2008 and 2009 and compared with goals set by the National Strategic Plan (NSP) to achieve universal access to ARVs by 2011.
South Africa, with an estimated 5.7 million people living with HIV, has the largest burden of HIV disease globally.1 By 2009, an estimated 2.9 million South Africans had died of AIDS, with an annual AIDS mortality of 374 000.2 The Free State (FS), one of 9 provinces in South Africa, with an estimated population of 2 792 000,2 has an AIDS prevalence rate of 18.5% among 15 - 49-year-olds, compared with the national figure of 16.9%.3 To combat the social disaster in high-burden countries, calls were made in 2003 to start the formidable task of getting antiretrovirals (ARVs) to people who needed them.4 By the end of 2008, the World Health Organization (WHO) estimated that over 4 million people had accessed ARVs in developing countries. In South Africa, specifically,
Knowledge Translation Unit, UCT Lung Institute, Cape Town, and Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein Kerry E Uebel, BSc (Med), MB BS, MFamMed Knowledge Translation Unit, UCT Lung Institute, Cape Town Venessa Timmerman, BSc, MSc Department of Social Medicine, University of Bristol, UK Suzanne M Ingle, BSc, MSc Centre for Health Systems Research and Development, University of the Free State, Bloemfontein Dingie H C J van Rensburg, MA, DPhil Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein Willie F Mollentze, MD, FCP (SA), MMed (Int Med), FACE
Corresponding author: Kerry E Uebel (
[email protected])
Results. New ARV enrolments increased annually to 25% of the estimated need by the end of 2007. Average waiting times to enrolment decreased from 5.82 months to 3.24 months. Median CD4 counts at enrolment increased from 89 to 124 cells/µl. There is a staff vacancy rate of 38% in the ARV programme and an inadequate increase in budget allocations. Conclusion. The current vertical model of ARV therapy delivery is unlikely to raise the number of new enrolments sufficiently to achieve the goals of universal access by 2011 as envisaged by the NSP. The Free State is implementing a project (STRETCH trial) to broaden the ARV roll-out in an attempt to increase access to ARVs. S Afr Med J 2010; 100: 589-593.
700 500 people were reported to be accessing ARVs.5 UNAIDS has published estimates of the total need for ARVs in different regions, defined as the number of people accessing ARVs plus those who qualify for ARVs, i.e. either with stage 4 disease (AIDS) or a CD4 count
