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#AIDS2016: SA to increase ARV roll-out in September

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Despite its multitude of developmental challenges – is well on its way to bridging the gap in the delivery of life-saving drugs to its HIV-positive citizens.

This makes it a fitting host for the 21st Aids Conference which begins on Monday, the theme of which is Access Equity Rights Now.

The conference – which will discuss this issue, among many others – brings together 18 000 delegates, including scientists, researchers, activists and sufferers to discuss, among other things, how to improve access to comprehensive treatment, preventative measures, care and support – while battling stigma and financial means.

“We’ve reached the goal of providing 15 million people with access to life-saving HIV treatment by 2015. Additionally, UNAids estimates that from 2002 to 2012, expanded access to HIV treatment averted 4.2 million deaths globally and contributed to a 58% reduction in new HIV infections,” said conference organisers in a recent statement.

However, they said, many of the obstacles that impeded effective HIV prevention and treatment programs in 2000 – when South Africa last hosted the conference – still existed today.

“More than 60% of people living with HIV remain without antiretroviral therapy; including women and girls, men who have sex with men, transgender people, sex workers, young people, and people who use drugs and other marginalised groups remain under-prioritised in the response.”

But South Africa, by September, will be addressing at least one of these concerns.

The country will be rolling out antiretrovirals (ARVs) to all HIV positive South Africans regardless of their CD4 count.

Currently only those HIV-infected patients with a CD4 count of 500 or less were eligible to receive treatment.

“But we will remove CD4 count as eligibility criterion for ARV treatment,” Health Minister Aaron Motsoaledi said in May while tabling his budget in Parliament.

While experts have lauded the move, they have also questioned how the department plans on dealing with the influx of millions more patients.

The department, however, was confident it could deal with the new recipients, employing the use of a pick-up system for comparatively healthy patients, making room for the new ones.

The new programmes were expected to cost the government an estimated R1 billion.

The World Health Organisation (WHO) said the expanded use of antiretroviral treatment was supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners.

“Based on the new recommendations, the number of people eligible for antiretroviral treatment increased from 28 million to all 37 million people who currently live with HIV globally,” said WHO recently.

Expanding access to treatment was at the heart of a new set of targets for 2020 with the aim to end the Aids epidemic by 2030.

“These targets include 90% of people living with HIV being aware of their HIV infection, 90% of those receiving antiretroviral treatment, and 90% of people on ART having no detectable virus in their blood.”

According to UNAids estimates, expanding ART to all people living with HIV and expanding prevention choices can help avert 21 million Aids-related deaths and 28 million new infections by 2030.

But the move, while welcomed by experts, has also left them asking questions.

Internationally renowned and leading South African researcher in maternal and child health Professor Hoosen “Jerry” Coovadia at MatCH (Maternal, Adolescant and Child Health Systems) affiliated with Wits University said the move was a “good thing”.

“But my heart shudders when I think about our infrastructure. The delivery of drugs on that scale could be enormously difficult.”

Director of the Centre for the Aids Programme of Research in South Africa (CAPRISA) Professor Salim Abdool Karim said the health system could “not easily” cope with the influx of new health care seekers.

“However, what is the alternative? Let people get sick and die? No, the solution lies to finding ways to provide Aids treatment in a way that keeps most of them out of hospitals – where they can initiate ART and continue ART at primary care clinics, GPs, etc. Since many of the new patients starting ART will now be quite well and healthy with high CD4+ counts, they may not need to burden large hospitals, where they would displace other sicker patients.”

It was estimated by the Department of Health that the country had just over 3 million patients on treatment, he said.

“Once the new guidelines come into place in September, another 3 million patients will be eligible to start ART. However, many of these 3 million patients do not yet know that they have HIV. So, it is going to take a few years before everyone eligible for treatment receives it.”

Karim warned against starting on ARVs and not continuing with them.

“Starting ART and then discontinuing these drugs is worse than not starting at all. Patients who start treatment and then stop are at high risk of developing drug resistance, which will mean that they will need more powerful and expensive drugs known as second-line treatment. For this reason, Aids treatment programmes put a lot of emphasis on patients being highly adherent to their treatment.”

Deputy Director General of HIV/Aids, TB and Maternal Child and Women’s Health (MCWH) at the National Department of Health Dr Yogan Pillay said the department estimated that 1.3 million people currently on treatment who were considered stable (virally suppressed).

“These patients will be referred to support groups and have their medicine couriered to a pick-up point outside the health facilities so that the facilities can cope with the new patients who need to be initiated on ARVs.”

The support groups would be used to ensure that people adhere to the treatment, said Pillay.

[Source: IOL]

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