Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study

Jan AC Hontelez,Richard J Lessells,Marie-Louise Newell,Till Bärnighausen,Kristen Munnelly,Ruth M Bland

doi:10.1186/1478-4491-10-39

Abstract

BackgroundAlthough access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria.MethodsWe performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year.ResultsFor universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$ 141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million).ConclusionsUniversal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.

Highlights

With about 22.5 million people living with HIV [1], the disease remains one of the most important health problems in sub-Saharan Africa (SSA)
Data collection We performed a time and motion study in the Hlabisa HIV Treatment and Care Programme in KwaZulu-Natal, South Africa, which is a partnership between the local Department of Health and a Wellcome Trust-funded research center based in the community [20]
We found that universal access to Antiretroviral therapy (ART) at CD4 cell counts of ≤350 cells/μl will require South Africa to commit a further 2,200 nurses, 3,800 counselors, and 300 doctors to HIV treatment, at a cost of ZAR 929 million (US$ 141 million) in salaries

Summary

Introduction

With about 22.5 million people living with HIV [1], the disease remains one of the most important health problems in sub-Saharan Africa (SSA). Because the cost of antiretroviral medicines has dropped dramatically over the past decade, the availability of well-trained health workers may be the most important barrier to providing life-saving HIV treatment to those in need [8,9,10]. Access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria

Methods

Results

Conclusion