Reconciling the science and policy divide: The reality of scaling up antiretroviral therapy in South Africa.

Alan Whiteside,Jamie Cohen,Michael Strauss

doi:10.4102/sajhivmed.v16i1.355

Abstract

With the world’s largest national treatment programme and over 340 000 incident cases annually, the response to HIV in South Africa is hotly contested and there is sometimes a dissonance between activism, science and policy. Too often, policy, whilst well intentioned, is informed only by epidemiological data. The state of the healthcare system and sociocultural factors drive and shape the epidemic and its response. By analysis of the financial, infrastructural, human resources for health, and governance landscape in South Africa, we assess the feasibility and associated costs of implementing a universal test and treat programme. We situate a universal test and treat strategy within the governance, fiscal, human resources for health, and infrastructural landscape in South Africa. We argue that the response to the epidemic must be forward thinking, progressive and make the most of the benefits from treatment as prevention. However, the logistics of implementing a universal test and treat strategy mean that this option is problematic in the short term. We recommend a health systems strengthening HIV treatment and prevention approach that includes scaling up treatment (for treatment and prevention) along with a range of other prevention strategies.

Highlights

South Africa currently has the world’s highest national incidence of HIV and AIDS, with 6.4 million people infected and over 340 000 incident cases annually.[1]
We examine how policy has changed and existing constraints on the South African government
Building human resource capacity to meet the needs of a universal test and treat programme will be a significant challenge in South Africa and will need to be an increasing priority as the treatment programme expands

Summary

Introduction

South Africa currently has the world’s highest national incidence of HIV and AIDS, with 6.4 million people infected and over 340 000 incident cases annually.[1]. We include working definitions of Universal Access and Universal Test and Treat ART rollout strategies as well as treatment as prevention (TasP) (see panel). Prevention necessarily results from any treatment programme,[16] it is important when developing policy not to conflate TasP with universal test and treat.

Results

Conclusion