Setting district-based annual targets for HAART and PMTCT - a first step in planning effective intervention for the HIV/AIDS epidemic.

Abstract

While the overall mismatch between people receiving highly active antiretroviral treatment (HAART) and those who need it -the treatment gap -has been well publicised less attention has focused on the number of incoming HIV clients with failing immune systems who will need to be added to the programme each year. Of the estimated 5.4 million South Africans currently infected with HIV 640 000 developed indications for HAART in 2006 and a similar number will come on stream for treatment every year for at least the next decade. While it has been publicised that over 200 000 clients have initiated HAART in government programmes since 2004 only an estimated 100 000 of the > 600 000 newly eligible clients requiring HAART were initiated on this treatment in 2006. After an initial period of rapid growth the annual increase in the number of patients initiated on HAART each year in government programmes has slowed suggesting that unless a different approach is adopted to rapidly expand this programme the existing gap between those requiring and receiving HAART will not be closed. The recent HIV and AIDS and STI strategic plan for South Africa 2007 - 2011 calls for 80% of the HIV-infected population to have access to comprehensive HIV/AIDS care including HAART. To build a system that has the long-term capacity to meet this ambitious goal targets for HAART should focus on the numbers who will be requiring HAART for the first time each year as well as those already on treatment. (excerpt)