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ARV programme to go where none have before
Caroline Hooper-Box. 14 March 2004. The Sunday Independent. Republished courtesy of Independent Newspapers (Pty) Ltd.
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South Africa's anti-retroviral programme will be the largest public health intervention of its kind that the world has yet seen.
There are now 350 000 people worldwide on anti-retrovirals (ARVs), 100 000 of those in Brazil. The South African government's roll-out programme will see 53 000 people on ARVs in the first year of the programme, and 1,4 million people by the end of 2007.
"What we are going to do here has never been done before," said Francois Venter, a Johannesburg-based Reproductive Health Research Unit clinical director and HIV/AIDS research expert, speaking this week at a meeting of the Infectious Diseases Society of Southern Africa. "The challenge to the public health sphere is absolutely phenomenal," Venter said. Five million South Africans are infected with HIV, and the disease kills about 400 000 a year.
"If we treat everyone we need to treat there will be more people on ARVs than on hypertension, diabetes and TB drugs combined."
The state health sector had been expected to begin providing ARV treatment to people infected with HIV next month, but signs are that the programme will be delayed until July or August, as state procurement of the drugs has not been finalised. The Treatment Action Campaign (TAC) said on Monday that it would launch litigation against the government to force an urgent resolution on the procurement policy for medicines.
The TAC argues that Manto Tshabalala-Msimang, the minister of health, could buy these drugs as an emergency measure, even if tenders are still in process.
The programme has been budgeted for the next three years to the tune of R2,1-billion, local manufacturers have been licensed to make generic ARVs, the Medicines Control Council has fast-tracked the registration of the drugs, and clinics and hospitals around the country have been prepared for the roll-out. The Gauteng provincial government last week advertised about 180 jobs to fill posts at five sites identified for providing ARVs that are ready to start as soon as the drugs are available.
The programme is planned to expand to 23 sites by March next year. By 2007, Gauteng alone plans to have more than 100 sites dispensing the medicines.
The Gauteng government is planning to buy ARVs on its own initiative so that it can begin the roll-out in the province next month, sources say. The Gauteng provincial government has issued a statement saying it will announce details of its roll-out of anti-retrovirals this week, "including timeframes and extent of the roll-out".
KwaZulu-Natal may go a similar route. Premier Lionel Mtshali has said he is helping to set up a non-profit company that will assist the provincial government in rolling out ARVs and help raise funds for the battle against the epidemic.
ARV drugs currently cost R620 a month per adult. With state tenders, this will drop to R120 a month, according to Francesca Conradie, a clinical investigator.
While the ARV roll-out had in his view been "delayed criminally", the state's plan for providing ARVs to HIV-positive people should be defended, Venter said.
"In terms of the programme and guidelines, this is state-of-the-art stuff, based on real African experience. Government has done its job, now we've got to make this public health programme work," Venter told assembled doctors. |
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