South Africa’s HIV antiretroviral (ARV) treatment programme saved 780 000 lives between 2003 and 2012, according to a recently released independent review.
But our tuberculosis (TB) programme is failing to meet targets, although TB diagnosis and treatment is much improved.
In addition, not enough children and teens are on ARVs, while not enough men are being circumcised and condom use is going down, reported the review.
The review assessed the progress and effectiveness of South Africa’s HIV and TB programmes, and involved visits to 100 facilities in 21 districts, including the best and worst district in every province.
It was supervised by a steering committee made up of health department officials and experts from the World Health Organisation, the UN Children’s Fund (Unicef ) and the Joint UN Programme on AIDS (UNAIDS).
In four years, the numbers of people are on ARV treatment increased fourfold. By 2016, an estimated 2,2-million lives will have been saved by the ARV treatment programme.
Meanwhile, the country also smashed its target of preventing pregnant women with HIV from passing the virus on to their babies, with only 2.7% transmission (the target was 7,5%).
But too few babies with HIV-positive mothers are tested for HIV at 18 months, as the virus can be transmitted by breast milk.
In addition, the medical male circumcision – which can decrease a man’s HIV risk by 60 percent – is not reaching enough men, mainly because doctors have to perform the circumcisions.
South Africa is also far from reaching its targets for the reduction of tuberculosis. Around one person in 100 gets infected with TB every year.
However TB treatment is widely available and almost 80 percent of patients with ordinary TB are cured.
But again patient follow-up is poor. There is no effective tracing of patients who drop out of treatment programmes.
Key recommendations to strengthen the HIV and TB programme include:
- Better patient retention, by making services easier to get at local level;
- Introduction of routine TB tests, especially for pregnant women, small children and health workers;
- Targeting ‘key groups’ particularly vulnerable to TB and HIV, including children and mining communities;
- Ensuring that all nurses, and not just professional nurses, are trained to start patients on ARVs;
- Introducing unique patient identifiers that can trace patients electronically even if they move.