Johannesburg,– South Africa has the highest HIV disease burden, as although it has less than 1% 
of the world’s population, it harbours around 18% of its HIV burden. There are around 5.5millin South Africans leaving with HIV. However, South Africa’s new and ambitious strategy to tackle HIV, under the leadership of the country’s Health Minister Dr Aaron Motsoaledi, is beginning to yield much-needed results. The latest strategic intervention, launched in April, is the roll-out of the fixed-dose combination (FDC) antiretroviral pill throughout South Africa.
The new FDC pill, containing a mix of 300mg tenofovir, 200mg emtricitabine, and 600mg efavirenz, increases patient compliance, reduces mother-to-child-transmission and promises to be more cost effectivein the long run. This is good news for South Africa as the Country, particularly in the Public Sector will be able to stretch its budget further and increase access to treatment. South Africa now has the cheapest ARV prices of any Country in the world and interventions such as the new FDC roll-out are undoubtedly beginning to have a positive impact on society, through increases in productivity, workplace motivation and reduced absenteeism – the latest Statistics SA figures indicate that life expectancy in South Africa has now increased by a year to 59.6 (that equates to 57.7 for males and 61.4 years for females). Over 1.9 million adults and children are receiving antiretroviral treatment nationwide.
At a practical level, the new roll-out of the single-dose antiretroviral drug, as an integral part of government’sHIV treatment campaign, means the majority of South Africans on state-sponsored ARV treatment,as of April 2013, need only one tablet instead of the previous three per day. Studieshave shown the benefits of this new treatment regime improve patients` treatment adherence, improve treatment outcomes and reduce onward transmission of HIV. It is also anticipated that FDCs will make prescribing, dispensing and monitoring treatment easier for nurses and pharmacists working in South Africa’s clinics and hospitals, a critical component given the dire lack of human resources in the South African Healthcare system, particularly the public healthcare system. Rolling-out drugs in FDC formulations will have significantly positive implications to help keep patients adherent to their life-long treatment.
The fixed-dose antiretrovirals will not only benefit patients, but also relieve the considerable burden on the South African health system by simplifying the ordering and monitoring of ARV stocks, because there is now only one tablet to administer. This will ensure better stock management and increased supplier security, with a reduced risk of disruption to patients. Under the new system, health district managers, facility managers, healthcare providers and pharmacy staff should work closely together to manage drug supply. Effective communication will ensure timely ordering of ARVs before a stock-out occurs. It is hoped that FDCs will eventually lead to easier procurement and supply-chain management across the country, thereby avoiding the situation where disruption of supply could result in patients not receiving their ARVs and therefore placing them at risk of viral resistance, which can lead to increased clinical complications and the need to prescribe more expensive drugs.
The good news is that the new FDC pill is suitable for the majority of adult patients in South Africa, except those patients with kidney complications, severe psychiatric conditions or those who unsuccessfully used their first ARV regimen. These side effects only affect a small portion of the overall population requiring treatment. Given the likely and significant uptake in demand for the FDC, in order to avoid stock-outs the FDC pill is being introduced in phases across South Africa by prioritising seven key priority groups of patients, where a greater impact would be made. As more of the FDC pills become available, more priority groups will be phased into the new treatment plan.
The seven priority groups identified by the Department of Health include all patients (adults, adolescents older than 18 years, and pregnant women) who are starting ARV treatment for the first time; all pregnant women needing triple therapy and breastfeeding women; virally suppressed patients (currently on first-line therapy) needing a switch due to toxicity; patients who are stable on a regimen containing tenofovir but with TB co-morbidity; patients who are stable on a regimen containing tenofovir but with other co-morbidities such as hypertension and or diabetes; patients who are stable on a regimen containing tenofovir who requested the change to the fixed-dose combination pill, and patients who are stable on a tenofovir containing regimen but after counselling agree to switch to the new fixed-dose combination pill.
This new ARV roll-out is part of the South African Government’s National Strategic Plan for HIV, Sexually Transmitted Infections (STIs) and TB 2012-2016 and marks a milestone in the nation’s response to the dual epidemics of HIV and TB. This five-year strategy reflects the progress now being made in the country in its efforts to achieve a clearer understanding of the challenges posed by these epidemics, supported by a shared vision to implement effective policies that can achieve the long-term vision of zero new HIV and TB infections.
Already under the new strategy, marked progress has been made in a number of critical areas such as a significant reduction in the vertical transmission of HIV, as well as expanding access to a comprehensive package of HIV, STI and TB services. For its part, government has expanded its menu of options across the range of care from prevention, treatment, support and addressing the social drivers of ill-health, as well as locating the strategy into the broader development agenda of government.
The Millennium Development Goals provide the common global vision to carry out those dedicated actions that will ensure that South Africa will do its part to meet these and other goals of improving response mechanisms. The country’s National Strategic Plan provides an essential framework for the next five years to assist in fulfilling a number of key strategic health objectives, including addressing social and structural barriers that increase vulnerability to HIV, STI and TB infection; preventing new HIV, TB and STI infections; sustaining health and wellness and increasing protection of human rights while improving access to justice. It is precisely by implementing the National Strategic Plan and rolling out important new interventions and awareness campaigns, that South Africa’s response and resolve will be strengthened, and efforts to contribute towards realising the vision of an AIDS-free world will finally be achieved.
Source : Lokesh Shastri