Access to antiretroviral treatment in South Africa, 2004 - 2011

Background. South Africa’s National Strategic Plan (NSP) for 2007 - 2011 aimed to achieve new antiretroviral treatment (ART) enrolment numbers equal to 80% of the number of newly eligible individuals in each year, by 2011. Objectives. To estimate ART coverage in South Africa and assess whether NSP targets have been met. Methods. ART data were collected from public and private providers of ART. Estimates of HIV incidence rates were obtained from independent demographic projection models. Adult ART data and incidence estimates were entered into a separate model that estimated rates of progression through CD4 stages, and the model was fitted to South African CD4 data and HIV prevalence data. Results. By the middle of 2011, the number of patients receiving ART in South Africa had increased to 1.79 million (95% CI 1.65 - 1.93 million). Adult ART coverage, at the previous ART eligibility criterion of CD4 <200/ìl, was 79% (95% CI 70 - 85%), but reduced to 52% (95% CI 46 - 57%) when assessed according to the new South African ART eligibility criteria (CD4<350/ìl). The number of adults starting ART in 2010/11 was 1.56 times (95% CI 1.08 - 1.97) the number of adults who became ART-eligible in 2010/11, well in excess of the 80% target. However, this ratio was substantially higher in women (1.96, 95% CI 1.33 - 2.51) than in men (1.23, 95% CI 0.83 -1.58) and children (1.13, 95% CI 0.74 - 1.48). Conclusion. South Africa has exceeded the ART targets in its 2007 - 2011 NSP, but men and children appear to be accessing ART at a lower rate than women.