Durban - With 3.1 million people on antiretrovirals, South Africa has the world’s largest ARV programme, but the cost of sustaining it will more than double in the next two decades, research has found.
Released at the SA Aids Conference in Durban, the research modelled the cost of the HIV response and what it would take to meet ambitious international development targets Health Minister Aaron Motsoaledi adopted last year.
Led by Wits University health economist Dr Gesine Meyer-Rath, the research found that South Africa’s HIV programme will cost about R40 billion each year by 2033 - more than double the R21bn budgeted for the programme in the next financial year.
The analysis also revealed the top 18 most cost-effective ways South Africa could tackle its epidemic. Top of the list was increasing condom distribution, male circumcision and communication campaigns promoting safer sex among teens.
Meyer-Rath said current budgets would allow the country to implement only about two-thirds of the programmes at the levels needed to meet the targets adopted by Motsoaledi last year.
The targets call for 90 percent of HIV-positive people to know their status, and access and adhere to treatment to achieve undetectable HIV viral loads by 2020.
HIV viral-load testing measures the amount of virus in a person’s blood. When the levels are low, they are said to be undetectable. While this does not mean a person is cured, it reduces the risk of the person transmitting the virus.
Staying Motsoaledi’s course would mean testing more than 35 million South Africans every year and continue moving HIV testing from clinics to communities through mobile testing units. It would also mean starting at least 670 000 people on ARVs every year, Meyer-Rath said.
But achieving the minister’s goals, dubbed the “90-90-90” targets, could also cut new HIV infections by 75 percent and Aids-related deaths by two-thirds by 2030. The move would further save the country money in about 10 years, she said.
“We already have a huge commitment to millions of people on ARVs that will require this funding to be continued. The cost of HIV will continue to rise. The question is how much do we want it to rise before we see some cost savings.”
TB, much of it fuelled by HIV, remains South Africa’s leading cause of death. About 60 percent of the country’s TB patients are also infected with HIV.
Researcher Sarah Magni said that reaching 90-90-90 targets with regard to TB would mean a 46 percent budget increase in the next five years.
Independent health economist Teresa Guthrie said the figures pointed to a need for South Africa to begin experimenting with alternative mechanisms to fund its HIV programme, such as financial transaction taxes or air travel levies.
Motsoaledi’s tenure as health minister has been marked by quick moves to bring the country in line with international HIV treatment guidelines.
Meyer-Rath’s research is expected to help the Department of Health decide whether it will adopt new guidelines likely to be proposed by the World Health Organisation in December. The guidelines will allow HIV-positive people to start ARVs as soon as they are diagnosed. Currently, patients must wait until their CD4 counts - a measure of the immune system’s strength - fall to 500.
“We need to start thinking ahead about the new guidelines and then try to figure out where those resources are going to come from,” said Dr Yogan Pillay, Department of Health de-puty director of HIV, TB and woman and child health.
“This is in the context where donor funding is flat-lining and the economy is in the toilet.”
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