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Health Minister Aaron Motsoaledi announced in his budget vote speech delivered earlier today in Parliament that South Africa will move to treating HIV-positive patients with anti-retrovirals (ARVs) at an earlier stage, starting January 2015.

The new treatment regimen will be in line with guidelines introduced by the World Health Organisation (WHO) in 2013, which recommends that countries give HIV-positive patients ARVs sooner.

For those covering the announcement, please find the following statements from MSF and the Stop Stockouts Project, a national project monitoring stock-outs of essential medicines, run by MSF RHAP, RuDASA, SA HIV Clinician's Society, SECTION27 and the TAC.

“MSF welcomes this bold policy shift which can allow South Africa to be at the forefront of global efforts to scale up the fight against HIV.

The decision to initiate patients at a CD4 count of 500 is an important step, but it will require increased efforts to plug the leaks in the health system, to ensure people are tested, linked to care, initiated and kept successfully on treatment for the rest of their lives.

To people earlier in the progression of their disease can only make a difference on the epidemic if a number of preconditions are met:
 

• More efforts are needed to ensure patients on ARVs remain adherent and in care (especially the ones starting when feeling perfectly healthy). This requires a clear commitment towards adherence support and community models of care that decrease the burden on patients and health facilities. Adherence support and Community Models of Care guidelines are urgently needed. Proper routine viral load monitoring and transparent reporting on retention in care as well as proportion of patients with an undetectable viral load is essential.
• The efforts announced by the minister to communicate prevention, testing and treatment messages better to the South African population is a crucial decision, more people qualify for ARVs but benefits will need to be clearly communicated for demand for testing and treatment to increase. For HIV testing and linkage to care to increase, more investment in community models of care is required, including HIV testing by community health workers (or community care givers).

Dr Gilles van Cutsem, MSF Medical Coordinator for South Africa & Lesotho

“The Stop Stockouts Project welcomes the move by the Health Minister to initiate HIV-positive patients on treatment earlier. However, it is now more urgent than ever to focus on building a functional supply chain and the Health Ministry will need to focus on rectifying this to deal with widespread provincial stock outs. The South African department of health needs to put in place an emergency response capacity to respond to stock outs, while longer term solutions are being put in place.

Facilities and depots will especially need support to help with current and future forecasting as this is one of the causes of stock outs. Adding more patients will also cause more congestion in already crowded facilities. New community models are needed to dispense drugs among stable patients outside the clinic to relieve some of the pressure.

The Stop Stockouts Project calls on civil society to continue to hold government to account.  We also urge patients and health care workers to continue reporting stock outs via our anonymous reporting system.

Monique Lines, Project Manager, Stop Stockouts Project

Issued by MSF