ARVs dropout rate worries UN

The world can learn from South Africa’s “impressive” roll-out of anti-retroviral treatment to more than two million people, but too many patients on treatment are being “lost” in the system.

This is according to the director of the World Health Organisation's HIV Department, Dr Gottfried Hirnschall.

Hirnschall said South Africa showed other countries that treatment could be scaled up quickly in a short time, adding the WHO learned from South Africa and used much of data for research.

Hirnschall travelled from Geneva to South Africa to present the WHO's independent review of South Africa's HIV and TB programmes to Health Minister Aaron Motsoaledi in Johannesburg yesterday. 

The report was commissioned by the Department of Health and examines the gains made in fighting HIV and explains what needs to be done to improve.

Hirnschall noted it was "concerning" that nobody knows what  happens to 40% of patients on ARVs after three years. 

This does not mean the patients have stopped taking treatment or died, he said. They could have moved to different provinces or countries.

Hirnschall called for “unique identifies” so that every patient is identified and tracked.

This will allow better data on the epidemic and make sure fewer people default from treatment with the possibility of developing ARV resistance or dying.

In response, Health Department director-general Precious Matsoso said 3370 computers are currently being installed in 700 clinics in South Africa to help with electronic tracking of patients who would provide ID numbers.

But she said as many of 30% of all patients at government facilities were foreign and needed another form of identification as they did not have ID books.

The government does not want patients to default from treatment as they could develop resistance to ARVs. The department cannot prevent widespread resistance to treatment,  if more than a third of patients are lost in the system and don't return to their initial clinic for medication. 

Deputy director-general Yogan Pillay said patients collecting treatment who had offered ID numbers in a pilot project were much more likely to stay on treatment. He said those that could not provide IDs were often patients at high risk of getting lost in the system.

The WHO noted that many people travelled to clinics far from their homes for HIV treatment as they did not want to be treated in their town for fear of stigma.

Hirnschall said the distribution of anti-retrovirals increased four-fold between 2009 and 2012. He also noted that ARVs had been given to 24% of HIV positive pregnant women in 2009 and now 80% of pregnant women receive them. This lowered the chances of babies contracting HIV from their mothers.

Hirnschall also praised South Africa for using innovative and modern technology to improve the treatment of TB. The country is a world leader in rolling out the TB testing machine Gene-Xpert to hundreds of facilities to improve the quality and speed of TB testing.

Almost three million of TB tests have been conducted with the Gene-Xpert machine that can detect drug resistant TB.

At the event, the United States’ Charge d'affaires from the embassy in Pretoria, Virginia E Palmer, announced that the President's Emergency Plan for AIDS Relief would increase its funding for medical male circumcisions in South Africa for 2014 from $36 million (about R360 million) to $47 million (R470 million).

The World Health Organisation said South Africa could improve its HIV treatment by: 

• Strengthening supply chain management of drugs "down to last kilometre" of delivery to clinics
• Making sure the number of staff at a clinic was based on workload, as they found the number of nurses and doctors at clinics and hospitals "seemed to vary significantly and there didn't seem to be any rationale" on how many staff were hired.
• Providing anti-retroviral treatment to more HIV positive children and teenagers.