Improving access to antiretrovirals in rural South Africa – a call to action

Abstract

South Africa already has the world’s biggest antiretroviral (ARV) programme. With the introduction of extended criteria for initiating ARVs, the National Department of Health wishes to increase the number of people on ARVs by around two million over the next 2 years. Adoption of a chronic disease management model, with extended task shifting, decentralisation and new approaches to distribution of ARVs, must be embraced if this is to be successfully achieved without huge increases in resources. In this editorial we discuss the need for change, and the current substantial blocks to progress (principally in prescribing and dispensing legislation) that contradict national treatment guidance and should be addressed as a matter of urgency. In addition, we draw attention to threatened regulatory changes that may further worsen the situation.