Estimation of adult antiretroviral treatment coverage in South Africa

Abstract

Objectives: To estimate the annual numbers of individuals receiving antiretroviral treatment in South Africa up to mid-2008, and the coverage of antiretroviral treatment in adults according to various definitions of need.
Methods: Antiretroviral coverage is defined as the number of patients receiving antiretroviral treatment at a point in time, divided by the number needing treatment. Numbers of patients receiving antiretroviral treatment are estimated from public sector data and data provided by disease management programmes and NGO programmes. The unmet need for treatment in adults is estimated using a Markov model of HIV progression in adults, combined with estimates of annual new HIV infections from a national AIDS and demographic model.
Results: By the middle of 2008, 547 000 adults and children were receiving antiretroviral treatment in South Africa, with the public health sector accounting for 78% of this total. Using the current Department of Health criteria for defining antiretroviral eligibility (CD4+ count <200/μl or WHO stage 4), antiretroviral coverage in adults was 38.4% in 2008, up from 4.9% in 2004. Coverage increases to 52.6% if eligibility is based on WHO stage 4 only, but reduces to 21.2% if the South African HIV Clinicians Society guidelines are used to define eligibility. Coverage in 2007 varied between provinces, from 14.6% in Free State to 58.3% in the Western Cape.
Conclusions: Significant progress has been made in expanding access to antiretroviral treatment in South Africa since 2004, but there remains a substantial unmet need for treatment in adults.