Outcomes of South Africa’s care and treatment program

South Africa’s national antiretroviral therapy (ART) treatment program, the largest in the world with roughly 4.5 million people on treatment, has made substantial impact on reducing morbidity and mortality for HIV-infected people. As the national program matures, it faces significant challenges in expanding access to harder to reach populations while also maintaining quality of care for those for whom HIV has become a manageable chronic disease, including treatment fatigue, resistance development, and ART side effects. South Africa has committed to the UNAIDS 90-90-90 goals, which seek to get 90% of those with HIV to know their status, 90% of those to initiate HIV treatment and 90% of those to be virally suppressed . To achieve this goal and monitor progress towards milestones along the way, the National Strategic Plan calls for evidence-based approaches to monitoring the national response to HIV and highlights several key populations as a priority for improving treatment outcomes on ART. In line with this call, our group has built up a body of work evaluating the outcomes achieved since the rollout of ART nationally in 2004 and its impact on priority population groups. This work has the potential to inform program management, policy-making, resource allocation, and modelling.

Publications and other documents

Johnson LF, Meyer-Rath G, Dorrington RE, Puren A, Seathlodi T, Zuma K, Feizzadeh A. The effect of HIV programs in South Africa on national HIV incidence trends, 2000-2019. J Acquir Immune Defic Syndr. 2022 Jun 1;90(2):115-123. doi: 10.1097/QAI.0000000000002927. Epub 2022 Feb 7. PMID: 35125471.

Bor J, Kluberg SA, LaValley MP, Evans D, Hirasen K, Maskew M, Long L, Fox MP. One pill, once a day: simplified treatment regimens and retention in HIV care. Am J Epidemiol. 2022 May 20;191(6):999-1008. doi: 10.1093/aje/kwac006. PMID: 35081613.

Hirasen K, Fox MP, Hendrickson C, Sineke T, Onoya D. HIV treatment outcomes among patients initiated on antiretroviral therapy pre and post-universal test and treat guidelines in South Africa. Therapeutics and Clinical Risk Management 2020;16:169–180.

Mokhele I, Mashamaite S, Majuba P. et al. Effective public-private partnerships for sustainable antiretroviral therapy: outcomes of the Right to Care health services GP down-referral programBMC Public Health 2019; 19:1471.

Maskew M, Bor J, Macleod W, Carmona S, Sherman GG, Fox MP. Adolescent HIV treatment in South Africa’s national HIV programme: a retrospective cohort study. Lancet HIV 2019; http://dx.doi.org/10.1016/S2352-3018(19)30234-6.

Mbengue M, Chasela C, Onoya D, Mboup S, Fox MP, Evans D.  Clinical predictor score to identify patients at risk of poor viral load suppression at six months on antiretroviral therapy: results from a prospective cohort study in Johannesburg, South AfricaClinical Epidemiology 2019:11 359–373.

Long L, Evans D, Rosen S, Sauls C, Brennan AT, Sanne I, Fox MP. Can routine inpatient mortality data improve HIV mortality estimates? Inpatient mortality at an urban hospital in South Africa. S Afr Med J 2018;108:870-875.

Hendrickson C, Evans D, Brennan AT, Patz S, Untiedt S, Bassett J, Levin L, Sanne I, Fox MP. Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa. SAMJ 2019; 109: 679-685.

Moorhouse M, Maartens G, Venter WDF, Moosa MY, Steegan K, Khadija J, Fox MP, Conradie F. Third-line antiretroviral therapy program in the South African public sector: cohort description and virological outcomesJ Acquir Immune Defic Syndr. 2019 Jan 1; 80(1): 73–78.