Rapid
Scale-up of Antiretroviral Therapy in South Africa Could Reduce HIV/AIDS Deaths
by 1.3 Million by Year 2012
Victoria
Cobokana, housekeeper, in her employer's dining room with her son Sifiso and daughter
Onica, Johannesburg, June 1999.
Victoria
died of AIDS 13 December 1999, Sifiso died of AIDS 12 January 2000, Onica died
of AIDS in May 2000.
In
South Africa at present, only 33% of HIV positive individuals are receiving antiretroviral
therapy (ART). The authors of the current study, published in the May 1 issue
of the Journal of Infectious Diseases, sought to estimate the impact of
alternative ART scale-up scenarios on patient outcomes from 2007-2012.
Using
a simulation model of HIV infection with South African data, the authors projected
HIV-associated mortality with and without effective ART for an adult cohort in
need of therapy (2007) and for adults who became eligible for treatment (2008-2012).
The researchers
compared 5 scale-up scenarios: (1) zero growth, with a total of 100,000 new treatment
slots; (2) constant growth, with 600,000; (3) moderate growth, with 2.1 million;
(4) rapid growth, with 2.4 million; and (5) full capacity, with 3.2 million.
Results
•
The projections
revealed that by 2011, the rapid growth scenario fully met the South African need
for ART.
•
By 2012, the
moderate scenario met 97% of the need, but the zero and constant growth scenarios
met only 28% and 52% of the need, respectively.
•
The latter
scenarios resulted in 364,000 and 831,000 people alive and on ART in 2012.
•
From 2007 through
2012, cumulative deaths in South Africa ranged from 2.5 million under the zero
growth scenario to 1.2 million under the rapid growth scenario.
Conclusion
Based
on their projections, the authors stated, "Alternative ART scale-up scenarios
in South Africa will lead to differences in the death rate that amount to more
than 1.2 million deaths by 2012."
"More
rapid scale-up remains critically important," they concluded.
Massachusetts
General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA; Center
for AIDS Research, Harvard Medical School, Boston, MA; Harvard School of Public
Health, Boston, MA; Boston University School of Public Health, Boston, MA; Johns
Hopkins University School of Medicine, Baltimore, MD; Yale School of Medicine,
New Haven, CT; Desmond Tutu Research Center, Institute of Infectious Disease and
Molecular Medicine, University of Cape Town, Cape Town, South Africa; Wits Health
Consortium, Johannesburg, South Africa; Service Universitaire des Maladies Infectieuses
et du Voyageur, Centre Hospitalier de Tourcoing, Laboratoire de Recherches Économiques
et Sociales, Lille, France.
5/09/08
Reference P
Rochelle, R Wood, C Milton, and others (CEPAC-International Investigators). Scaling
Up Antiretroviral Therapy in South Africa: The Impact of Speed on Survival. Journal
of Infectious Diseases 197(9): 1324-1332. May 1, 2008.
Results
