An overview of the pharmaceutical market for Tenofovir-Emtracitabine-Efavirenz (TEE) and Tenofovir-Lamivudine-Dolutegravir (TLD) within the South African private sector

The scale up of access to HIV care and treatment is critical to the success of achieving the UNAIDS 95-95-
95 goals in South Africa (SA)(1). There were an estimated 5.4 million people on Antiretroviral therapy (ART) in the SA public sector in 2021, including 137,655 children (<15 years) and 5,328,800 adults(2).

Despite the large HIV burden, it is estimated that only 62% of the 7.5 million people who are living with HIV (PLHIV) in the country are on ART. Recent reports suggest that the increasing trend in
PLHIV being lost to care is of growing concern (3). The perception of poor-quality HIV health service delivery in the public sector, e.g. long waiting times, are potential drivers of disengagement from care (4). This has led to a number of cash-paying, uninsured PLHIV seeking care in the private-sector, where approximately 420 000 insured patients already access ART (5). These patients are obliged to pay cash to access private-sector Antiretrovirals (ARVs).
Private-sector medicine prices including that of ARVs are regulated through the Single Exit Price (SEP) legislation and may not be affordable.

Determining the number of cash-paying clients in the private sector has proven difficult. This review therefore sought to understand the distribution of private-sector TEE(Tenofovir, Emtricitabine, Efavirenz) and TLD(Tenofovir, Lamivudine, Dolutegravir) ARV volumes (where 1-pack = 1-month supply), quantify the number of cash-paying private-sector ART clients and to unpack existing market dynamics influencing demand. Secondly, this review intended to understand patterns of TEE versus TLD utilisation to assess the rate of uptake of optimised regimens at provincial- and district-level to inform policy review in line with the national guidelines.