Ten years on ART – where to now?

By  Dr. Denise Evans  |  | 


Next year marks the tenth anniversary since the rollout of antiretroviral therapy (ART) in South Africa (SA), the country with the largest number of people living with HIV in the world. SA also has the world’s largest antiretroviral therapy (ART) programme, with approximately 1.8 million people estimated to have received ART by mid-2011. The massive investments in treatment and prevention have been accompanied by great successes. Increasing ART coverage has led to a decline in HIV-related adult mortality. During the first 3 years of ART rollout, although ART uptake averaged around 40% of those in need, it has been estimated that AIDS mortality dropped by approximately 25%. Since the announcement of a comprehensive care, management and treatment programme by the Department of Health in late 2003, access to ART in SA has increased dramatically. Over time, revisions to the national treatment guidelines have meant that more patients than ever are eligible to initiate lifesaving therapy. The shift from an ART eligibility criterion of a CD4 count <350 cells/µl, from the previous threshold of <200 cells/µl, resulted in adult ART coverage dropping from 79% to 52%, although clearly more patients were eligible to start ART. Although HIV testing figures have increased in the country, mainly because of the National Testing Campaign launched by the Minister of Heath in 2010, they are not yet high enough. Over a quarter of the population has been tested for HIV, but this has not translated into all those with a positive result being enrolled into care. The 2012 SA Clinicians Guideline recommends starting ART at a CD4 count <350 cells/µl and argues for the use of ART in discordant couples. This again increases the number of patients deserving of being enrolled into care.


Publication details

South African Medical Journal