AIDS drug rollout still months away

The South African cabinet has finally approved the provision of AIDS drugs to HIV-positive citizens through the public health system. It has instructed the health ministry to act "with urgency".

But people living with HIV/AIDS will have to wait six to nine months before they can access the drugs.

According to the joint task team - whose report on the costing of a national treatment plan was accepted by cabinet on Friday - a treatment programme should be implemented in phases over a two or three year period.

The task team suggested that six to nine months' "preparatory activities" were required before the first patients would start to receive antiretroviral (ARV) medication on the ground.

"This timeframe must be communicated clearly to the public and health workers from the start," the report noted.

But the drug rollout could be implemented at certain sites, and the practical lessons learnt from these centres could then be incorporated into the wider programme.

The report recommended a number of measures to strengthen the ARV implementation. These included improved nutritional support for HIV-positive people, and "a stronger and more widely distributed and accessible VCT [voluntary counselling and testing] infrastructure and capacity". The ARV programme would also necessitate a "massive" campaign for HIV testing.

Strengthening the quality of care and training health care providers was another consideration. The responsibility for this would rest with the soon-to-be established "regional training centres".

The report also recommended continued efforts to secure better prices for drugs and improve drug availability and distribution systems.

Strict selection criteria for ARV treatment, such as a CD4 cell (cells that orchestrate the body's immune response)count lower than 200 and a high viral load count, would be enforced. Existing guidelines for managing patients on antiretroviral therapy (ART) use viral load and CD4 count testing to measure the impact of ART on the patient's health.

The pace of implementation and expansion would have to be viewed as flexible. Setting fixed targets would be "highly problematic", as it would be difficult to predict the actual pace of expansion of the programme, the report warned.

If there was 100 percent ARV coverage, up to 1.7 million lives could be saved by 2010, the report found.

The health ministry, assisted by researchers and experts from the William J. Clinton Presidential Foundation
HIV/AIDS initiative, will develop the programme.

Meanwhile AIDS lobby group, the Treatment Action Campaign (TAC) welcomed the move, saying it was cause for "celebration and optimism".

"Properly implemented, this will restore hope, dignity and life for millions of people in our country, and, hope throughout the continent," the TAC said in a statement.