Waiting to hear if treatment will start earlier

More South Africans could access HIV treatment earlier if government approves recommendations by the South African National AIDS Council (SANAC), a move that could finally align national policy with international best practice.



Rebecca Hodes, director of policy, communications and research at the AIDS lobby group, Treatment Action Campaign (TAC), said the recommendations – if adopted – had the potential to save thousands of lives in a country where many start treatment too late.



SANAC has recommended that government allow HIV-positive patients to be given antiretroviral (ARV) treatment earlier by raising the CD4 count (which measures immune system strength) needed to qualify from 200 to 350.



While AIDS activists have long called for such changes, it will be the formal review by the National Health Council, an advisory body to the health minister, which is expected to discuss the recommendations and their financial implications this week.



If approved, the decision would bring South African treatment standards in line with World Health Organization (WHO) guidelines introduced in 2006.



SANAC has been criticized for being ineffectual and non-inclusive, and its deputy chairperson, Mark Heywood, attributed the delay to "the struggle to get SANAC functional."



"They [recommendations] aren't new ... but that they are finally supported by the plenary of SANAC, which is its highest body ... [is] a big step," he said.



Spending could jump



The changes will come at a steep price. Government concern over the cost of implementing the recommendations led the Department of Health to compile an estimate as early as January 2009. Heywood said he wouldn't be surprised if adopting the recommendations pushed up treatment budgets considerably.



"This is going to be expensive to implement, but these recommendations will eventually lead to cost savings," said Hodes. "It's a cost that has simply been deferred."



Mother, infants stand to benefit



SANAC also recommended that HIV-positive babies receive ARVs before 12 weeks of age. Children will account for an estimated 14 percent of all new infections in South Africa in 2009, according to Statistics South Africa, a government body.

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"The recommendations are very important, especially for children," said Prof Ashraf Coovadia, chair of SANAC's treatment and care support task team and head of paediatric HIV services at the Rahima Moosa Mother and Child Hospital in Johannesburg. "Infants have a very high mortality rate - if you wait for a child's CD4 count to decline by 20 percent before you administer treatment, it's too late."



Increasing the CD4 count threshold for expectant mothers would result in fewer infant infections. "We think the current prevention of mother-to-child transmission (PMTCT) programme will deliver, but what we need now is implementation - optimize it and we'll see mother-to-child transmission rates of less than 5 percent," he told IRIN/PlusNews.



However, Coovadia cautioned that expanding treatment for infants would only be effective if more babies who had been exposed to HIV during childbirth were tested.



"We have to make sure no child is missed at six weeks, and we also have to make sure that people understand that if children are sick before six weeks, [they] need to be tested, because they may well be presenting with the first signs of HIV."



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