Cape Town - The international medical aid organisation Médecins Sans Frontières (MSF) celebrates the approval yesterday by the South African Government of the Operational Plan for Comprehensive Treatment and Care for HIV and AIDS.
Critically, the plan incorporates the provision of antiretroviral (ARV) therapy in the public sector with immediate effect. The roll out of the Plan starts with an intensive effort to set up at least one service point per district in the first year. This geographic dispersion is central to ensuring equitable access to the life saving intervention, as it will bring the intervention to the poorest and to those living in the most remote areas of the country.
"This is great news for South Africa and for the global fight against AIDS," said Dr Eric Goemaere, Head of Mission of MSF in South Africa.
"There is a huge responsibility now ahead for the Government to lead the implementation of what is the most ambitious and largest ARV treatment plan in the world".
The cabinet acknowledges that the implementation of such a Plan will only be possible with a parallel effort to upgrade the health system. In the meantime, MSF believes that the first intensive phase of implementation necessitates to join efforts of all different partners involved in the fight against AIDS.
Critically, it will need the leadership of people living with HIV and AIDS, and all affected community.
"The Treatment Action Campaign (TAC) will mobilise communities to understand and promote this Plan," said Ms Nomfundo Dubula, a treatment educator from TAC in Khayelitsha. "People need to be explained about the new intervention. If they understand they will certainly help implementation since they will know that it is about our lives. And people are tired of so much suffering and death."
Because of the large scale of the Plan, if carefully monitored, it will generate extremely valuable lessons that will be crucial to help similar efforts in other high prevalence countries. Only the three HIV/AIDS clinics run by MSF in Khayelitsha, which were pioneering in the provision of ARV therapy in South Africa, are now recognized by the World Health Organization as a model of implementation of treatment at public primary health care centres.
Today, MSF runs four of the 70 sites designated by Government to implement the first phase of the Operational Plan. Currently MSF treats 650 people with antiretroviral drugs, the largest cohort on treatment in the public sector in South Africa. The use of generic antiretroviral drugs in our clinics has been critical for the success of our programs, since it has proven that antiretroviral drugs can be done in an affordable manner.
As acknowledged in the cabinet statement, the dramatic price reduction of ARV drugs in recent years has been capital in making all these possible. For more than five years, MSF has played a central role to create an international legal framework that allows access to quality low cost ARV drugs, access to generics - particularly where they were patent protected like in South Africa - and, ultimately, promote local production of generics.
"We are committed to work with Government in the implementation the Plan," said Dr Goemaere. "Nevertheless, we have not seen the full text of the Plan yet and the information available is still unclear about critical points - such as concrete time lines, involvement of people living with HIV/AIDS, role of running centres and interim strategy for immediate implementation."
Today in South Africa, 600 people die daily to AIDS and 500,000 people need antiretroviral therapy to stay alive.
Because of the large scale of the Plan, if carefully monitored, it will generate extremely valuable lessons that will be crucial to help similar efforts in other high prevalence countries.