Motsoaledi's big HIV treatment jump: Is it true?

Mail & Guardian

a day ago

How close is South Africa to meeting its HIV treatment goals? We look at the numbers. (NIAID/Wikimedia)
Numbers are powerful. They can also be dangerous if not used correctly.
When the
The health department's goal is
In his words, the department has reached 'more than 50% of the target' they set out to achieve by the end of the year.
If that gap is closed, South Africa would have met two of the three
But knowing exactly how much the gap is closing is tricky, because people who know they have HIV may start and stop and then restart treatment again later — sometimes several times — during the course of their care.
So, many of the 520 700 previously diagnosed people Motsoaledi says are now on medication could, at least in theory, very well be people who are counted repeatedly as they cycle in and out of treatment. But because the patient information system isn't digitally centralised — most clinics still keep track of their clients on paper, which means different facilities can't easily access one another's records — someone who stops treatment at one clinic can easily be counted as a new start at another, rather than a restart.
The set of UN targets aim for 95% of people in a country with HIV to know their diagnosis, 95% of those being on treatment and 95% of those taking medication having such low levels of virus in their bodies that they can't infect someone through sex.
'The reason that we [were] able to reach half a million within a short space of time, was because of weekly check-in meetings with provinces, where reports that come from the ground are verified in the presence of all provincial colleagues before they are regarded as final figures for reporting,' said the minister.
But simply counting better isn't the same as doing better, and critics called the reported progress
Why?
Because for the past few years, the number of people with HIV who have gone on treatment has
Moreover, that was while treatment programmes had funding and US-backed money for HIV projects was in place.
So now, at a time of
We dive into the data to get a sense of what the numbers really mean.
Mind the gap
In 2021, South Africa was about 1.2-million people short of its 95%-treatment goal; by 2025 the shortfall will likely be 990 000. That means that the gap — that is, the difference between where the country actually is and where it wants to be when it comes to HIV treatment — has closed by about 210 000.
So there's been progress, but it's been slow: in total, only about 700 000 more people are on HIV medication today than five years ago.
'Getting that last one million or so people on treatment is not simple,' says Kate Rees, public health specialist at the
Sometimes people miss an appointment to get a refill of their medicine because they can't afford to take time off work to go to the clinic or they might have moved to another province or district and so they don't go back to the facility where they first got their prescription, she explains. The longer the interruption lasts, the more hesitant people are to go back, says Rees, because they dread
Says Rees: 'The health service expects people to be very rigid with their appointments, but life just is not like that.'
Slow progress
To get a sense of the progress towards meeting the UN's second target in its 95-95-95 cascade, it's best to look at the difference in the total number of people on HIV treatment from year to year, says Leigh Johnson, one of the lead developers of the
Although the number of people on medication is increasing, the number grows less and less each year. For example, in 2020, about 291 000 more people were on treatment than in 2019. By 2021, though, the number had grown only by about 225 000.
Current forecasts from the model are that the total number of people on treatment will grow by only about 160 000 this year. But that's based on programmes running like they have up to now — and with recent upsets because of US funding cuts, it may be an unreasonable assumption, Johnson says.
Part of the reason for the small net gain every year, is that although many people sign up for medication in a year, many also stop coming back to get their scripts refilled. Of those who drop out of treatment, some might choose to restart within a couple of months again, while others may pause their treatment for more than a year.
In 2023, for example, roughly 793 500 people who had been on treatment before weren't any longer, but about 728 000 who received medication were restarters, Thembisa numbers show.
So even though some people who stop taking their medication might not restart — or restart quickly — the total number who are on treatment still grows; it's just slow-going. This means getting a handle on how close to — or far from — the 95%-treatment mark South Africa is, is more dynamic than simple addition.
Stops, starts and restarts
'There will always be people who interrupt their treatment,' says Rees. 'It's not possible to keep everyone perfectly in the system all the time — that's life.'
But what's important, she says, is to make those pauses as short as possible by helping people to get back on medication quickly and easily — without judgment.
Gesine Meyer-Rath agrees. She's a health economist at
Data in the Thembisa model shows that over the years, the number of people starting medication for the first time — in other words, those who have never been on treatment before — has shrunk, but at the same time counts of restarters have grown. Her group's analyses have shown that honing in on keeping people on HIV treatment is the best way to go —
But to plan sensibly, she explains, policymakers should know how many people are first-time starters, how many pause treatment but then restart, and how many stop and don't come back at all.
'The more detail programme planners have in the data, the better,' she says. 'The [government's]
This is exactly where things can become tricky in future if the holes left by the US funding cuts aren't plugged.
Because of the US's aid withdrawal, about 40% of South Africa's HIV data capturers will likely have lost their jobs by September,
Says Meyer-Rath: 'The less data we have, the more we're flying blind, which leaves space for bickering over the data that is still there.'
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