South African Antiretroviral Drug Program ‘Affordable,’ ‘Feasible,’ Cost Study Says
Antiretroviral drugs are "affordable" and launching a program to deliver the medicines to HIV-positive people throughout South Africa is "feasible," according to a cost study completed by the country's national health and finance ministries, the Wall Street Journal reports (Schoofs, Wall Street Journal, 5/13). The South African government in October 2002 assembled a task force of officials from both the department of health and the national treasury to examine the cost of an antiretroviral program. The report generated by the task force was to be considered last week at a meeting of provincial health ministers and national Health Minister Manto Tshabalala-Msimang. Both Tshabalala-Msimang and Finance Minister Trevor Manuel must approve the report before it can be passed on to the nine provincial health ministers for their approval. Only then could the report be sent to the cabinet for consideration. Although the ministers have the option of referring the report back to the task force for further clarification, they are expected to send it to the cabinet (Kaiser Daily HIV/AIDS Report, 5/9). The report says that the per-person cost of an antiretroviral drug program for each year of life saved would be approximately $1,100, but the study predicts the cost would fall "sharply" after a few years. The report also provides suggestions on how to reduce prices, such as offering generic drugs and a budget to "accelerate regulatory approval," the Journal reports. According to the report, the government could provide antiretroviral drugs to 500,000 HIV-positive South Africans within five years, which could help the country negotiate "volume discounts" with pharmaceutical companies, according to the Journal.
Political pressure may force the government to implement a nationwide treatment program, as more and more companies begin providing antiretroviral drugs to their HIV-positive employees and other HIV treatment programs, including two sponsored by former President Nelson Mandela, begin operation, according to the Journal. In addition, the treatment advocacy group Treatment Action Campaign, which launched a civil disobedience campaign in March and has kept the issue visible, and the country's leading trade union have said that they will take further action against the government if it does not implement a national program. While some South African government officials, policy makers and scientists say that the focus on antiretroviral drugs is "too narrow" -- they stress poverty alleviation and nutrition as important factors in the epidemic and note that tuberculosis treatment programs still have trouble with patients adhering to six months of therapy -- the country has not established any adult HIV/AIDS treatment pilot programs to identify and solve problems that may arise. However, the government has increased its AIDS budget three-fold from the most recent fiscal year and is scheduled to triple it again next year to about $455 million, according to the Journal. In addition, the government is improving the availability of HIV testing and counseling at clinics around the country. Currently, only about 25% of clinics provide those services, the Journal reports (Wall Street Journal, 5/13).