Supporting the massive scale-up of antiretroviral therapy: the evolution of PEPFAR-supported treatment facilities in South Africa, 2005-2009

• Published in: BMC public health Vol. 12; no. 1; p. 173
• Main Authors: Larson, Elysia, O'Bra, Heidi, Brown, J W, Mbengashe, Thobile, Klausner, Jeffrey D
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09-03-2012; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Community Health Services - utilization; Demographic aspects; Disease control; Drug therapy; Government Programs - statistics & numerical data; Government Programs - trends; Health aspects; Health care access; Health Facility Administration - statistics & numerical data; Health Facility Administration - trends; Health services; Health Services Accessibility - statistics & numerical data; Health Services Accessibility - trends; Health Systems; Healthcare Disparities; Highly active antiretroviral therapy; HIV; HIV infection; HIV Infections - drug therapy; HIV/AIDS; Host country; Human immunodeficiency virus; Humans; Information management; International Cooperation; National Health Programs; NGOs; Nongovernmental organizations; PEPFAR; Program Evaluation; South Africa; South Africa
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/1471-2458-12-173

South Africa has an estimated 1.5 million persons in need of antiretroviral therapy (ART). In 2004, the South African government began collaborating with the United States President's Emergency Plan for AIDS Relief (PEPFAR) to increase access to ART. We determined how PEPFAR treatment support changed from 2005-2009.
In order to describe the change in number and type of PEPFAR-supported ART facilities, we analyzed routinely collected program-monitoring data from 2005-2009. The collected data included the number, type and province of facilities as well as the number of patients receiving ART at each facility.
The number of PEPFAR-supported facilities providing ART increased from 184 facilities in 2005 to 1,469 facilities in 2009. From 2005-2009 the number of PEPFAR-supported government facilities increased 10.1 fold from 54 to 546 while the number of PEPFAR-supported NGO facilities (including general practitioner and NGO facilities) increased 6.2 fold from 114 to 708. In 2009 the total number of persons treated at PEPFAR-supported NGO facilities was 43,577 versus 501,089 persons at PEPFAR-supported government facilities. Overall, the median number of patients receiving ART per site increased from 81 in 2005 to 136 in 2009.
To mitigate the gap between those needing and those receiving ART, more facilities were supported. The proportion of government facilities supported and the median number of persons treated at these facilities increased. This shift could potentially be sustainable as government sites reach more individuals and receive government funding. These results demonstrate that PEPFAR was able to support a massive scale-up of ART services in a short period of time.