Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study

Abstract

BackgroundAlthough access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria.MethodsWe performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year.ResultsFor universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$ 141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million).ConclusionsUniversal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.

Elimination of HIV in South Africa through Expanded Access to Antiretroviral Therapy: A Model Comparison Study

“…This raises questions about the value for money of the additional investments required to implement UTT. Although we show that the UTT intervention proposed by Granich et al [9] is highly cost-effective, the required number of health workers and financial resources for such a strategy far exceeds the current availability in South Africa [61]. Also, the assumed rates of HIV testing, ART uptake, retention in care, and treatment adherence are rather optimistic [62],[63].…”

Change of treatment guidelines and evolution of ART initiation in rural South Africa: data of a large HIV care and treatment programme

“…A previous modelling study showed that the number of people eligible for ART in South Africa increased from 1.7 million to 2.6 million after the change of ART eligibility criteria from CD4 ≤ 200 cells/μL to CD4 ≤ 350 cells/μL [ 26 ]. Our results from a rural South African study area suggest that the HIV programme, with the funding available at this time (PEPFAR/USAID and the KZN Department of Health), could adapt on the field to the change of national guidelines, with a number of individuals accessing clinics for initiating ART that increased over time and with higher CD4 count at the date of ART initiation as showed in a previous analysis [ 27 ].…”

“…It has then been estimated that expanding the ART eligibility criteria to CD4 ≤ 500 cells/μL would dramatically increase the number of individuals eligible for ART to 4.1 million countrywide [ 26 ]. Thus, the true test of the impact of the change of guidelines will be with the evaluation of the implementation of the 2013 WHO guideline that has begun in January 2015 in South Africa ( http://www.iol.co.za/news/politics/hiv-drugs-treatment-to-start-earlier-motsoaledi-1.1724412#.VDuOLRbH-ZT ), and especially within the Hlabisa sub-district where the HIV care and treatment programme is, since 2013, only funded by the KwaZulu-Natal Department of Health.…”

Using Intervention Mapping to Develop a Motivational Interviewing Training and Support Program for HIV Lay Counsellors to Improve ART Uptake in The Primary Health Care Setting in Gauteng, South Africa

“…Plans to increase the number of patients on treatment and initiating ART on the same day as testing positive for HIV are being implemented in the context of limited specialist healthcare professionals [8][9][10][11][12] . This has led to a greater reliance on lay health care workers to perform health promotion activities [13][14][15] , support HIV testing, and provide adherence support and community-based HIV care and treatment 5,16,17 .…”