SAHR 2007 - Health Systems Trust

Demographic Impact of HIV/AIDS in South Africa” report was
released by the Centre for Actuarial Research, ASSA and
the MRC [HIV Indicators 2006]. The ASSA2003 AIDS and
Demographic model now estimates that 5.4 million South
Africans are HIV-positive and 600 000 have AIDS in mid-
2006. Prevalence is reaching a plateau in most provinces,
albeit at different levels. The report also predicts that ART
can still have a significant effect on reducing the number
of AIDS deaths. Without ART the model predicts about
505 000 deaths a year by 2010. With ART offered at the
level assumed by the model (50% coverage), this would be
reduced to about 388 000 deaths a year. If 90% of patients
requiring treatment are reached, the death toll could be as
low as 291 000 a year. Importantly, the report estimates that,
as at the middle of 2006, 225 000 people were on ART, out
of about 711 000 needing treatment at that time. The scale
of the challenge is underlined by the prediction that, if 90%
treatment coverage is to be maintained, there will be over 2
million on ART by 2015 (Figure 10).
The annual antenatal survey of HIV prevalence remains a
key input into many processes. This year a major step was
taken when results were disaggregated to district level for
the other provinces in addition to WC. This allows for more
detailed comparisons of the results from routine data collection
(such as the DHIS) and various surveys. It also required
major changes to the sampling process. The overall sample
was doubled to 36 000. Sentinel sites were chosen using
the Probability Proportional to Size (PPS) sampling method,
in which a stratified proportional sample was drawn and
the sample size was proportionally allocated to each facility
using antenatal clinic attendance data, providing a selfweighting
sample for each district. In order to be eligible, the
facility had to routinely draw blood from antenatal attendees
and have the ability to store the sample at 4 o C. In addition,
routine DHIS data needed to show that a minimum of 20
subjects would be recruited over a period of a month. Finally,
the facility needed access to transport that would allow for
samples to be taken to a laboratory within 24 hours if there
is no centrifuge in the facility or within 72 hours if the samples
could be centrifuged on site.
It has been known that provincial averages mask substantial
differences between districts, and the WC data [Antenatal
Survey 2005 WC] show big differences even within one
district, such as the high of 32.6 in Khayelitsha and a low
of 5.1 in Mitchell’s Plain, within the City of Cape Town metro.
Figure 11 shows the provincial results from DHIS and the
annual survey, while Figure 12 displays the district results,
supplemented by Map 1 and Map 2. In general the DHIS
and antenatal survey data show similar trends, with the
survey data on average 5.4 percentage points higher (a
23% increase over DHIS values). In KZN however the survey
results are on average 13% higher (a 50% increase over
DHIS values), whereas the WC results are in general more
closely matched. Across districts, estimates of HIV prevalence
from the antenatal survey range from 5.3% in Namakwa
(NC) to 46.0% in Amajuba (KZN).
Figure 10: Projected numbers receiving treatment by level of coverage of national ART programme
2 500 000
2 000 000
Numbers on ART
1 500 000
1 000 000
500 000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Year
20% ART coverage 50% ART coverage 90% ART coverage
Source: HIV Indicators 2006.
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