Operational plan for comprehensive HIV and AIDS care and ...

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DRAFT - Confidential whose CD4 remains above 200, and those patients with CD4 200 Patients on ARVs Total in Programme 2003/04 212,000 53,000 265,000 2004/05 628,705 188,665 817,370 2005/06 1,078,446 381,177 1,459,623 2006/07 1,497,580 645,740 2,143,320 2007/08 2,167,834 1,001,534 3,169,368 The ultimate cost of care and treatment is a function of two cost drivers: the components of the care protocols in use, and the number of patients receiving care. The costs of care protocols are described below in detail. Estimates of patient demand (see Table 16.8 and Table 16.9) have been developed using the ASSA2000 model as a starting point for discussion with provinces; an upper and lower boundary for expanding coverage for each province was delineated (accounting for different levels of readiness and to accommodate the inherent uncertainty regarding patient uptake) to ensure that provinces will move within a reasonably consistent range to expand coverage, while allowing some degree of flexibility. Retaining flexibility within the programme budget to accommodate uncertain overall uptake levels and differential rates of progress between provinces will be of fundamental importance to the ultimate success of the programme. Proposed mechanisms to facilitate flexibility in budgeting are discussed later in this chapter. The budget for laboratory monitoring and antiretroviral treatment presented below is based upon the following estimates of uptake, based on provincial plans and target ranges as described above. The aim is to achieve universal coverage of new AIDS cases by the end of FY 2008/09 (excluding Medical Aid members). The model used in the calculation of the budget factors in survival and mortality of people on ARV therapy. It also estimates the likely proportion of patients who will need to switch from regimen 1 to regimen 2 in any given year, assuming that, for every year spent on regimen 1, there will be a 24% probability that, by the end of that year, the patient will have switched to regimen 2. Chapter XVI: Budget 247
DRAFT - Confidential Table 16.8: Planned Number of Patients on Antiretroviral Treatment Years New Cases Starting ARVs Total Cases on ARVs 2003/04 53,000 53,000 2004/05 138,315 188,665 2005/06 215,689 381,177 2006/07 299,516 645,740 2007/08 411,889 1,001,534 Table 16.9: Expected Total Number of Cases on Antiretroviral Treatment by Province Provinces 2003/04 2004/05 2005/06 2006/07 2007/08 Eastern Cape 2,750 15,626 38,826 72,411 121,804 Free State 2,127 11,883 24,415 42,065 66,555 Gauteng 10,000 45,000 77,358 112,840 149,851 KwaZulu-Natal 24,902 74,208 202,057 353,600 496,584 Limpopo 6,965 21,494 41,479 72,150 116,419 Mpumalanga 1,934 10,767 26,782 48,105 77,061 Northern Cape 790 2,492 4,907 8,698 14,282 North West 1,808 10,426 26,744 49,289 80,890 Western Cape 2,728 5,728 11,072 21,084 37,078 Note: These figures total to a slightly higher number in each year than those in Table 16.8, based on slightly different assumptions in some provinces on the number of AIDS patients who will be eligible for the programme. The total number of planned cases on treatment falls within the range of likely total ARV cases estimated in the JHTTT report “100% Coverage” scenario, namely between 918,000 and 1,200,000 cases by 2007/08. Laboratory Monitoring for Antiretroviral Therapy The revised care and treatment protocol for diagnostic monitoring of patients on ARVs has been costed using revised prices negotiated with the National Health Laboratory Service. The costs per patient per year of the monitoring protocols accompanying each of the drug regimens are presented in Table 16.10a: Chapter XVI: Budget 248
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OPERATIONAL PLAN FOR COMPREHENSIVE
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LIST OF TABLES Table 0.1: Total Pro
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LIST OF ACRONYMS ADR AIDS ALT API A
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Foreword I would like to thank the
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We hope that all South Africans who
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16. Dr. Fazel Randera, Health Advis
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Executive Summary BACKGROUND 1. The
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6. Following the discussion of this
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health status and to prolong life),
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extreme inequalities and disparitie
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9.5 Providing a Comprehensive Conti
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efforts through additional investme
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elements in a containment strategy
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18. The programme detailed in this
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monitoring of patients for TB, a co
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40 The drug procurement strategies
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follow-up and monitoring for patien
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CHAPTER III - TRADITIONAL MEDICINE
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74 The minimum service point accred
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85. Task Team projections of AIDS p
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patented and/or branded drugs suppl
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102. It proposes a significant expa
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measure the outcomes of the program
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119. Examples of specific research
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Table 0.1: Total Programme Budget E
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the existing health care system and
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Table 0.2: New Patients Starting AR
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DRAFT - Confidential Chapter I Prev
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DRAFT - Confidential The key preven
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DRAFT - Confidential practitioners,
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DRAFT - Confidential 6. Levels of C
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DRAFT - Confidential Patients seen
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DRAFT - Confidential c. Adult ARV D
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DRAFT - Confidential increased freq
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DRAFT - Confidential first few week
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DRAFT - Confidential development of
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DRAFT - Confidential evidence, nevi
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DRAFT - Confidential their lives. A
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DRAFT - Confidential point of conta
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DRAFT - Confidential ADMINISTRATIVE
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DRAFT - Confidential joint collabor
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DRAFT - Confidential reduces the po
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DRAFT - Confidential Coordination w
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DRAFT - Confidential Chapter III Tr
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DRAFT - Confidential In addition to
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DRAFT - Confidential Development of
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DRAFT - Confidential SPECIAL CONSID
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DRAFT - Confidential SECTION TWO HU
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DRAFT - Confidential collaboration
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DRAFT - Confidential effectiveness)
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DRAFT - Confidential 18. A system i
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DRAFT - Confidential Chapter V Huma
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DRAFT - Confidential • ARV treatm
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DRAFT - Confidential Table 5.3: Cor
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DRAFT - Confidential Table 5.5: Tot
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DRAFT - Confidential forward, the e
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DRAFT - Confidential The general ch
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DRAFT - Confidential • ARV treatm
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DRAFT - Confidential Human Resource
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DRAFT - Confidential met. These bur
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DRAFT - Confidential capacity in ma
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DRAFT - Confidential 4. Explore cha
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DRAFT - Confidential ADMINISTRATIVE
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DRAFT - Confidential Chapter VI PRO
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DRAFT - Confidential Table 6.3 list
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DRAFT - Confidential Laboratories N
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DRAFT - Confidential Table 6.1: Fac
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DRAFT - Confidential Table 6.2: Pro
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DRAFT - Confidential SECTION THREE
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DRAFT - Confidential generic produc
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DRAFT - Confidential Fourthly, the
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DRAFT - Confidential Security of Su
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DRAFT - Confidential SPECIAL CONSID
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DRAFT - Confidential manufacturer.
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DRAFT - Confidential • Management
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DRAFT - Confidential Pharmacies at
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DRAFT - Confidential • The Pharma
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DRAFT - Confidential as a contingen
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DRAFT - Confidential the first five
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DRAFT - Confidential • Improving
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DRAFT - Confidential Johannesburg.
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DRAFT - Confidential Infant diagnos
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DRAFT - Confidential SECTION FOUR C
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DRAFT - Confidential Chapter X Soci
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DRAFT - Confidential • Clear guid
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DRAFT - Confidential Care and Suppo
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DRAFT - Confidential The communicat
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DRAFT - Confidential SECTION FIVE I
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DRAFT - Confidential The systems sh
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DRAFT - Confidential and location o
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DRAFT - Confidential should enable
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DRAFT - Confidential The Cluster of
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DRAFT - Confidential or services. O
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