Estimation of adult antiretroviral treatment coverage in South Africa.

OBJECTIVES To estimate the annual numbers of individuals receiving antiretroviral treatment in South Africa up to mid-2008, and the coverage of antiretroviral treatment in adults according to various definitions of need. METHODS Antiretroviral coverage is defined as the number of patients receiving antiretroviral treatment at a point in time, divided by the number needing treatment. Numbers of patients receiving antiretroviral treatment are estimated from public sector data, and data provided by disease management programmes and NGO programmes. The unmet need for treatment in adults is estimated using a Markov model of HIV progression in adults, combined with estimates of annual new HIV infections from a national AIDS and demographic model. RESULTS By the middle of 2008, 568 000 adults and children were receiving antiretroviral treatment in South Africa, with the public health sector accounting for 79% of this total. Using the current Department of Health criteria for defining antiretroviral eligibility (CD4+ count <200/microl or World Health Organization (WHO) stage 4), antiretroviral coverage in adults was 40.2% in 2008--up from 4.9% in 2004. Coverage increases to 54.2% if eligibility is based on WHO stage 4 only, but falls to 22.2% if the Southern African HIV Clinicians Society guidelines are used to define eligibility. Coverage in 2008 varied between provinces, from 25.8% in the Free State to 71.7% in the Western Cape. CONCLUSIONS Significant progress has been made in expanding access to antiretroviral treatment in South Africa since 2004, but a substantial unmet need for treatment in adults remains.