From 20-25 July 2014 the big AIDS conference in Melbourne was held. There continues to be discussion about eligibility criteria for starting antiretroviral treatment (ART) for HIV positive people, also within South Africa. Around the time of this conference, the South African Centre of Epidemiological Modelling and Analysis (SACEMA) released a policy brief on the challenges around early access to ART for all.
My interest in this issue of early initiation of ART for all those tested HIV positive has been raised by the numerous publications that have been written on this topic in the SACEMA Quarterly. Since 2009 I am one of the editors of this online newsletter reporting on work in the field of epidemiological modelling. It includes both work conducted by SACEMA as well as from other researchers in the field. Although most work focuses on HIV, articles on other infectious diseases (TB, malaria) and non-communicable diseases are also published.
One of the most important things that SACEMA's policy brief highlights is that there should be a change in the thinking; from "Can we put everyone on ART and when?" to "How can we put everyone (or at least as many people in need) on ART"? Access the full policy brief.
Also coinciding with the time of the conference was the budget speech of South Africa's Health Minister Aaron Motsoaledi. The government plans to start treating HIV/AIDS patients earlier; current guidelines say treatment with ART should begin when an HIV/AIDS patient's CD4 count falls below 350. From January 1 2015, that threshold would rise to 500, which is in line with World Health Organisation (WHO) guidelines. Also here the question of "how to do this" comes up, as it was commented that this will further strain already overstretched clinics and hospitals.