Scale-Up and Continuation of Antiretroviral Therapy in South African Treatment Programs, 20052009

Klausner, Jeffrey D MD, MPH; Serenata, Celicia MBA; O'Bra, Heidi MPH; Mattson, Christine L PhD; Brown, JW PhD; Wilson, Melinda PhD; Mbengashe, Thobile MBChB; Goldman, Thurma M MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182067d99
Brief Report: Epidemiology and Prevention

Background: South Africa has the greatest burden of HIV-infection in the world with about 5.2 million HIV-infected adults. In 2003, the South African Government launched a comprehensive HIV and AIDS care treatment program supported by the United States in 2004 through the President's Emergency Plan for AIDS Relief (PEPFAR).

Methods: To describe the scale-up and continuation of antiretroviral therapy in South African Government and PEPFAR-supported sites in South Africa, we conducted a retrospective analysis of routinely collected program reporting data, 2005-2009.

Results: From 2005 through 2009, the average rate of persons initiated on antiretroviral therapy in PEPFAR-supported South African Government treatment programs increased nearly four-fold from 6,327 a month in 2005-2006 to 24,622 a month in 2008-2009 resulting in an increase from 33,543 patients on continued treatment in April-June 2005 to 631,985 patients in July-September 2009. Of those 631,985 patients receiving treatment, 65% were women. Men were more likely to be lost to follow-up (9.2% vs. 7.8%, PR 1.18, 95% CI 1.17-1.19) and more likely to die (5.6% vs. 4.1%, PR 1.36, 95% CI 1.35-1.37) than women.

Conclusions: Scale-up and continuation of antiretroviral therapy in South Africa has been a remarkable medical accomplishment. Because more women receive and continue treatment, more efforts are needed to treat and retain men.

Author Information

From the *Centers for Disease Control and Prevention, Global AIDS Program, Atlanta, Georgia; †United States Agency for International Development, Health Programs, Washington, DC; and ‡National Department of Health Programs, Pretoria, South Africa.

Received for publication September 6, 2010; accepted October 15, 2010.

The authors have no funding or conflicts of interest to disclose.

Presented in part at the 17th Conference on Retroviruses and Opportunistic Infections, February 16-19, 2010, San Francisco, CA. Poster Z-111.

Correspondence to: Jeffrey D. Klausner, MD, MPH, 877 Pretorius Avenue, Pretoria, South Africa 0083 (e-mail:

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