Can South Africa meet its ambitious goal to end AIDS?

published on July 22, 2016 by Jon Cohen, in PBS

On a Wednesday morning in April, a line of 600 HIV-infected people snakes through the hallways to the first waiting room of the Themba Lethu Clinic, a wing of the Helen Joseph Hospital in Johannesburg, South Africa. In most places in the country, where clinics are overtaxed, this would presage a wait of up to 10 hours. But here something different is happening. Staffers at computer monitors swiftly log in people and dispatch them for triage or, if they have tuberculosis, a special area away from others. Those who only need their antiretroviral (ARV) drugs walk directly to the pharmacists, who retrieve each patient’s electronic medical record and use a robotic system to pull drugs from shelves and fill orders. The average wait time is 30 minutes to two hours to complete a doctor or nurse visit and 15 minutes at the pharmacy. A prototype ATM promises to further speed visits by directly dispensing ARV pills; one day, it is hoped, similar pill machines in shopping malls could make some clinic visits unnecessary.

“This is an awesomely efficient place,” says Dr. Ian Sanne, who heads Right to Care, a nongovernmental organization that runs this and several other clinics in collaboration with the health department. In developed countries, where patients complain about much shorter waits, this boast might seem absurd. But in South Africa, the Themba Lethu Clinic is celebrated as an example of what can be done to care for large numbers of HIV-infected people. This is at once a compliment to the clinic and a hint of the country’s overwhelming HIV/AIDS challenge.

South Africa has pledged to ramp up efforts to end its massive HIV/AIDS epidemic, the world’s largest. Come September, it will offer every infected person ARVs, which both stave off disease and make people less infectious. The immediate goal is to reach what is known as 90-90-90 by 2020: to have 90 percent of infected people aware of their status, 90 percent of known positives start ARVs, and 90 percent of that group drive the amount of virus in their bloodstream down to un-detectable levels. The theory is that as viral levels drop, transmission will, too, leading the epidemic to spiral downward. This 90-90-90 target is the cornerstone of a grand campaign, articulated by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and widely embraced by world leaders, to end the AIDS epidemic “as a global public health threat” by 2030.

In a nation estimated to have at least 6.6 million HIV-infected people—18 percent of the world’s total—the drive to hit 90-90-90 by 2020 seems overly ambitious to many experts. And the obstacles faced by South Africa provide a sobering reality check to the lofty, laudable aspiration of ending AIDS, a topic that promises to occupy center stage later this month in Durban at the biannual International AIDS Conference.

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Can South Africa meet its ambitious goal to end AIDS?

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