Evaluation of HIV treatment and prevention programs in South Africa with recommended future actions
Ramatowski, John W.
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The outbreak of Human Immunodeficiency Virus (HIV) is one of the largest public health challenges in history. South Africa disproportionately bears the burden of HIV infections with an estimated 7.7-million people living with HIV. Although a comprehensive treatment and prevention program has been enacted in the country, the health gains achieved by these interventions have fallen short of targets set by the United Nations Programme on HIV/AIDS. Significant proportions of the population are unaware they have contracted HIV and knowledge about HIV transmission is generally lacking. For patients accessing HIV treatment services, adherence to prescribed regimens is a principal barrier to positive health outcomes. These challenges are further compounded by the development of resistance to HIV treatments. Between 2017-2022, South Africa will implement the four-generation ‘National Strategic Plan on HIV, Tuberculosis, and Sexually Transmitted Infections.’ This framework outlines interventions that will address the biomedical, behavioral, and structural barriers that have sustained HIV transmission while accelerating health advances for people living with HIV. As a result of this integrated approach and the targeted intervention population, South Africa operates the largest HIV treatment program in the world. Evaluation of South Africa’s HIV treatment and prevention activities are needed to ensure the enacted programs continually meet the needs of the population as they change over time. Additionally, program evaluation ensures limited resources are allocated in a judicious manner. Collectively, these evaluations can result in program alterations that deliver the maximum health benefit for all South African citizens. Upon analysis of the South Africa’s National Strategic Plan, several flaws in current program delivery, funding allocations, and accountability actions are immediately evident. The four generation Plan does not include specific steps outlining the exact actions that should be followed by local health officials. The Plan architects failed to incorporate key recommendations from previous investigations there were specific to the South African HIV care delivery model. If these shortcomings persist, South Africa is unlikely to meet proposed HIV reduction targets set by global health organizations. From this analysis, several amendments are recommended to the current plan, including the application of artificial intelligence behavioral mapping for at risk populations and the reallocation of funding to condom distribution, medical-male circumcisions, and social behavior change activities. These amendments represent actionable items that can spur health advancements for the HIV treatment and prevention program in South Africa.