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In addition, an estimated 35 000 babies were born with HIV during that same period in the country because a feasible mother-to-child transmission prophylaxis programme using nevirapine (an anti-Aids drug) was not implemented, the authors write.
The paper estimates the consequences of the HIV/Aids policies followed by the South African government for a five-year period when neighbouring countries ramped up their HIV-prevention programmes.For comparison, the authors used Botswana and Namibia, neighbouring countries facing epidemics of similar scale and dynamics and with similar resources per capita.
South Africa is one of the countries most severely affected by the Aids epidemic. The authors cite UNAIDS data that the prevalence of HIV/Aids in the adult population is 18.8 percent, with approximately 5.5 million persons infected with HIV.
Under the leadership of Thabo Mbeki, who was president of South Africa during the period examined in the paper, the government restricted use of donated nevirapine and blocked funds for more than a year from the Global Fund to Fight Aids, Tuberculosis, and Malaria awarded to KwaZulu Natal, the authors recount. President Mbeki formally resigned in September 2008.
The authors estimated the lost benefits of ARV drug use for two groups: Aids patients and children born to HIV-infected mothers. The research team framed those lost benefits as "person-years", meaning the number of years of life lost due to premature death from HIV/Aids. The team chose a limited time period for examination to estimate only the ARV benefits already lost and to avoid speculation about the future direction of ARV policies in South Africa.
The pharmaceutical company Boehringer Ingelheim announced in July 2000 that it would offer nevirapine free of charge for five years for the prevention of mother-to-child transmission of HIV-1 in developing economies. South Africa restricted the availability of nevirapine to two pilot sites per province until December 2002, said study lead author Dr Pride Chigwedere.
The government launched a national programme for the prevention of mother-to-child transmission in August 2003 and a national ARV treatment programme in 2004. By 2005, the authors estimated, there was 23% ARV treatment coverage and less than 30% prevention of mother-to-child transmission coverage in South Africa.
By comparison, neighbouring Botswana began a programme for the prevention of mother-to-child transmission in 1999 and a national ARV treatment programme in 2001. Using WHO initiative data, the authors estimated that there was 85% ARV treatment coverage in Botswana and 71% in Namibia by 2005.
Both Botswana and Namibia achieved greater than 70% prevention of mother-to-child transmission coverage by 2005.
To estimate the lost benefits, the research team compared the actual number of persons who received ARVs for treatment or for prevention of mother-to-child transmission between 2000 and 2005 with what was reasonably feasible in the country during that period. They then multiplied the difference by the average efficacy of ARV treatment or prevention of mother-to-child transmission prophylaxis.
"The analysis is robust," said Dr Chigwedere. "We used a transparent and accessible calculation, publicly available data, and, where we made assumptions, we explained their basis. We purposely chose very conservative assumptions and performed sensitivity analyses to test whether the results would qualitatively change if a different assumption were used."
In conclusion, the authors write: "Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available ARVs to prevent and treat HIV/Aids in a timely manner."
The study was published online in the Journal of Acquired Immune Deficiency. – (EurekAlert)
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