Reconciling the science and policy divide: The reality of scaling up antiretroviral therapy in South Africa

Abstract

With the world’s largest national treatment programme and over 340 000 incident casesannually, the response to HIV in South Africa is hotly contested and there is sometimes adissonance between activism, science and policy. Too often, policy, whilst well intentioned, isinformed only by epidemiological data. The state of the healthcare system and socioculturalfactors drive and shape the epidemic and its response. By analysis of the financial,infrastructural, human resources for health, and governance landscape in South Africa,we assess the feasibility and associated costs of implementing a universal test and treatprogramme. We situate a universal test and treat strategy within the governance, fiscal,human resources for health, and infrastructural landscape in South Africa. We argue that theresponse to the epidemic must be forward thinking, progressive and make the most of thebenefits from treatment as prevention. However, the logistics of implementing a universaltest and treat strategy mean that this option is problematic in the short term. We recommenda health systems strengthening HIV treatment and prevention approach that includes scalingup treatment (for treatment and prevention) along with a range of other prevention strategies.