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The Health Impact of a Decade of Free ART Access in South Africa

29 Pages Posted: 15 Jun 2019

See all articles by Cobus Burger

Cobus Burger

Stellenbosch University - Department of Economics

Ronelle Burger

Stellenbosch University - Department of Economics

Eddy van Doorslaer

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

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Abstract

Background: Since 2004 the South African government has rolled out free antiretroviral therapy (ART) at public health care facilities nationwide. No prior studies have estimated the impact of the ART rollout on health and survival based on a longitudinal household survey with national coverage.

Methods: We match household member deaths and self-assessed health from a large national longitudinal survey to community-level ART enrollment indicators to estimate the reduction in mortality and morbidity attributable to ART access. We focus our analysis on black Africans aged 25-49 because this demographic group represents more than two-thirds of all South African HIV cases.

Findings: We find that access to ART has reduced annual mortality by 0∙5 percentage points (95% CI - 0∙80 – -0∙11) and has decreased the likelihood of reporting poor health by 1∙8 percentage points (95% CI -3∙00 – -0∙66) for black Africans aged 25-49. In relative terms, these estimates amount to annual reductions of 30∙7% in annual mortality and a reduction of 46.6% in the proportion of individuals reporting poor health in this demographic category.

Interpretation: Our findings confirm that access to ART treatment had a dramatic impact on health, both in terms of prolonged survival, and in terms of improved health-related quality of life, with most of these gains concentrated among the high HIV prevalence group of black Africans aged 25-49.

Funding Statement: This work is based on research supported in part by the National Research Foundation of South Africa (Grant Numbers: RCA13102556861 and CPRR150722129596).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: Not required.

Keywords: HIV, ART, mortality, self-reported health, South Africa

Suggested Citation

Burger, Cobus and Burger, Ronelle and van Doorslaer, Eddy, The Health Impact of a Decade of Free ART Access in South Africa (June 13, 2019). Available at SSRN: https://ssrn.com/abstract=3403352 or http://dx.doi.org/10.2139/ssrn.3403352

Cobus Burger (Contact Author)

Stellenbosch University - Department of Economics ( email )

Private Bag X1
Matieland, 7602
South Africa

Ronelle Burger

Stellenbosch University - Department of Economics

Private Bag X1
Matieland, 7602
South Africa

Eddy Van Doorslaer

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

Netherlands

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