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The Health Impact of Free Access to Antiretroviral Therapy in South Africa
33 Pages Posted: 6 Jan 2020More...
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 enrolment indicators to estimate the reduction in mortality and morbidity attributable to ART availability, using a difference-in-difference model specification. The analysis focus 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 the availability of 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 the availability of 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). Eddy van Doorslaer acknowledges the Stellenbosch Institute for Advanced Study for a Research Fellowship in 2016. Ronelle Burger is grateful for funding from the National Research Foundation’s Research Career Advancement Programme.
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: Stellenbosch University institutional review committee issued an ethical waiver for this secondary data analysis.
Keywords: HIV; ART; mortality; self-reported health; South Africa
Suggested Citation: Suggested Citation