MARCH HIV ISSUE 1-16


THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE                                            MARCH 2005  4 1

NEWS

The low registration of patients on HIV management
programmes has received a fair amount of negative
publicity recently. However, research suggests that
enrolment of those who stand to gain the most benefit
from accessing treatment is relatively high. In addition,
the inclusion of antiretroviral therapy into the HIV
prescribed minimum benefits (PMBs) will have a limited
effect on medical schemes.

This is according to Rodney Cowlin, managing director
for Aid for AIDS, a Medscheme initiative that has been in
operation for almost seven years. ‘Aid for AIDS has
looked critically at number of beneficiaries registered on
HIV programmes in relation to the estimated HIV
prevalence within medical schemes,’ he says.

To ensure accuracy, the analysis was carried out on
several medical schemes covering 680 000 lives and the
HIV prevalence for these schemes was calculated to be
10% as of early 2005.

‘To date, 2.7% of beneficiaries from these schemes are
enrolled on AfA (1.9% are receiving antiretroviral
therapy). This includes people at all stages of the
disease,’ says Cowlin. ‘While this enrolment may sound
low, it is unlikely that all HIV-positive beneficiaries
would enrol on an HIV management programme, either
because the disease is in its early stages, and they have
no or few symptoms and are unaware of their HIV
status, or because of the perception that there is no
reason to register on HIV management programmes
until antiretroviral therapy is required.’

An alternative approach to analysing statistics would be
to look at the number of HIV-positive beneficiaries who
have joined HIV management programmes as a
percentage of the number that should be on
antiretroviral therapy (ART). ‘Based on data from the
World Health Organization (WHO), we estimate that at
least 21% of HIV-positive patients should be on ART.
Using the 10% prevalence indicated by the modelling
exercise, this equates to 2.1% of the 680 000 lives.
Currently, 1.9% of lives are actually on ART, which is
close to the estimated number who should be on
treatment,’ Cowlin says.

The data therefore suggest that enrolment of those who
stand to gain most benefit from registering on AfA and
accessing treatment is relatively high. ‘However, this
does not mean that management programmes should
not continue to make every effort to enrol as many HIV-
positive beneficiaries as possible. Early enrolment
provides a valuable educational opportunity and enables
ART to be commenced at the optimal time.’

From 1 January 2005 the PMBs related to HIV infection
have include the provision of ART and appropriate
monitoring tests. However, a 2002 report from the
Centre for Actuarial Research, University of Cape Town
showed that 90% of medical aid beneficiaries already
had access to highly active antiretroviral therapy
(HAART). ‘Currently all 32 of the medical schemes
contracted to AfA make provision for HAART across all
benefit options.’ As a result, the new regulations are
likely to have little impact on the industry as a whole.
The provision of HAART will in fact improve the financial
position of those schemes that did limit access to
HAART in the past, as a result of the favourable impact
on hospital admissions. Further benefit is possible if the
scheme makes use of an HIV management programme.
‘Analysis of HIV-related expenditure incurred by the
schemes referred to in the AfA modelling exercise shows
that the monthly cost of treating a patient who requires
ART (first-line therapy) is R935.00. This includes ART,
consultations, monitoring tests, preventive antibiotics
and the management of common associated conditions,’
Cowlin says.

Generally speaking, medium- to high-contribution
medical scheme options offer good benefits of up to
R25 000 per beneficiary per annum, which is more than
adequate to cover treatment costs for a year (HAART,
including second-line and salvage therapy, PEP and
PMTCT, related medicines and pathology tests).

‘Furthermore,’ says Cowlin, ‘anticipated reductions in the
cost of drugs and monitoring tests will assist schemes to
continue providing reasonable benefits for the
treatment of HIV/AIDS.’

MEDICAL SCHEMES OVERCOMING
HIV/AIDS HURDLES

INCLUSION OF ART INTO THE HIV PMBs

MARCH HIV ISSUE 17-48  4/16/05  10:46 AM  Page 41