1. Characterizing the South Africa ART Market
Heather Awsumb, K. Little, P. Aylward and N. Hasen
9th IAS Conference on HIV Science (IAS 2017)
26 July 2017

2. Conflict of Interest
No conflicts of interest to declare.
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3. Background

4. There is little known about the role of HIV treatment service delivery in the private sector
Source: Prevention Gap Report, 2016, UNAIDS

5. Why South Africa?
Data Notes: All data from aidsinfo.unaids.org

6. South Africa spends the most on HIV, the majority of it from domestic/public sources
Data Notes: All data reported for 2015 at aidsinfo.unaids.org

7. Key Questions
Has the rapid increase in public sector treatment access reduced demand for treatment in the private sector?
Is there any evidence that patients with treatment failure are turning to the private sector?

8. Methods

9. Data Sources & Definitions
Global Price Reporting Mechanism (GPRM) – exported January 2017
IMS Health sales data for South Africa from June 2011 to May 2016
Complete data sets for calendar years
First line (1L) regimen = Efavirenz or Nevirapine & paediatric LPV/r
Second line (2L) regimen = Atazanavir or Lopinavir/Ritonavir (all other doses)

10. Methods
Only comparable units in GPRM and IMS Health datasets were total volume of units procured.
Calculated “patient years of treatment” (PYT) by dividing the number of units procured by the number of units needed to treat a patient for 1 year.
𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑢𝑛𝑖𝑡𝑠 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑢𝑛𝑖𝑡𝑠 𝑝𝑒𝑟 𝑃𝑌𝑇 =𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑃𝑌𝑇
Analyzed data using Pivot Tables in Excel

11. Results

12. Private sector procurement would be enough for the 14th largest treatment program in the world and the 10th largest in Africa
Data Notes: Data reported for 2015 at aidsinfo.unaids.org

13. The number of PYTs for 1L ARVs peaked in 2014 in the private sector

14. Rapid growth in total public sector PYTs for 1L regimens did not appear to significantly displace 1L PYTs in the private sector

15. TDF/FTC/EFV had the highest PYTs for 1L ARVs in the public and private sector
Other for Private Sector included: LPV/r 80/20mg, LPV/r 100/25mg, EFV 200 mg, AZT/3TC/NVP 300/150/200, NVP 50mg/5ml, EFV 50mg, AZT/3TC/EFV 300/150/600mg
Other for Public Sector included: LPV/r 80/20mg, EFV 50mg, NVP 10mg/ml

16. PYTs for 2L treatment in the private sector increased by 15% overall between 2012-2015

17. Growth in total public sector PYTs for 2L regimens also did not appear to significantly displace 2L PYTs in the private sector

18. Conclusions

19. Limitations
The GPRM and IMS Health data may not be completely analogous.
A patient year of treatment (PYT) is not the same thing as a person receiving treatment.
Some private sector providers may be providing treatment using public sector procurement and/or financing.

20. Results
Total procurement in the South African private sector is significant when looked at on a global scale.
Evidence indicates that patients continue to rely on the private sector for 1L and 2L treatment even as they become increasingly available in the public sector.
It appears that, on the whole, the private sector is in line with the South Africa treatment guidelines.
Data suggests that there is almost no paediatric treatment in the private sector.

21. Opportunities
There may be opportunities to leverage domestic funding through the private sector as donor and domestic public sector budgets and facilities reach capacity.
Conduct landscaping of cost to patients in both the private and public sector.