Applying National Guidelines on ART - Monitoring on ART

Author: Ian M. Sanne, MBBCH, FCP(SA); Lesley Erica Scott, BSc Hons, MSc, PhD; Wendy Susan Stevens, MD
Editor in Chief: Ian M. Sanne, MBBCH, FCP(SA) (More Info)

Last Reviewed: July 8, 2016 (What's New)

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inPractice® Africa’s Continuing Education Unit (CEU) provider, the South African Medical Association, offers physicians 3 CPD points on a 70% pass rate for completing this individual module. Nonphysicians who successfully complete the module will receive a participation certificate. To learn more on CPD credits and participation certificates, click here.

Global and South African Epidemiology of HIV

The UNAIDS Global Report for World AIDS Day 2015 reported that worldwide, an average of 2 million people became newly infected with HIV in 2014.[UNAIDS 2015] In the same year, an estimated 25.8 million people living with HIV resided in sub-Saharan Africa, representing 70% of the global HIV burden.[UNAIDS 2015]

UNAIDS estimated that 15.8 million people living with HIV had access to antiretroviral therapy (ART) as of June 2015.[UNAIDS 2015]  In South Africa, an estimated 6.8 million individuals are living with HIV, with an estimated 3.1 million infected individuals currently accessing HIV care and treatment, which is 45% of those infected. The South African National Strategic Plan strongly supports ensuring access to universal HIV testing and tuberculosis screening for all South Africans with a strong emphasis being placed on early diagnosis.[NSP 2012-2017] There is also a focus placed on health and wellness programmes for those infected and further attempts to increase access to treatment, particularly in the pre-ART group where loss to follow-up remains high.[Clouse 2013a; Clouse 2013b] Each of these programmes for HIV-infected patients (screening, wellness follow-up, and ART) requires an infrastructure to support laboratory monitoring that is managed in a tiered fashion (level 1: primary laboratory; level 2: district laboratory; level 3: regional provincial laboratory; and level 4: national reference laboratory) as outlined by the Maputo declaration.[Maputo 2008] In the public sector in South Africa, this laboratory monitoring is managed through the National Health Laboratory Service (NHLS) (, which provides service to over 80% of the population. Testing for HIV in individuals presenting to the healthcare system follows South Africa National Department of Health Guidelines (Management Guidelines)[ZA NDOH HIV Tx 2015] and World Health Organisation guidance (Management Guidelines).[WHO ART 2013]