Official statistics show that viral load testing declined by up to 21% among key groups in the last two months
Funding cuts, particularly from the United States’ President’s Emergency Plan for AIDS Relief (Pepfar), have been cited as a reason behind South Africa’s startling decline in viral load testing.
Earlier this year, President Donald Trump withdrew funding from the Pepfar. This meant suspending some of the United States’ funding for HIV and TB programmes in African countries for 90 days.
During his State of the Nation Address, President Cyril Ramaphosa said the US funding represents about 17% of South Africa’s HIV spend.
Reuters on Wednesday reported that data from the National Health Laboratory Service, a government entity, showed that viral load testing declined by up to 21% among key groups in the last two months.
For individuals with HIV undergoing anti-retroviral therapy, viral load testing quantifies the amount of virus present in their bloodstream.
Viral load testing for individuals aged 15-24 declined by 17.2% in April compared to last April, after dropping 7.8% year-on-year in March. Overall population testing decreased 11.4% in April, according to Reuters.
Maternal viral load testing was down 21.3% in April, after declining by 9.1% in March. Early infant diagnostic testing was also down 19.9% in April after declining by 12.4% in March.
Additionally, nationwide, viral suppression rates among tested individuals decreased by 3.4% in March and 0.2% in April. Young adults experienced even greater declines, suggesting potential disruptions in patient treatment, the data showed.
This is from unpublished data the news agency has seen.
Centre for the AIDS Programme of Research in South Africa (Caprisa) community programmes head and Treatment Action Campaign (TAC) deputy general secretary Patrick Mdletshe said: “The decline in viral load testing in South Africa can be attributed to funding cuts, particularly from the United States’ President’s Emergency Plan for AIDS Relief (Pepfar).
”These cuts have significantly impacted HIV testing and treatment programs, especially among vulnerable populations such as pregnant women, infants, and young adults.”
Mdletshe said key factors contributing to the decline are:
Reduced funding: Pepfar funding cuts have led to a decrease in health worker budgets, resulting in reduced access to care and testing services.
Closure of clinics: NGO-run clinics, which were primarily funded by Pepfar, have been shut down, further limiting access to testing and treatment.
Impact on vulnerable populations: The decline in viral load testing has been particularly significant among key groups.
He said the expected consequences include:
Increased risk of transmission: The decline in viral load testing and suppression may lead to an increased risk of HIV transmission, particularly among vulnerable populations.
Disruption of treatment: Patients may have had their treatment interrupted, which can lead to treatment failure and the development of drug-resistant strains of HIV.
Responding to Reuters, Department of Health spokesperson Foster Mohale said additional analysis was necessary, as South Africa was already facing difficulties with patient retention and viral load testing before the reduction in aid.
However, he said the government was speaking to prospective local and international donors about covering funding gaps.
According to a World Health Organisation (WHO) policy brief, evidence suggests that if a mother living with HIV is taking antiretroviral therapy and maintains a suppressed viral load during pregnancy, delivery and breastfeeding, the risk of vertical HIV transmission can be as low as <1%. If a mother is taking antiretroviral therapy and is undetectable before and throughout pregnancy and delivery, there is no risk of transmitting to the infant during pregnancy.
Additionally, people living with HIV who have an undetectable viral load have zero risk of transmitting HIV sexually, and those with a suppressed viral load have almost zero risk of transmitting HIV to a sexual partner.
