Longer HIV treatment supplies can support better long term adherence

Over the past decade, South Africa’s HIV response has come a long way. However, more than 2.3 million people living with HIV (PLHIV) in South Africa are still not on lifesaving antiretroviral treatment (ART) — either because they do not know their HIV status, or more worryingly having been diagnosed with HIV and possibly having started treatment and then stopped. One of the biggest challenges now facing South Africa’s HIV response is how to support many more PLHIV to engage or re-engage and then stay on treatment. 

One way to make it easier for PLHIV to adhere to treatment is to provide a longer supply of medicines. It is well known that each time someone is asked to return to the clinic or spend an extended time at a clinic, there is an increased risk of that person disengaging from care. Taxi fares, long waiting times, and the fear of being shouted at the clinic, can all drive people to avoid or be unable to collect prescriptions, only worsened as a result of the COVID-19 pandemic. Longer supplies simply means less trips to the clinic. 

Currently national government policy says that all PLHIV should receive at least two months supply of ARVs, however both the Department of Health and PEPFAR are committed to extend this to three months supply and eventually six months supply. We welcome this commitment, however the rollout of longer supplies needs to happen much more quickly.  

According to Ritshidze data collected from October to December in 2020, currently most PLHIV are receiving a 2 month supply of ARVs — yet worryingly, 18% of PLHIV still reported receiving refills of 1 month or less. 

In total, 81% of PLHIV interviewed through Ritshidze received 2-months or shorter refills, compared to only 21% of PLHIV supported by PEPFAR in other countries receiving less than three months. Further, amongst PLHIV supported by PEPFAR in other countries between July-September 2020, 20% of adult men and 19% of adult women received 6 months of ART refills. Yet only 1% of Ritshidze respondents reported receiving 6 months supply. Compared to other PEPFAR supported countries, South Africa is lagging far behind. 

There is a substantial difference in length of ARV supplies given out across provinces that were monitored. The table below outlines the percentage of PLHIV reporting 1 month or less supply per province, with a large variance amongst provinces.

When we look at a site level, some clinics are doing well, and ensuring longer supplies for PLHIV, which is to be commended:

However, for PLHIV at other sites, the situation is far worse. Below highlights the sites with the most PLHIV reports of 1 month supply. It is critical that the Department of Health and PEPFAR urgently investigate why these clinics are failing to provide at a minimum 2 months supply in order to urgently address the challenges. 

So what can the Department of Health and PEPFAR do?

  • Investigate all clinics shown to be providing 1 month or less supply of ARVs to people living with HIV and take action to remedy the situation urgently. 
  • People on ART for at least 6 months and responding well, should be offered refills of ART lasting 3 to 6 months, preferably six months.
  • Retain the government gazetted commitment to allow for 12 month ART prescriptions.
  • Implement the March 2020 revised Standard Operating Procedures (SOPs) on repeat prescription collection strategies with fidelity

This data set was presented to the Operation Phuthuma meeting on 5th March 2021. You can view the full presentation here. 

Please note: data related to the Western Cape has been excluded from the presentation and blog. This is whilst ongoing discussions with the Western Cape provincial department of health continue in order to allow for Ritshidze to proceed with monitoring. Until this negotiation has concluded, Western Cape DOH has refused to allow us to engage in monitoring or publish any findings.


“Ritshidze” — meaning “Saving Our Lives” in TshiVenda — has been developed by people living with HIV and activists to hold the South African government and aid agencies accountable to improve overall HIV and TB service delivery.

Partner organisations include the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN) and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+)—in alliance with Health Global Access Project (Health GAP), the Foundation for AIDS Research (amfAR), and Georgetown University’s O’Neill Institute for National and Global Health Law.

CLICK HERE to read more and see where we work.