- People living with HIV being given a shorter supply of ARVs is one among a number of challenges outlined in a new Ritshidze State of Health report for KwaZulu-Natal (5th edition). The report looks at the impact of the PEPFAR disruptions in our clinics, following the U.S funding cuts and slow response of the government earlier this year.
“I would appreciate receiving a 6 month supply of ARVs. Going to the clinic every month or two is difficult. I have to miss work, wait long hours, and sometimes don’t receive the service I need, only to be told to return the next day. This is a serious problem.”
Giving people living with HIV more pills to go home with reduces how often people must go to the clinic – making it easier to stay on treatment. This is critical to achieving the goal committed to by the National Department of Health – to put 1.1 million of the 2 million people living with HIV not on treatment, on or back on treatment by the end of 2025.
Before the PEPFAR disruptions, KwaZulu-Natal had made considerable progress. 84% of people surveyed in January 2025 were getting a 3 month supply or longer of ARVs. King Cetshwayo was one of the best performing districts in the country with 97% of people on HIV treatment receiving a 3 month supply.
However, after the PEPFAR disruptions, only 53% of people surveyed took home a 3 month supply or longer – a worrying 31% drop. Only 43% of people reported taking home a 3 month supply or longer in King Cetshwayo where PEPFAR support has been permanently withdrawn.
While PEPFAR support is still active in eThekwini, still only 45% of people reported taking home a 3 month supply or longer and extremely concerningly 45% of people reported only taking home a 1 month supply. This did not just happen at one site, but was a trend across multiple clinics in the district. “There was a time when they opened one bottle and shared it among two patients and they said there’s a shortage of ART,” one person living with HIV in the district described about a recent experience. Another explained: “They used to give me a 3 month supply of treatment, but now they are giving me a 1 a month refill from April until now, and they never explained why”.
King Cetshwayo and eThekwini had fallen to be among the worst three performing districts monitored by Ritshidze. The provincial and district health departments must urgently investigate why so many more people are reporting getting a 1 month supply, especially in eThekwini, and intervene to ensure 90% of people get a 3 month supply now.
PEPFAR disruptions have not had the same impact on 3 month supply of ARVs across provinces. The Eastern Cape managed to increase the amount of people getting a 3 month supply or longer to 88% becoming the best performing province monitored by Ritshidze.
Shorter treatment supplies only increase the likelihood of a person interrupting treatment or them never coming back to the clinic at all. The provincial and district health departments must ensure that all clinics immediately adhere to National ART Guidelines and ensure everyone who is not sick is getting at least a 3 month supply of ARVs. In addition, national and provincial level monitoring and management of ARV stock at facilities must urgently be improved.
On top of this, TAC and Ritshidze have been pushing for people to be given a 6 month supply of ARVs at a time for many years, based on evidence from many other countries. “I would appreciate receiving a 6 month supply of ARVs. It would help a lot because when I inform my workplace that I’m going to the clinic, I’m marked absent. I usually leave the clinic around 12pm or 1pm… a 6 month supply of medication would make a big difference because we lose income every time we spend hours at the clinic,” explained one person living with HIV in KwaZulu-Natal.
A commitment was made on World AIDS Day last year from the Minister of Health and Deputy President to begin rollout, and ensure at least 30% of people eligible are receiving 6 months supply. However implementation only started in August with less than 3,000 people enrolled to date in the highest HIV burden province in South Africa.
Very low targets were set nationally that are inequitable and far too slow – only 10 facilities per province until end March 2026. The National Department of Health must adjust targets to ensure that phase 1 and 2 implementation from now until end March 2026 includes a minimum of 50% of all facilities – with full roll out during the last phase.
For more information or to arrange interviews contact:
Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za
Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org
Notes:
The KwaZulu-Natal State of Health report is available here: https://ritshidze.org.za/wp-content/uploads/2025/10/Ritshidze-State-of-Health-KwaZulu-Natal-2025.pdf
A summary presentation is available here: https://ritshidze.org.za/wp-content/uploads/2025/10/Ritshidze-KwaZulu-Natal-State-of-Health-October-2025.pdf
What is Ritshidze?
Ritshidze is a community-led monitoring (CLM) system implemented by the Treatment Action Campaign (TAC). Through Ritshidze, community members systematically collect data at clinics and in the community that are analysed, and then used to generate solutions to problems that are put to duty bearers for action. Community-led monitoring is an indispensable strategy for improving the state of our public healthcare system, and getting more people on ARVs.
How does Ritshidze collect data?
Ritshidze collects both quantitative and qualitative data through observations, as well as through the implementation of standardised surveys and in depth interviews with healthcare users (public healthcare users, people living with HIV, members of key populations) and healthcare providers (Facility Managers, pharmacists/pharmacist assistants). All Ritshidze’s data collection tools, our data dashboard, and all raw data are available through our website.
What changes have been made in where Ritshidze collects data following the PEPFAR disruptions?
Prior to the end of January 2025, Ritshidze data was collected across sites in six PEPFAR priority districts in KwaZulu-Natal: eThekwini, King Cetshwayo, Ugu, uMgungundlovu, uThukela, and Zululand. Following cuts in funding, Ritshidze monitoring has continued in eThekwini, King Cetshwayo, and uMgungundlovu only. PEPFAR implementing partners are still active in eThekwini, Harry Gwala, uMgungundlovu, uThukela, and Zululand – while contracts have been terminated in King Cetshwayo and Ugu. Ritshidze data will be able to document any changes in the quality of service provision following the PEPFAR disruptions in the districts we are monitoring.
What changes were made to data collection to determine the impact of PEPFAR funding cuts on HIV services?
A new tool was developed in this reporting period to survey patients as they exit the clinic. This was to gather evidence to the state of service provision that day – to better understand the impact of the PEPFAR disruptions on clinics. All monitoring tools are available here: https://ritshidze.org.za/category/tools/
Data collection periods and locations
- Facility level data was collected between April 2025 and June 2025 at 60 public health facilities in three districts: eThekwini (20 sites), King Cetshwayo (20 sites), uMgungundlovu (20 sites). Surveys were carried out with 60 Facility Managers, 3,204 public healthcare users and 1,593 people living with HIV in the Patient survey, and 3,425 public healthcare users in the Patient Exit survey.
- Key Population service data was collected in the community between July 2024 and September 2024 in 6 districts in KwaZulu-Natal. A total of 4,252 surveys were carried out (including 2,456 people using public health facilities). This combined 497 gay, bisexual, and other men who have sex with men (GBMSM), 1,257 people who use drugs, 471 sex workers, and 231 trans people.