The operational plan. Implementation of the antiretroviral therapy component.

South Africa launched its Operational Plan for Comprehensive HIV and AIDS Care Management and Treatment for South Africa (Operational Plan) in November 2003. This chapter reviews particularly the implementation of the antiretroviral therapy (ART) component of the Operational Plan. Following the release of the Operational Plan substantial progress has been made in the accreditation of sites and patients being initiated onto ART. By the end of March 2005 each of the 53 health districts had at least one accredited site. Unfortunately a national monitoring system is not yet in place. This makes it difficult to provide reliable information regarding ART provision. There has been a substantial increase in ART provision from previous years and individual patient benefits are increasingly visible. However at this stage the numbers of patients on ART are too small to have had large scale effects on the population who are HIV+ or on the broader public health system. Although one of the key principles of the Operational Plan is to strengthen the health system as a whole through an injection of resources paradoxically there is concern that because of the sheer scale of the epidemic in the short term the demand on scarce resources may be undermining the very systems that the Operational Plan seeks to build and strengthen. Sustaining the growth of the programme while ensuring that existing weaknesses in the health system and inequities are not worsened will prove to be the next major challenge to be faced. In addition improved patient and programme monitoring systems that feed back into practice supplemented by a coherent research strategy will be necessary to inform future strategies policy development and funding requirements. (authors)