The health impact of free access to antiretroviral therapy in South Africa

Cobus Burger, Ronelle Burger, Eddy van Doorslaer*

*Corresponding author for this work

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8 Citations (Scopus)
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Since 2004 the South African government has rolled out free antiretroviral therapy (ART) at public health care facilities nationwide. No prior studies have estimated the impact of the ART rollout on health and survival using a longitudinal household survey with national coverage. We match household member deaths and self-assessed health from a large national longitudinal survey to community-level ART availability in clinics to estimate the reduction in mortality and morbidity attributable to ART availability between 2006 and 2016, using a difference-in-difference model. Our analysis focuses on black Africans aged 25–49 because this demographic group represents more than two-thirds of all South African HIV cases. We find that the rollout of free ART has reduced annual mortality by 27% and decreased the likelihood of reporting poor health by 36% for black Africans aged 25–49. These estimates amount to annual reductions in this demographic category of 31% in annual mortality and 47% in individuals reporting poor health. Our findings confirm that making ART treatment freely available nationwide has had a dramatic impact in terms of both prolonged survival and improved health, with most of these gains concentrated in the high HIV prevalence group of black Africans aged 25–49.

Original languageEnglish
Article number114832
JournalSocial Science and Medicine
Early online date25 Feb 2022
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
The authors acknowledge financial support for this research from the D.P. Hoijer Fonds, Erasmus Trustfonds, Erasmus University Rotterdam for research on health impact in Africa. This work is based on research supported in part by the National Research Foundation of South Africa (grant numbers: RCA13102556861 and CPRR150722129596 . Academic support from ReSEP (Research on Socio- Economic Policy) is also acknowledged.

Publisher Copyright: © 2022


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