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Health Department green-lights longer supply of antiretroviral medicine amid US aid freeze

Health Department green-lights longer supply of antiretroviral medicine amid US aid freeze
Tamsin Metelerkamp
By Tamsin Metelerkamp
18 Feb 2025
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The Department of Health has given public health facilities the go-ahead to implement six-month antiretroviral therapy dispensation for eligible patients, as part of a ‘contingency plan’ to respond to the temporary suspension of support by the US President’s Emergency Plan for Aids Relief.

The department’s director-general, Dr Sandile Buthelezi, issued a circular, dated 11 February, detailing the measures that form part of the “contingency plan” to respond to the temporary suspension of support from Pepfar and its implementing partners. 

The notice was addressed to provincial heads of health, directors of health services and CEOs of public health facilities. It green-lit the implementation of six-month antiretroviral therapy (ART) dispensation for eligible patients – a move for which health activists in the HIV sector have been advocating since long before the Pepfar freeze. 

Patients who meet the criteria for a suppressed viral load can receive six-month ART refills where there is sufficient stock at the health facility, according to the circular. This means they would only have to return to clinics twice a year to collect their medication.

Buthelezi noted that the priorities laid out in the circular were focused on “reducing clinic visits and alleviating the burden on health facilities, as already endorsed in national guidelines or implemented as emergency measures during the Covid-19 pandemic”.

Read more: Hundreds march for longer supply of antiretroviral medicine

“The Department of Health’s emergency guidance is both timely and essential. It identifies critical service gaps and where resources may need to be redeployed while also providing practical ways to free up healthcare workers’ time,” said Linda-Gail Bekker, CEO of the Desmond Tutu HIV Foundation and director of the Desmond Tutu HIV Centre at the University of Cape Town.

“By expanding differentiated service delivery, including more self-care where safe, we can reduce dependence on clinic visits and ensure that in-person care is prioritised for those who need it most. With shifts in Pepfar funding, we must be even more strategic – streamlining services and expanding community-based options to safeguard the hard-won gains in HIV treatment and prevention.”

Read more: Trump’s executive orders spark chaos — South Africa’s vital HIV programmes face uncertain future

Read more: Pressure mounts on Health Minister Motsoaledi to remedy ‘catastrophic consequences’ of US aid freeze


Six-month dispensation


The guidelines for six-month ART dispensing were laid out in the department’s 2023 ART Clinical Guidelines. However, these had yet to be implemented nationally at the time of US President Donald Trump’s foreign aid freeze.

Lynne Wilkinson, a Gauteng-based public health specialist in the HIV/Aids sector who co-led the drafting of the 2023 ART guidelines, said patients could qualify for a six-month dispensation once they had been on ART for 10 to 12 months, if both their first two viral loads were suppressed and they were clinically stable. Patients don’t need to be on three-month ART dispensation to receive a six-month dispensation.

Data published by the community-led HIV monitoring group Ritshidze showed that of 12,626 respondents surveyed in January to March 2025 77% were already on three-month ART dispensation. However, Wilkinson noted that this survey didn’t cover infants from six months, post-natal women and people re-engaging after missing their scheduled appointment at their clinic by more than 28 days, who were also eligible for three-month ART dispensation in the guidelines confirmed in the circular.

“Six-month ART dispensation will be provided by clinics – we are not sure as yet that a client will be able to collect more than 3-4MMD [three- to four-month ART dispensation] from [an external] pick-up point,” Wilkinson said.

The Health Department circular also prioritised the enrolment of patients in RPCs (repeat prescription collection strategies), which allow people to collect their medications from external pick-up points.

“This will include assessing every client who has been on ART for more than three months for RPCs enrolment. Offer and enrol immediately and script for six-months with a minimum for two- [to] three-month ART refills,” it stated.

Other strategies laid out in the circular include:

  • Redeploying trained Department of Health staff to ensure the provision of critical services and fill gaps left by Pepfar-funded personnel;

  • Task-shifting at the level of hospitals and clinics, allowing enrolled health workers to assume responsibilities previously managed by Pepfar-supported staff;

  • Implementing a 28-day late collection allowance for patients collecting ART refills at an external or facility pick-up points, or adherence clubs;

  • Implementing automatic script renewal for a further six months at the level of the Central Chronic Medicines Dispensing and Distribution programme (the same emergency action implemented during Covid-19 pandemic);

  • Providing critical clinical service outreach to continue key gender-based violence services; and

  • Strengthening telemedicine and digital health platforms.


“The National Department of Health is in ongoing communication with Pepfar-funded South African implementing partners to ensure the immediate continuation of these life-saving services,” Buthelezi said in the circular.

Read more: USAID-funded HIV organisations in SA struggle to return to work despite US court ruling

“While redeployment of Department of Health staff is necessary at this time, this may change in the very near future should the implementing partners resume services covered by the waiver. However, the priorities emphasised in this circular remain critical for both Department of Health and implementing partner operations to prepare for and shield the HIV programme from potential risks should the US foreign assistance review process result in further cuts to Pepfar funding.”

Daily Maverick approached the department about the budget allocation for the strategies detailed in the circular but had not received a response by the time of publishing. 

Pepfar freeze as ‘opportunity’


On 13 February, US federal judge Amir Ali ruled in favour of the healthcare organisations Aids Vaccine Advocacy Coalition and Global Health Council (GHC) in a lawsuit against Trump and the legality of the foreign aid freeze. The Washington-based judge ordered Trump’s administration to temporarily lift the suspension of all funding for US Agency for International Development (USAID) programmes around the world.

However, many South African organisations that rely on funding from Pepfar have yet to receive any communication from funders that would allow them to go back to work, despite the court ruling and US Secretary of State Marco Rubio’s waiver on the foreign aid freeze for “life-saving humanitarian assistance”, issued on 28 January.

Pepfar spending constituted 17% of South Africa’s R44.4-billion campaign for HIV counselling and testing, according to Health Minister Aaron Motsoaledi. The programme supported 15,374 workers in the health sector at a cost of R4.6-billion.

Bekker told Daily Maverick that the crisis caused by the cut in funding could be seen as an opportunity to introduce measures that would not only improve the lives of people living with HIV, but also “streamline and decongest” the health system.

“There are those people who are perfectly capable of taking care of themselves, and in fact are better off if we allow them, particularly in chronic disease, to get on with taking care of themselves, and that can then free up the resources to provide extra support for those who find it challenging, because of circumstance or complications,” she explained.

The Pepfar freeze was a “wake-up call”, demonstrating the need for South Africa to assume full control of its HIV response, Bekker continued.

“We’ve learned a lot about the HIV response in the last 10, 15 years – around people-centred care, about quality care that retains people in treatment so that they are virally suppressed... and of course, we know that if we do not roll out primary prevention to scale, we are not going to see the reduction in incidents that we believe needs to happen in order to make HIV go away as a public health threat.” DM

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