Page 266 - HIVMED_v21_i1.indb

Page 2 of 8 Original Research

has been accompanied by the increased survival of people In this study, the prevalence rate of treated PLWH was
living with the HIV (PLWH), that is, an increase in the calculated per 1000 medical scheme beneficiaries annually
1
number of persons on long-term care. The increase in PLWH who claimed one or more prescriptions during the specific
11
is also seen in the SA medical schemes environment. year :
7,8
Between 2012 and 2017, the Council for Medical Schemes
(CMS) reported that the number of its members on ART Allnew andpre-existing cases
increased by 72.4%, that is an average annual growth rate of Prevalence rate = during a given period (10)
×
n
about 11.51%, to 25.12/1000 beneficiaries in 2017. In spite of The population during the same period
7
managed HIV or AIDS being ranked fourth after n = 3
hypertension, hyperlipidaemia and diabetes mellitus on SA-
CDL, and being the ‘best managed’ chronic condition in [Eqn 1]
7,8
the SA private sector, the influence of HIV or AIDS remains
9
poorly studied in the private healthcare environment. The population in Equation 1 includes the total population or
Understanding the epidemic of HIV or AIDS in this context the population of specific gender or age group on the
is important to follow and monitor. Hence, against this database who claimed one or more prescriptions during the
background, this observational study sought to determine specific year.
possible changes in the incidence and prevalence rates of
treated SA-PLWH who accessed private medical schemes The incidence rate was used to determine the proportion of
care from 2005 to 2015. study participants who had newly registered their HIV or
AIDS status with their medical schemes during the study
Research method and design period without taking into account when participants
contracted the disease. Each participant was followed from
Study design and setting the time he or she was registered with the central database.

The study design incorporates a longitudinal and Participants who cancelled their membership with a specific
retrospective review of data of an open cohort of PLWH from medical scheme did not contribute to the year’s denominator,
01 January 2005 up to 31 December 2015. The data were whereas new members did.
sourced from a large SA pharmaceutical benefit management
(PBM) company with more than 1.8 million beneficiaries in The HIV or AIDS incidence rate was calculated as the number
42 medical schemes and capitation plans. To ensure the of new cases per 1000 medical scheme beneficiaries who
quality of its data, the PBM company applies several claimed one or more prescriptions during the specific year.
11
automated confirmatory validation steps to the data. The The incidence rate was calculated as follows:
cohort includes all its members who claimed ART and whose Number of new cases of a disease on
International Classification of Diseases-10 (ICD-10) diagnostic the database in a specified period
n
codes, namely, B20–B24, confirmed the presence of HIV and/ Incidencerate = Size of population at start of × (10)
or an HIV-related condition. The research database includes the specified period
only those PBM members who claimed one or more
prescriptions during the study period. Table 1 summarises n = 3
the yearly demographic profile of the study population. The [Eqn 2]
dataset includes the following fields: patient’s demography,
namely, date of birth, gender, a unique code for the medical The population in Equation 2 includes the total population or
scheme member and beneficiary, prescription number, date the population of specific gender or age group on the
of dispensing, trade name of the medication, the National database who claimed one or more prescriptions during the
Pharmaceutical Product Index (NAPPI) code of each particular year.
medicine, the International Statistical Classification of
Diseases and Related Health Problems, 10th Revision (ICD- Data analysis
10) code and name of the province where each item was
10
®
®
dispensed. The Statistical Analysis System (SAS 9.4 ) software (SAS
Institute Inc., 2002–2012) was used to analyse the data. Variables
were expressed using descriptive statistics, which include
Statistics: Variables and measurements numbers (n) and proportions presented as percentages (%).
The number of HIV or AIDS patients on the database was
stratified by year, gender, age group and province. The Ethical consideration
patient’s age was determined at the time of the first dispensing
in the index year, namely, 2005. It was thereafter divided into This study was approved by the Health Research Ethics
seven age groups: > 0 and < 6 years; ≥ 6 and < 12 years, ≥ 12 Committee of the North-West University (certificate number
and < 18 years; ≥ 18 and < 40 years; ≥ 40 and < 60 years; ≥ 60 NWU-00179-14-A1), and the ‘Goodwill Permission’ to
and < 70 years; and ≥ 70 years. Patients were also grouped perform the study was obtained from the board of directors
into two categories according to their gender (male and of the company. All data were anonymised prior to the
female) and province. incorporation in this study.

http://www.sajhivmed.org.za 258 Open Access