Switch to six-month ARV supplies running behind schedule

Switch to six-month ARV supplies running behind scheduleActivists from the Treatment Action Campaign take to the streets to demand longer ARV refills for people living with HIV. (Photo: TAC)
News & Features
27th May 2026 | Christina Pitt

By March 2027, the health department aims to have 1.5 million people living with HIV on a new programme where they can get a six-month supply of antiretroviral medicines at a time. Early indications suggest that implementation of the programme is slow and uneven.

For 1.5 million people in South Africa living with HIV, the routine of long clinic queues, missed work, and travel costs could be cut to just two clinic visits a year by March 2027. This is according to Dr Musa Manganye who is the National Department of Health’s director of HIV/AIDS Treatment, Care and Support.

Under the six-month multi-month dispensing programme (6MMD), people who have been on antiretroviral therapy (ART) for at least 12 months and are virally suppressed can collect a six-month supply of treatment at a time. This effectively reduces medicine pickup visits from four or more per year to just two. Fewer clinic visits could also ease pressure on overcrowded health facilities while limiting the risk of treatment interruption linked to missed appointments.

The 6MMD initiative comes as South Africa continues to carry one of the world’s largest HIV burdens where an estimated 7.9 million people are living with HIV. Of those, only eight in ten are currently on antiretroviral treatment, with well over nine in ten of those on treatment being virally suppressed. Consistently taking antiretroviral medicines as prescribed keeps HIV levels in the blood suppressed, dramatically reducing the risk of illness, death and onward transmission of the virus.

Some evidence from Malawi and Zambia suggests that six-month dispensing of antiretroviral therapy can improve retention in care.

How does 6MMD work?

6MMD forms part of what is called a differentiated service delivery model. The idea is to adapt HIV services to people’s needs. For example, under such a differentiated model, someone who is healthy and stable on treatment would not be asked to come to the clinic all the time, but someone who just started taking treatment and is struggling will be offered lots of extra support.

During a routine clinical consultation, healthcare workers assess whether someone meets the 6MMD eligibility criteria, which includes viral suppression and having been on antiretrovirals for at least 12 months. If someone qualifies, they are given the first six-month supply right away. They are then required to return to the facility twice a year for follow-up consultations and to collect their six-month refills.

Public health specialist Lynne Wilkinson told Spotlight that South Africa has used multi-month dispensing in various forms for many years. For instance, three-month multi-month dispensing (3MMD) was expanded in 2020 during the Covid-19 pandemic. This was when temporary emergency measures allowed stable patients to receive longer prescriptions, including up to 12 months in some cases.

Helping shape the thinking behind longer dispensing models, a study found that patients receiving 12-month scripts had similar retention in care and viral suppression outcomes to those on six-month prescriptions, while attending clinics less often, Wilkinson said.

South Africa included 6MMD in its 2023 ART Clinical Guidelines, which also includes three- or four-month supplies, replacing the previous two-month dispensing model. In reality, the amount of antiretrovirals people are given at a time has differed widely across the country.

Policy promises vs real-life delays

The plan to scale up 6MMD to 1.5 million people by March 2027 followed initial commitments made on World AIDS Day 2024 by Health Minister Dr Aaron Motsoaledi. While he set targets for three-month dispensing in his speech, he mentioned, but did not announce any 6MMD targets. At the time, civil society groups called for at least 30% of eligible patients – estimated to be around 750 000 to 1 million people – to receive six-month supplies by June 2025.

Following funding disruptions due to the withdrawal of United States aid, a February 2025 Western Cape health circular instructed facilities in the province to urgently implement 6MMD for eligible patients where stock allowed. While the province moved ahead with implementation, Manganye said, the broader national scale-up only began in August 2025.

The health department’s plan was to introduce the 6MMD programme in phases:

  • Phase 1 started in August 2025 at around 10 to 15 facilities per province.
  • Phase 2 began in September 2025 and expanded implementation through to April 2026, with a combined target of enrolling 200 000 patients.
  • Phase 3 started in April 2026 and involves a full rollout to facilities across the country by March 2027.

Community-led clinic monitoring group Ritshidze, which HIV activist organisation the Treatment Action Campaign (TAC) forms part of, has been keeping an eye on whether people living with HIV have been able to get three-month or longer supplies of HIV medicines.

A Ritshidze report citing data obtained from the health department showed that around 25 000 people had been enrolled for 6MMD across 82 facilities in eight provinces, by October 2025.

TAC chairperson Sibongile Tshabalala told Spotlight that progress in the early rollout phases was “very slow across most provinces” with no rollout in Limpopo by the end of January 2026.

Manganye said that Limpopo has since caught up. He explained that the initial delay was due to extended consultations to ensure an effective rollout. Limpopo’s 6MMD rollout began in February 2026, and by the end of March 27 805 patients were part of the programme, the province’s health department spokesperson, Neil Shikwambana, told Spotlight.

125 000 by April 2026

Overall, Manganye maintains that the country’s 6MMD programme is showing early signs of success. He said that it has resulted in reduced clinic visits, alleviating pressure on clinics, and improving service efficiency. It has also improved retention in care by reducing barriers such as missed appointments and transport-related delays, Manganye added.

As of April 2026, 124 623 patients across 142 facilities had joined the programme nationally, he said.

This is around 75 000 short of the department’s phase two target of 200 000.

Beyond the pace of the rollout, TAC has also taken issue with the structure of the programme.

They caution that a narrow Phase 3 rollout might limit progress. For instance, not allowing patients to sign up for 6MMD because they are already part of other programmes like the Centralised Chronic Medicines Dispensing and Distribution (CCMDD) system could affect access. The CCMDD system, among others, allows people to collect their medicines at pickup points like private pharmacies rather than clinics.

“Now that we are in the last phase of rollout, we expect a very quick catch-up to ensure that across provinces, 1.5 million people are receiving 6MMD by the end of March 2027,” Tshabalala said. “In order to meet these targets, all barriers must be removed, and all facilities must be offering 6MMD to those eligible immediately.”

Different postal codes, different access

According to Manganye, early implementation of 6MMD was geographically uneven, with rollout in the first two phases concentrated in selected districts in certain provinces.

As a result, Tshabalala noted that “getting 6MMD depended very much on where you live and whether you are lucky enough to live or work close to one of the facilities implementing it”.

These concerns about equity are also reflected in broader patterns of HIV medicines dispensing across the country. Uneven access to multi-month dispensing predates 6MMD. Despite years of national rollout of 3MMD, implementation has been inconsistent across facilities and districts.

Based on Ritshidze’s facility-level surveys conducted in selected districts, KwaZulu-Natal (KZN) illustrates these disparities:

  • In King Cetshwayo, provision of a three-month ARV supply or longer fell from 97% (300 people out of 307 surveys) in January 2025 to just 43% (324 people out of 758 surveys) by April to June 2025.
  • In eThekwini, three-month ARV dispensing dropped from 82% (1 643 people out of 1 982 surveys) to 46% (483 people out of 1 058 surveys) as shorter one-month refills increased.
  • By contrast, uMgungundlovu showed relative stability, with three-month ARV dispensing increasing slightly from 81% (278 people out of 342 surveys) to 84% (477 people out of 562 surveys).

A recent Stop Stockouts Project report by SECTION27 and the Centre for Child Law shows similar patterns over time, with three-month dispensing remaining dominant overall but uneven across the three KZN districts in 2024.

However, the report presents data suggesting that disruptions linked to last year’s cuts to United States aid resulted in more fragmented dispensing practices. This includes a split between one- and three-month refills in eThekwini and a shift toward intermediate dispensing in King Cetshwayo, while uMgungundlovu remained stable.

Such variation has been linked to pressure on the health system, including staff shortages and high vacancy rates, exacerbated in some areas by the loss of staff that were funded with United States aid money. However, some healthcare worker staffing constraints in KZN pre-date these disruptions, with only 18% of 127 facility managers reporting adequate staffing in 2024.

KZN health department spokesperson Ntokozo Maphisa told Spotlight that the decline in three-month HIV medicine refills did not indicate reduced access to treatment, but reflected shifts towards other dispensing models, including CCMDD and 6MMD. For example, he said 14 204 patients in eThekwini had been enrolled on 6MMD by the end of December 2025, moving them out of the 3MMD category.

However, Ritshidze’s facility-level monitoring did not show a corresponding increase in 6MMD uptake, suggesting differences in how dispensing categories are recorded and measured across datasets.

For the national health department, greater access to six-month treatment refills is a work in progress, with the aim being to promote a more universal rollout across urban and rural settings. “Our understanding is that everyone at every level, be it an urban or rural setup, there should be a unison approach in terms of making sure that we upscale and make sure that we decongest our facilities,” Manganye said.

Dashboards promised

Manganye said that routine data does not always reflect the full picture due to challenges in record-keeping and reporting.

There is currently no publicly available national dashboard that tracks 6MMD implementation. But Manganye said they are working with the digital health unit to expand national dashboards tracking 6MMD enrolment. They are expected to go live by the end of May 2026 and will provide visualised data on implementation across facilities and provinces for health officials, providers and the public.

In the meantime, monitoring continues through technical working groups, stakeholder engagements and accountability forums, including South African National AIDS Council structures and Ritshidze, where implementation performance is reviewed.

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TAC argues that in the absence of comprehensive public reporting, public oversight still relies heavily on Ritshidze’s facility-level surveys and targeted community data collection.

They point to previous 3MMD campaigns as evidence that community-led monitoring can influence implementation. In Thabo Mofutsanyana in the Free State, only 11% of the people surveyed by Ritshidze between April and May 2024 reported receiving a three-month supply of HIV medicines, compared to 97% in Bojanala in the North West.

They point out that, following a TAC campaign pushing for wider implementation of 3MMD in the district, Ritshidze data later showed provision of three-month supplies rising to 88% within six months, making it one of the best-performing districts in the province.

Tshabalala said the example highlighted how monitoring data can be used to identify districts and facilities failing to implement national HIV dispensing policies, a concern that TAC says now applies to the 6MMD rollout as well.

“People living with HIV should not have to depend on Ritshidze monitoring and TAC campaigning in their district just to access policies that already exist and should be implemented,” Tshabalala said.

Disclosure: SECTION27 is mentioned in this article. Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

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