Pioneering value-based care in HIV disease management
South Africa’s private healthcare system faces serious sustainability challenges. These include the rise of non-communicable diseases such as diabetes and hypertension, as well as mental health issues like depression and anxiety. An ageing population also requires long-term, comprehensive and costly care. The ongoing HIV/AIDS epidemic continues to place additional strain on the system. These factors, coupled with the inefficiencies of the fee-for-service model, fuel medical inflation and make healthcare increasingly unaffordable.
The fee-for-service model encourages overutilisation, fragmented care and does not empower patients with access to their healthcare data, leaving them in a passive role. Aid for Aids (AfA), a subsidiary of AfroCentric, has led HIV disease management for over 25 years. Its unique value proposition lies in a fully integrated and highly confidential programme that prioritises patient-centric interventions. The aim is to improve quality of life and extend the lifespan of individuals living with HIV.
AfA’s approach has always reflected value-based care principles – well before these frameworks were formally introduced. Today, AfA’s value-based contracting is anchored in our quintuple aim framework:
We recognise there are often trade-offs within these dimensions. For example, removing co-payments may improve access but could also increase unnecessary healthcare costs. Our framework puts members at the centre, with initiatives designed to enhance their overall outcomes.
Our scheme contracts are built around measurable, achievable targets, reviewed annually to improve impact while managing costs. We track clinical outcomes via viral load suppression, medicine adherence and hospital readmission rates. Research confirms that individuals with suppressed viral loads live longer, healthier lives and are less likely to transmit HIV.
AfA also uses geo-mapping to optimise provider networks and actively reduces out-of-pocket expenses, ensuring access to essential care without financial strain. Member and provider experiences are measured through surveys and influence our contracting.
Initial results show fewer hospital readmissions and improved viral load suppression. Our schemes have collectively reached the 95% viral suppression target, demonstrating the success of AfA’s value-based care model and its potential for broader application across the healthcare sector.
These initiatives support SDG 3.3, which aims to end the epidemics of AIDS, tuberculosis, malaria, neglected tropical diseases and to combat hepatitis, water-borne diseases and other communicable diseases by 2030.