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Background In 2001, an international beverage company implemented an HIV workplace programme providing free antiretroviral treatment (ART) for employees and dependents in sub-Saharan Africa, at a time when ART, cost assessments of ART programmes and related public funding was hardly available. This study describes the outcomes of this programme with respect to achieving the UNAIDS 90-90-90 targets in five African countries and analyses trends over the past 15 years. Methods Anonymous human resource data were analysed in three cohorts of participants (those enrolling in 2001– 2005, 2006–2010 and 2011–2015). Results Over 15 years, 42,490 unique individuals in five African countries were tested for HIV in this programme and 746 (1.8%) were found to be HIV-infected. Between 2002 and 2015, the proportion of HIV-positive participants on ART increased from 42% to 94% and the proportion of participants on ART who achieved virological suppression increased from 38% to 87%. Conclusions This study shows that in one of the earliest HIV treatment programmes in Africa long-term success has been achieved, approaching the current UNAIDS 90-90-90 targets, demonstrating that the treatment of HIV in developing countries is possible with superior results at low costs (45 US dollars/employee). Reasons for this success include continuous access to on-site quality care and ART and the assistance of an independent NGO with experience in HIV treatment. This provides an argument to continue private sector involvement in international efforts to combat HIV/AIDS, particularly in light of increased ART targets, under-capacity in the public sector and stagnating international funding.

PROBLEM: A multinational company with operations in several African countries was committed to offer antiretroviral treatment to its employees and their dependants. APPROACH: The Accelerating Access Initiative (AAI), an initiative of six pharmaceutical companies and five United Nations' agencies, offered the possibility of obtaining brand antiretroviral drugs (ARVs) at 10% of the commercial price. PharmAccess, a foundation aimed at removing barriers to AIDS treatment in Africa, helped to establish an HIV policy and treatment guidelines, and a workplace programme was rolled out from September 2001. LOCAL SETTING: Private sector employers in Africa are keen to take more responsibility in HIV prevention and AIDS care. An important hurdle for African employers remains the price and availability of ARVs. RELEVANT CHANGES: The programme encountered various hurdles, among them the need for multiple contracts with multiple companies, complex importation procedures, taxes levied on ARVs, lack of support from pharmaceutical companies in importation and transportation, slow delivery of the drugs, lack of institutional memory in pharmaceutical companies and government policies excluding the company from access to ARVs under the AAI. LESSONS LEARNED: The launch of the AAI enabled this multinational company to offer access to ARVs to its employees and dependants. The private sector should have access to these discounted drugs under the AAI. A network of local AAI offices should be created to assist in logistics of drugs ordering, purchase and clearance. No taxes should be levied on ARVs.

The International AIDS Conference held in Durban in 2000 was a watershed for highly active antiretroviral treatment (HAART) in Africa. Since then HAART in sub-Saharan Africa has been firmly on the international agenda and access to treatment in resource-poor settings has become a top priority. Multiple initiatives were developed to realise the goal of expanding treatment access (The Global Fund to Fight AIDS Tuberculosis and Malaria the US Presidents Emergency Plan for AIDS Relief the World Banks Multi-country AIDS Programme and many others). Although private sector employers in Africa were some of the first to embark on HAART for their workers (eg Anglo-American Compagnie Ivoirienne dElectricite Volkswagen South Africa) public sector approaches have now largely surpassed these efforts. Few large companies in Africa have launched comprehensive AIDS treatment schemes for their workers and dependants. Most employers in Africa hesitate to take responsibility and refer employees to government HIV programmes that are benefiting from international financial support but struggling with implementation. There is an encouraging trend among companies in countries with high prevalence to have HIV policies but even in countries with prevalences between 5% and 20% less than half of companies claim to have an HIV policy. In sub-Saharan Africa only 26% of the companies that have HIV policies provide antiretroviral treatment to their workers. (excerpt)