The health department expects to announce the results of its next Aids drug tender in the first week of December, a senior official said on Monday.

The tender is a vital step in switching state patients to a dolutegravir-based regimen, which will provide a cheaper and more effective alternative to the three-drug cocktail currently taken by most state patients.

“We think we can save $900m over five years,” said the health department’s Yogan Pillay, emphasising this was an estimate affected by many variables.

The planned switch is an important aspect of the government’s plans to expand HIV treatment to more patients, in line with its commitment to start patients on treatment as soon as they are diagnosed.

SA has the world’s worst HIV epidemic and had an estimated    7.2-million people living with the disease in 2017, according to  UNAIDS. It also has the world’s biggest treatment programme, which reaches over 4-million state patients.

Six companies had registered generic three-in-one pills containing dolutegravir, tenofovir disoproxil fumarate and lamivudine with the SA Health Products Regulatory Agency, according to Pillay. The latest company to announce the registration of its product is local pharmaceutical manufacturer Aspen Pharmacare, which on Monday launched its version, branded Emdolten. 

The current tender, valued at R14bn when it was announced in January 2015, was originally due to end in March, but was extended by a year to allow enough companies to register products to ensure competitive bidding. There were also delays due to safety concerns, as interim results from a small study in Botswana found women who took dolutegravir in early pregnancy were at higher risk of having fetuses with neural tube defects. Those findings still have to be confirmed when the final results of the study are published in 2019.

Dolutegravir offered considerable public health advantages as the likelihood of patients developing resistance to it was extremely low, said Francois Venter, deputy director of the Wits Institute for Sexual & Reproductive Health, HIV and Related Diseases. Just under a million patients were taking dolutegravir-based regimens around the world, and none had developed resistance so far, he said.

“That is pretty remarkable,” he added.