IMPLEMENTATION PLANTO SCALE UP

HIV/AIDS PREVENTION AND TREATMENT

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Background

• World AIDS Day 2009– President announces new approach in the

fight against HIV and AIDS– All public health facilities (fixed and mobile)

must provide HIV testing– All PHC facilities to provide ART– Directs that the announcement will be with

effect from 1st April 20102

National Strategic Plan on HIV and AIDS, 2007-2011 Goals

• To reduce the rate of HIV infection by 50% by 2011

• 80% of people that need treatment to be provided with antiretroviral treatment

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Implementation of World AIDS Day Announcements

Prevention strategy for HIV/AIDS

• Information, education, mass mobilisation

• STI detection and management

• Know your status – HIV testing and counselling

• Widespread provision of condoms (male and female)

• Medical male circumcision

• Prevention of mother to child HIV transmission (PMTCT)

• Safe blood transfusion• Post-exposure

prophylaxis• Life skills education 4

HIV Counselling and Testing (HCT) Campaign• HCT is moving from voluntary testing, to a

service delivery model to offer HCT to all patients at their entry point in the health system

• Objectives– Mobilize people to know their status.– Support people with key prevention messaging in

order to take proactive steps to a healthy lifestyle irrespective of HIV status

– Increase incidence of health seeking behaviour; and– Increase the access to treatment, care and support

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Components of the HCT Campaign

• National Launch• Provincial launches (all 9 provinces)• Mass social mobilisation• Communication and advocacy• Health systems strengthening• Ongoing monitoring & evaluation

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I AM RESPONSIBLE...I must take responsibility for my own

health and HIV status i.e. if I am HIV negative, to stay negative, if I am HIV

positive, to seek support and services to ensure I am healthy and don’t spread

the virus to others, be they partners or children

Campaign Theme – Continuation from World AIDS Day

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WE ARE RESPONSIBLEWe must take collective responsibility for

enabling those in our sphere of influence to make healthy choices (be they our children, our sexual partners,

our employees etc.)

Campaign Theme – Continuation from World AIDS Day

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SOUTH AFRICA IS TAKING RESPONSIBILITY

Government and social partners are taking collective responsibility to ensure that quality services are

available when people present to test and to treat

Campaign Theme – Continuation from World AIDS Day

Target Population, June 2011

• 15 million people targeted for HCT– 3.8 million people in 9 initial launch districts – 9.9 million in phase II (July 2010 – March 2011)– 1.2 million in phase III (April – June 2011)– Paying specific attention to 18 health priority

districts (poorest districts)

Location• Health facilities• School campaign• Outreach in the community (mobile units)

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HCT Rollout PlanProvince Districts Rolled out

Apr – Jun 2010Phase I

Districts Rolled out Jul 2010 – Mar 2011

Phase II

Districts Rolled out Apr – June

2011Phase III

EC 1 3 3

GP 1 3 2

LP 1 2 2

NC 1 2 2

WC 1 2 3

KZN 1 5 5

MP 1 1 1

FS 1 2 2

NW 1 2 1

TOTAL 9 22 21 11

HCT Targets – Initial launch districts

   TOTAL

POPULATIONTARGETED

POPULATIONTARGETED

PRETEST COUNSTARGETED

TESTS

EC OR Tambo 1,828,557 1,009,611 544,177 494,709

FS Motheo 794,184 519,765 280,154 254,685

GP Ekurhuleni 2,622,298 1,805,692 973,268 884,789

KZN Ugu 710,847 425,518 229,354 208,504

LP Capricorn 1,206,089 696,763 375,555 341,414

MP Gert Sibande 920,205 568,001 306,152 278,320

NWDr. Kenneth Kaunda 708,193 466,495 251,441 228,583

WC Cape Town 3,242,009 2,167,516 1,168,291 1,062,083

NCJT Gaetswe (Kgalagadi) 197,627 116,970 63,047 57,315

Total 12,230,009 7,776,331 4,191,439 3,810,40212

HCT Targets- Provinces

 TOTAL

POPULATIONTARGETED

POPULATION

TARGETED PRETEST COUNS

TARGETED TESTS

EC All districts 6,884,482 4,117,741 2,219,462 2,017,693

FS All districts 2,972,983 1,926,174 1,059,396 963,087

GP All districts 9,859,543 6,834,865 3,683,992 3,349,084

KZN All districts10,077,620 6,243,334

3,365,157 3,059,234

LP All districts 5,357,949 3,144,090 1,694,664 1,540,604

MP All districts3,646,123 2,236,374

1,205,405 1,095,823

NW All districts 3,229,078 2,038,488 1,098,745 998,859

WC All districts 4,945,732 3,280,801 1,768,351 1,607,592

NC All districts 1,108,599 689,675 371,735 337,941

National 48,082,109 30,511,542 16,466,907 14,969,91713

HCT Campaign National Launch

• Venue: Gauteng Province (follow-up to World AIDS Day)

• Date: 15th April 2010• Target person: President / Deputy

President

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National Campaign

• Mass media – national radio, television, video snippets, personal journeys and testimonials of range of South Africans– Includes Prevention messaging

• Cellphone outreach to encourage testing• Use new technologies for outreach and

monitoring

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Provincial Launches

• The event will be simultaneously launched in the other 8 provinces by the National Ministers and Deputy Ministers on 19 April 2010

• The provincial launches will take place at the largest and most accessible hospital/health facility in the selected district (next slide)

• Form: health and wellness fairs, offering visitors access to a range of health tests available through the health facility. Mobile testing will also be offered by partners

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HCT Campaign Provincial Launches - 19th April 2010

(As selected by Provinces)Province District• Eastern Cape OR Tambo• Free State Motheo• Gauteng Ekurhuleni• KwaZulu-Natal Ugu• Limpopo Capricorn• Mpumalanga Gert Sibande• Northern Cape JT Gaetsewe• North West Dr. Kenneth Kaunda• Western Cape City of Cape Town

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District social mobilisation interventions (all SANAC sectors)

• Door to door campaigns • Taxi rank/malls/public gathering

activations• Education Institution events• Community events• Engaging the religious sector• Linking HCT to existing community events,

health and wellness days 18

Health Systems Strengthening

Health facility readiness includes:• Recruitment of health workers:

– Retired nurses and other cadres of health workers – Letter from Minister has been sent

• Orientation of health care workers in the new HCT guidelines– Started 8 March in North West – 120 health

workers trained

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Health Systems Strengthening

Health facility readiness includes:• Procurement of test kits and

commodities – national tender in place

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Flow Diagram – Adult PatientsRegistration

Triage; Blood Pressure; Consent

Pre-Test Counselling

HIV Testing(2 rapid tests)

Both PositiveCD4 and clinical staging

(See Next Page)

Both Negative

Post-Test

Counselling; Risk Assessm

ent; Preventi

on Messagi

ng; Condom

s; STI screenin

g

One Negative,

One PositiveBlood taken

for ELISA

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Flow Diagram – HIV PositiveCD4

> 200

Pre-ART PackageWomen:

Positive Prevention; Nutrition

Counselling; Cotrimoxazole; INH;

Condoms; Pap Smear; Family

planning advice; Repeat CD4 6-

monthly or annually

Men:Positive Prevention;

Nutrition Counselling;

Cotrimoxazole; INH (TB Prevention);

Condoms; Repeat CD4 6-monhtly or

annually

< 200

Full ScreeningFBC, ALT, TBInitiate ART

TB Treatment / INH Prophylaxis

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Flow Diagram – HIV Positive Pregnant Women

CD4 Count

> 350

Full antenatal screeningFBC, Syphilis, TORCH, Pap

SmearTwo ARV drugs from 14 weeks of

pregnancy until 1 week after delivery

BabyNVP syrup on

breast-milk

< 350

Full Antenatal ScreeningFBC, Syphilis, TORCH

Full ART

Baby gets NVP at birth daily for 6 weeks

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Full range of services to be provided by HCT sites

• HIV counselling and testing (HIV)• Blood pressure (Hypertension)• Blood sugar (Diabetes mellitus)• HB (Anaemia)• TB screening (symptomatic screening, 5

questions)– Full clinical TB screening is yes to any of the

5 questions (sputum, culture, x-rays)24

Testing

CURRENT NEXT 12 MONTHS

CURRENT NEXT 12 MONTHS

Condoms

Medical Male Circumcision

CURRENT NEXT 12 MONTHS

INH Prophylaxis for TB Prevention

CURRENT NEXT 12 MONTHS

8,000 patients provided INH prophylaxis

Increase to 45,000 HIV+ patients accessing INH

ART for Pregnant Women

CURRENT NEXT 12 MONTHS

TB-HIV Co-infected Patients

CURRENT NEXT 12 MONTHS

Infants accessing ART

CURRENT NEXT 12 MONTHS

Total ART Patients

CURRENT NEXT 12 MONTHS

ART Provision

CURRENT NEXT 12 MONTHS

4,300 PHC Facilities providing

Full package ART by

March 2011

Human Resources

CURRENT NEXT 12 MONTHS

Summary Estimates by end of June 2011:

Total tested: 15 millionTotal testing positive: 1.65 million

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Campaign in Numbers

• Lay counsellors – 9,000 trained, in facilities

• Nursing Council – 9,385 letters sent• Letters written to retired pharmacists,

social workers, SA Retail Association (50 testing sites to be set up in 50 malls by April 2010, increasing to 500 sites in 3 years)

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THANK YOU

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