Percent of people reporting 2+ partners for the past month among those who had sex in the past year, KwaZulu-Natal (NCS 2006 and 2009) Source: HDA secondary analysis NCS 2006 and 2009. Note: All sample sizes above 260, apart from the Non-African stratum of 2009 (N= 53)
Source: Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. AIDS 1992; 6: 1535-9 Age & gender distribution of HIV infection in South Africa 0 <910-14 Prevalence (%) 15-1920-2425-2930-3940-49 2 4 6 8 10 Female Male >49
PSP 2007-2011 review The review of the current strategic plan document (KZNPSP 2007- 2011) to: (1) determine progress made in the implementation of programmes and interventions; (2) identify main achievements, challenges and opportunities and (3) identify emerging issues. The findings of the review are aimed at assisting in the determination of key priorities for and in the development of a new KZNPSP that will guide the response to HIV & AIDS, TB and STI over the next five years.
PSP 2007-2011 review The KZNPSP 2007-11 is the key guiding document of the provincial response. It envisions a province that is free of new HIV infections where all infected and affected enjoy a high quality of life and aimed to, within five years: 1. to reduce new HIV infections by 50%; and 2. to provide a package of treatment, care and support to at least 80% HIV infected people in order to reduce AIDS-related deaths by 50%. Furthermore it identified the following priority areas: (1) Prevention; (2) Treatment, care & support; (3) Management, Monitoring, Research, and Surveillance of the response and (4) Human rights, Access to justice and Enabling Environment.
Methodology The review principally used: qualitative methods to gather and analyse information. This included: documents and literature review; key informants interview and stakeholder workshops
Achievements Prevention The incidence of HIV is estimated to have declined from 3.8% in 2005 to 2.3% in 2008. HIV transmission rate from mother to child declined from 22% in 2005 to 2.8% in 2010. 100% of primary schools in KZN provide life skills-based education. Further the “My Life My Future” Behaviour Change Programme has been introduced to supplement the Life Skills Programme. Forty eight (48) High Transmission Areas (HTAs) have been established. 100% of government and private health facilities provide continuous supply of PEP medicines. 100% of all blood and blood products are screened in a quality assured manner.
Achievements Prevention The Operation Sukuma Sakhe (OSS)-the poverty eradication programme in KZN is addressing poverty through intensified and renewed strategies that directly focus on individuals and households at community level. The programme is critical to integration and mainstreaming of HIV & AIDS activities. 86.2% of the population in KZN has access to clean water as compared to 70.3% in 2005. Similarly the population with access to sanitation increased to 80.5% from 74.1% in 2005. Male circumcision has been introduced and accepted in the province. The province reported 54 670 MMC operations in the period April 2010 to June 2011 surpassing its yearly target of 53000. It is the province with the highest MMC operations in the country. There has been strong Traditional and political support for this Programme.
Achievements Treatment, Care and Support The estimated number of deaths due to HIV and AIDS has reduced from 67, 429 in 2008/09 to 54,337 in 2010/11. HCT coverage has increased. The 2010/11 HCT mobilisation campaign achieved 95% of its target. ART programme has achieved universal coverage with cumulative total of 459,670, of which 45, 598 are children, having been registered on ART in 2011. HBC is provided in an integrated manner by the Community Care Givers Over 40,000 OVC were provided with services TB and HIV integration interventions have witnessed successful implementation. For example, there was increased uptake of IPT leading to a 71,5%(124,963 patients) achievement against the target of 170,000 patients by June 2011
Achievements Management, Monitoring, Research and Surveillance The province has been able to put in place one M&E framework, thereby consolidating the “Three Ones” principle. Stakeholders in the response have recognized the value of M&E. The province has one coordinating authority at provincial, district and local level, thereby achieving the “Three Ones” principle The Provincial Council on AIDS is fully functional while 82% of the District AIDS Councils and 53% of Local AIDS Councils are fully functional.
Achievements Human Rights, Access to Justice and Enabling Environment There is strong political commitment for Human rights, access to justice and in governance of the response.
Challenges Prevention STI services have not yet reached optimum effect. There is still a high volume of new cases. For example, the total number of new episodes treated in 2010/2011 was 440,714. Further despite 100% partner notification, only 22% of the partners were treated. Condom distribution remains inadequate. Only 18% of male and 27% of female condoms were distributed. Teenage pregnancy remains high. The coverage of MMC remains significantly low. Integration of services remains inadequate. Data from government sector only
Challenges Treatment, Care and Support Poor follow-up of ART patients. Anecdotal evidence suggests that concentrating on following up patients is not as strong. OVC services coverage is inadequate. Only 40% of OVC requiring services were reached. Coverage of the HBC programme cannot be ascertained suggesting gaps in data collection Data was only from Government sector
Challenges Management, Monitoring, Research & Surveillance The practice of M&E has not been fully entrenched as evidenced by absence of data sets for this review. The M&E framework has not been fully aligned to stakeholder operational plans. Research in uncoordinated and the absence of a provincial research agenda means a lost opportunity to ensure that the provincial research needs are fully addressed
Challenges Human Rights, Enabling Environment & Access to Justice Very little information is available to determine extent of implementation and effectiveness of human rights, access to justice and enabling environment interventions
Recommendations Scale up prevention efforts as this is central to the success of HIV and AIDS,TB and STI response in the province. The combined prevention efforts need to be brought to scale and at a faster pace. Proven emerging prevention interventions should be scaled up based on national policies and guidelines. New prevention technologies such as male medical circumcision (MMC) should be rapidly scaled up.
Recommendations The anti-retroviral therapy (ART) programme has matured over the years and should be integrated with the other Primary Health Care programmes. The current strong political commitment should be encouraged, continued and stepped up in order to ensure momentum of the response is maintained. Coordinating structures such as District AIDS councils (DACs) and Local AIDS councils (LACs) and ward AIDs committees should be strengthened to improve their effectiveness. Strengthening should be in the form of human resource capacity both in numbers and training, operational support (through development of operational guidelines) and in technical support among others.
The Review Document recommends Build capacity and capability for M&E systems within the Province Strengthening the M&E system, ensuring that the sectoral M&E systems are well aligned to the multi-sectoral one. This may require alignment of indicators and capacity building. Strengthen the capacity of the HIV and AIDS and TB Chief directorate to better monitor the sectoral responses. Strengthen the ward-based approach to implementation of the HIV and AIDS and TB response. Strengthen Sukuma Sakhe as an integrated approach to all social ills.
The Review Document recommends Ensure that usable reports are produced and disseminated and shared amongst stakeholders at all levels. Furthermore, information should be disseminated to the public at regular intervals. Build upon existing research coordinating mechanisms and develop a provincial research agenda that cuts across scientific, social and economic aspects of HIV & AIDS response The agenda and intervention on the human and legal rights must be made clearer and monitored regularly. Clearly defining interventions around human and legal rights and monitor them consistently.
The 20-year vision of the new PSP 2012-2016 linked to the UN vision) Zero new infections Zero deaths associated with HIV and TB Zero discrimination
KZN vision “a KwaZulu-Natal that is free of new HIV, STI and TB infections where all infected and affected enjoy a high quality of life”. Four priority areas/pillars that include: (a) Prevention; (b) Sustained health and wellness; (d) Human, economic, social and cultural rights. (e) Reducing structural vulnerability
GOALS OF THE PSP (1) Reduce new infections by at least 50% in 2016 using the combination approach (2) Initiate 80% of eligible patients on ART with 80% of them alive five years after initiation (3) Reduce the number of new TB case registration by 50% and reduce the number of TB deaths by 50% (4) Ensure an enabling and accessible legal framework to support the implementation of the NSP (5) Reduce self reported stigma related to HIV and TB by 50%
The goal under the prevention priority area/pillar is two folds: To reduce the incidence HIV infection to less than 1% by 2016. To reduce new smear positive TB infection to less than 200 per 100,000 population by 2016
Priority Area/Pillar 2: Health and Wellness goal To reduce mortality, sustain wellness and improve quality of life of at least 80% of those infected and affected by 2016.
Human, economic, social and cultural rights. To reduce vulnerability to HIV, STIs and TB by creating a supportive policy, human rights and regulatory environment and; promoting desirable social norms in the province by 2016.
Reducing structural vulnerability To reduce vulnerability to HIV, STIs and TB due to poverty, socio-cultural norms and gender imbalance by 2016.
APPROACH FOR THE IMPLEMENTATION OF THE PLAN IN KWAZULU NATAL The services delivery approach for KZNPSP 2012-2016 will be underpinned by 3 national and provincial agendas. These are (a) Operation Sukuma Sakhe; (b) the PHC re-engineering and; (c) National Health Insurance policy.
WARD BASED APPROACH - OPERATION SUKUMA SAKHE (OSS) Community participation Behaviour change, including Human Rights Integration of government services through the ward teams Economic activity linked to job creation and infrastructure development Environmental care Linked to OSS is fully functional AIDS Councils, - Provincial, District, Local and Ward levels. HIV, AIDS, STI AND TB interventions in the wards as per plans to be developed APPROACH FOR THE IMPLEMENTATION OF THE PLAN IN KWAZULU NATAL
ENABLING FACTORS FOR ALL LEVELS OF THE RESPONSE Leadership Partnerships and multisectoralism Mainstreaming: Each stakeholder to mainstream HIV and AIDS and TB response Monitoring and Evaluation