1. Yogan Pillay National Department of Health, South Africa July 24, 2014
The HIV programme & implications for health systems strengthening in South Africa
Yogan Pillay
National Department of Health, South Africa
July 24, 2014

2. HIV and ART in South Africa
6.4 million people living with HIV and AIDS (total population 54 million)
Prevalence amongst pregnant women: 29%
Prevalence in the general population: 12.2%
Incidence: 1.07% (0.71% in males; 1.46% in females)
50% of maternal mortality and under 5 mortality associated with HIV
2.5 million on ART
ART Coverage: 80% of women, 65% of children and men

3. PROGRESS Significant domestic investment in the treatment programme
Investment case done since 2008/09; currently TB/HIV investment case being completed (used to convince Treasury to fund the programme)
20 million tested in 20 months (campaign); currently 8 million tested annually
Treatment at PHC level (NIMART) and integrated with TB
Large numbers on treatment (initiation at CD 4>200)

4. Progress contd
>90% of pregnant women tested and >80% on treatment
MTCT: <2.6% at 6 weeks
Fixed dose combination since April 2013 (1.2m on FDCs); drug cost declines
Courier service for stable patients piloted
First ever independent integrated TB, HIV and PMTCT programme review conducted in Sept/Oct 2013

5. HIV/AIDS deaths cut by >50% since 2006

6. Life expectancy is increasing

7. Key factors in HIV response success
Political leadership & domestic funding
Strategic information for steering the response
Design of programmes that fit the epidemic
Delivering effective services
Enabling and sharing innovations

8. HIV spending in South Africa

9. Strategic information for decision-making
Joint Review of HIV, TB and PMTCT
Programmes in South Africa
Main Report
April 2014

10. Political leadership
Deputy President chairs the South African National AIDS Council (with civil society rep as co-chair)
President Zuma address World AIDS Day in 2009 and announced new treatment guidelines
President Zuma and Deputy President Mothlanthe launch HIV, STI and TB Strategy Plan,
President Zuma launches national HCT Campaign to test 15 m South Africans in 15 months
President Zuma tests and announces his HIV status publicly

12. Design programmes that fit the epidemic
National Strategic Plan for HIV/AIDS, STIs and TB
Nine provincial strategic plans
Costed implementation plans
Reprogramming of national grants to align with these plans
One national proposal for grant renewal, national investment strategy

13. Delivering effective services
Well managed health services (at all levels)
Drug procurement & delivery/availability
Task shifting
Reducing laboratory costs
Involvement of civil society and private sector
Strengthening integration
Links to social safety nets

14. Integrated, independent programme reviews
Five yearly individual programme reviews (HIV and TB)
2013: joint review to review level of integrated service delivery – TB, HIV and PMTCT (led by WHO)
2014: using lessons from the 2013 joint review – midterm review of the maternal, newborn, child and women’s health and nutrition strategy (led by UNICEF)
Currently programming the recommendations from these reviews (most relate to the need for health systems strengthening)
Must create the conditions and evidence for use in reflecting on successes and challenges in programme implementation

15. Progress towards the Millennium Development Goals (SAMJ, Vol 104, No 3 (2014)
Progress towards the Millennium Development Goals in SA Y Pillay, P Barron
Successfully controlling malaria in South Africa L Blumberg, J Frean, D Moonasar, South African Malaria Elimination Committee
Effectiveness of pneumococcal conjugate vaccine and rotavirus vaccine introduction into the South African public immunisation programme S A Madhi, L Bamford, N Ngcobo
Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa G G Sherman, R R Lilian, S Bhardwaj, S Candy, P Barron
Elimination of mother-to-child transmission of HIV in South Africa: Rapid scale-up using quality improvement S Bhardwaj, P Barron, Y Pillay, L Treger-Slavin, P Robinson, A Goga, G Sherman
Tuberculosis control in South Africa: Successes, challenges and recommendations G J Churchyard, L D Mametja, L Mvusi, N Ndjeka, A C Hesseling, A Reid, S Babatunde, Y Pillay
A brief history of South Africa's response to AIDS N P Simelela, W D F Venter

16. Challenges (lets also learn from challenges and what does not work)
Joint planning across the social sector to take into account the social determinants of health
Increasing inputs and involvement of communities
Improving quality of care at the same time as we expand coverage rapidly
Moving from pilots and demonstration projects (largely development partner funded) to review and to scale
How to keep front line health providers motivated
The list is endless Hence the need to learn from each other......

17. I THANK YOU FOR YOUR ATTENTION