KZN TB AND HIV AND AIDS DISEASE BURDEN

1. KZN TB AND HIV AND AIDS DISEASE BURDEN DR SM ZUNGU HEAD OF DEPARTMENT PARTNERSHIP CONFERENCE 12 OCTOBER 2010

2. PRESENTATION OUTLINE • Introduction • TB/HIV Disease Burden • 2009 ANC HIV Prevalence • KZN’s Response • Partnerships • Conclusion

3. INTRODUCTION • KZN is second most populous province after Gauteng with a population of just > 10,4 million which is 20,9% of total SA population • KZN has the highest HIV prevalence in South Africa and accounts for 28% of SA HIV infection • The province also has the highest TB disease burden.

4. Introduction cont. • TB case load is 1161:100 000 population with a TB/HIV co infection rate of about 70% • More than 70% of medical admissions are HIV related

6. HIV PREVALENCE: ANC SURVEY 2009

7. KZN HIV ANC PREVALENCE 2009

8. HIV PREVALENCE 2009 cont

9. HIV and SYPHYLLIS Prevalence 2009….

10. Trend in Age related prev. from 2007 - 2009

11. Age & gender distribution ofHIV infection in South Africa 10 Male Female 8 6 Prevalence (%) 4 2 0 <9 10-14 15-19 20-24 25-29 30-39 40-49 >49 Source: Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. AIDS 1992; 6: 1535-9

12. HIV Burden cont • There is a higher HIV prevalence amongst the ages 15-29 yrs with a rising trend amongst the ages of 10 -14yrs • The other represents HIV prevalence for mothers who were the under the age of 10 yrs • This is indicative of early sexual debut and • The high HIV prevalence amongst young females is indicative of trans-generational sex – younger females having sex with older men as the same age group males have a significantly lower HIV prevalence

13. Socio-Cultural Factors Driving the Epidemic • Some of the socio- cultural factors driving the epidemic include but not limited to: • Poverty • Unemployment • Multiple –sexual partners • Substance abuse • Gender based violence • Gender inequalities

14. Provincial Response CCMTP • Consolidation of the comprehensive management of patients with HIV and AIDS. • Prevention, Treatment, Care and Support • Strengthening of the health system NSP 2007-2011 • Two primary aims • reduce the number of new HIV infections by 50% by 2011 • reduce the impact of HIV and AIDS on individuals, families, communities and society • expanding access to appropriate treatment, care and support to 80% of all people diagnosed with HIV

15. Provincial Response cont • Presidential declaration of 01 December 2009: • to treat HIV and TB under one roof • ART for pregnant women and TB/HIV co infected individuals • Treatment for all the HIV infected infants <1yr • HIV Counseling and Testing campaign – Aim to test 15million people in South Africa • KZN HCT target is just above 3million people to be tested by end June 2011

16. FISCAL COMMITMENT (,000)

18. HIV COUNSELING and TESTING • 100% of all public health facilities providing HCT services • Provider Initiated Counseling and Testing approach being promoted to scale up HIV testing • HCT also available at non medical sites; tertiary institutions, correctional services • Link and Clicks pharmacies have joined forces with DOH in HCT campaign and are now offering free HIV Testing – Commitment from all Link and Clicks pharmacies in the province • Other initiative in the pipeline to form partnerships with private hospitals in the HCT and MMC – e.g. MEDI Clinics

19. HCT Sites

20. HCT Progress • HCT targets ambitious but achievable • Province has achieved 66% of its target in 5 months • Ugu district has achieved 102% so far whilst other districts range between 48 –70 % of their targets • Districts are currently doing data mop –up • Districts are planning more activities to reach the target

21. Country Performance @ 5months

22. HCT Targets and progress

23. HCT Targets and progress

24. High Transmission Area (HTA) Intervention • Targeting high transmission areas • There are currently: • 6 Truck Stops • 16 Correctional Services • 13 Tertiary Institutions • 3 Taxi Ranks • 11 Hostels • 3 Farm areas

25. HTA Sites

26. Condom Distribution • Condoms (male and female) are distributed at medical and non medical sites • Distribution at taverns, malls, community gathering areas • However condom distribution continue to be a challenge – low distribution rates • Challenge in meeting targets set during the HCT campaign

27. Condom Distribution cont • Condom distribution reports only on CHOICE condoms • Need to interrogate possible reasons for low distribution and also ascertain the extent of preference of other brands of condoms e.g. Lovers Plus over CHOICE condoms

28. Prevention of Mother to Child Transmission • PMTCT offered in 100% facilities • PMTCT integrated into MCWH programme • Improve package of care implemented as per presidential mandate • Emphasis is on early booking before 14 weeks and HIV testing in order to facilitate early access to HIV prophylaxis and treatment • Mother to child transmission rate reduce to 8,8%

29. Medical Male Circumcision (MMC) • HIV Prevention strategies targeting males • Evidence that MMC reduces the risk of HIV acquisition • It is community driven strategy announced by His Majesty King Zwelithini • Clinical strategy which is aligned to traditional approach • Comprehensive package for youth including life skills coaching and nation building approach • MMC Campaigns running in all districts • MMC provided in district hospitals • Target for 2010/11 is 372,754 • A total of 10 229 MMC have been conducted since April 2010.

30. Antiretroviral Therapy • KZN has the largest ART programme in SA • ART initiations expanded to PHC level • Approach changing from Dr driven to nurse driven approach - Nurse Initiated and Managed antiretroviral Therapy (NIMART) • There are currently 300 initiating facilities including PHC facilities

31. ART Pts & INITIATING PHC’s

33. ART cont. • PHC ART expansion is bringing HIV and AIDS services closer to the communities thus increasing access • Great commitment from municipalities – aiming at 100% coverage of their facilities

34. Health Systems strengthening • In order to provide an efficient and effective TB, HIV and AIDS program the DOH together with partners its is implementing following: • Human resource provisioning – integrated TB/HIV teams • Capacity development training for health care workers including community care givers • Infrastructure development and improvement • Monitoring and evaluation of programmes

35. Partnerships • TB, HIV and AIDS requires a multi-pronged collaborative response from all sectors of society e.g. NGOs, CBOs, FBOs, Civil Society, Political leaders, traditional leaders, business sector, traditional practitioners, and other government departments • This collaborative response is coordinated through the Provincial Council on AIDS

36. Conclusion • The road ahead of us demands that we work together in an aggressive and integrated manner in the fight against TB HIV and AIDS • This can only be achieved through the Flagship Programme which is pioneered by our Honorable Premier Dr Zweli Mkhize • The emphasis is on : • Household Food Security – “ONE HOME ONE GARDEN” • Ward based Intergovernmental programmes of action • Strong volunteer programme

37. Conclusion • It is important that all sectors rally around all efforts aimed at combating TB, HIV and AIDS including poverty alleviation to improve the livelihood of the people of KZN • As we celebrate our partnership let us remember that HIV and TB is one of the factors that continue to cement and strengthen our partnership as warriors against TB, HIV and AIDS

38. THANK YOU